Assessing early implementation of state autism insurance mandates.
Insurance mandates open the door, but workforce shortages keep families waiting—so BCBAs must scale smart and advocate for workforce funding, not just celebrate coverage.
01Research in Context
What this study did
Baller et al. (2016) interviewed state officials, insurers, and families in states that had just passed autism insurance mandates. They asked how the new laws were working and what was still blocking kids from getting therapy.
What they found
States said more families now had coverage, but waitlists grew because there were not enough trained providers. Paperwork delays and low reimbursement rates kept many BCBAs from joining insurance panels.
How this fits with other research
Morris et al. (2019) surveyed 27 studies and heard the same thing: doctors and therapists feel unprepared and under-paid for autism care. The problem is not just laws—it's workforce capacity.
Habayeb et al. (2025) later showed one fix: train pediatric clinic staff to do evaluations in-house. Their program cut wait times and kept families happy, giving states a concrete model after mandates pass.
Zhu et al. (2026) looked at 0-6 year-olds in China and found identical barriers—low pay, scarce training, and long waits—showing the pattern holds even in very different health systems.
Why it matters
If you practice in a mandate state, expect more calls than you can serve. Raise your rates to insurance levels, join panels early, and offer group or telehealth slots to stretch capacity. Push state associations for loan-forgiveness or BCBA pipeline grants so the workforce catches up to the law.
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02At a glance
03Original abstract
In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined five states' experiences implementing autism insurance mandates. Semi-structured, key-informant interviews were conducted with 17 participants representing consumer advocacy organizations, provider organizations, and health insurance companies. Overall, participants thought that the mandates substantially affected the delivery of autism services. While access to autism treatment services has increased as a result of implementation of state mandates, states have struggled to keep up with the demand for services. Participants provided specific information about barriers and facilitators to meeting this demand. Understanding of key informants' perceptions about states' experiences implementing autism insurance mandates is useful for other states considering adopting or expanding mandates or other policies to expand access to autism treatment services.
Autism : the international journal of research and practice, 2016 · doi:10.1177/1362361315605972