Missouri State-Regulated Insurance Coverage
Missouri requires meaningful coverage for autism under state-regulated plans.
Missouri’s autism insurance bills, HB 1311 and HB 1341, were enacted in 2010 and became effective on January 1, 2011. Missouri expanded its coverage to include those with physical and developmental disabilities in SB 514 during the 2019 legislative session.
To which plan types does the STATE autism insurance law apply?
- Fully Insured Large Group Plan - YES
- Individual Grandfathered Plans - A mandated offering is required
- Individual Non-Grandfathered Plans - YES
- Fully Insured Small Group Plans - YES
The Missouri autism insurance law does not require that insurers provide coverage for the treatment of autism in individual plans, rather it requires that insurers offer such coverage i.e., the law requires a “mandated offering.”
What services are covered by law?
- Diagnosis
- Habilitative or Rehabilitative Care (e.g. Applied Behavior Analysis)
- Pharmacy Care
- Psychiatric Care
- Psychological Care
- Therapeutic care (e.g. speech, occupational and physical therapy)
Does Missouri have caps on ABA coverage?
Yes. Coverage for ABA is limited to individuals with autism under the age of 19 years and is subject to a maximum benefit of $40,000/year.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. This includes quantitative treatment limits like age and dollar caps.
Where can I find more details about the Missouri autism insurance law?
Click here for a copy of HB 1311 and 1341 as enrolled. A copy of SB 514 can be found here.
If you have additional questions, please email advocacy@autismspeaks.org.
Last Updated: December 2019