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Florida Autism Mandate

Florida’s Autism Insurance Benefits Mandate Who Will Benefit, Who Will Not, and Why?: Chapter 4

Chapter 4: Mandate Exemptions (Originally published July 7, 2008)

In this and other Chapters, in a Q&A format, we provide some basic information that we hope will help you answer questions you may have on various topics related to the Florida autism legislation.  See Introduction and Table of Contents.  Speaker Rubio estimated that the mandate would cover only 14% of children with an autism spectrum disorder.  Sadly, we think his estimate is accurate.  See “Q:  If these exemptions are so extensive, how many Floridians will the autism insurance mandate actually help?” below.  To determine who the mandate will help, you must first understand why the scope of the mandate is so limited.  In this Chapter, we summarize the extensive exemptions to the mandate.

Please keep in mind that we are answering general questions that may or may not apply to your specific circumstances.  You should consult a lawyer or other specialist if you think you are entitled to benefits that you do not receive.  Behavioral Lifeboat can help you do that.

Q:  Which health plans are exempt from the autism insurance mandate?

A:  [The data in this section has not been updated since 2008.]  The mandate exempts several categories of health plans:

  • Proposed Developmental Disabilities Compact: See Chapter 5.
  • Uninsured Floridians:  Recent estimates indicate that 21% of all Floridians are uninsured.  The State of Florida currently offers no benefits to these uninsured Floridians to which the mandate applies.
  • Cover Florida Health Care Access Program – enacted in 2008, this legislation creates a health insurance package to extend no-frills coverage to Florida’s uninsured residents that are specifically exempt from all of Florida’s insurance mandates (recently estimated to be more than 50 mandates).
  • Florida’s Employee Health Care Access Act defines small employers to be employers with not more than 50 employees.  This act, which promotes the availability of health insurance coverage to small employers, does not include an autism insurance mandate for small employers.
  • In 2005, of Florida’s approximately 6.9 million private sector employees, 24.6%worked for small employers.
    • Excludes approximately 1 million government employees.  Nationally, in 2005, approximately 12.9% of state and local government employees worked for governmental bodies with fewer than 250 employees
  • Approximately 68%of the insured private sector employees of medium or large employers (50 or more employees) were enrolled in self-insured plans.
    • In 2005, approximately 5.2 million private sector employees in Florida worked for approximately 96,000 medium or large employers, 94.4% of which (approximately 90,000) offered health insurance.  Of these employers that offered health insurance, approximately 63%self-insured at least one plan.
      • Approximately 4.3 million of these private sector employees were full time employees.  Approximately 97% of these full time employees worked for medium or large employers that offered health insurance, 69.3% of whom enrolled in the employer’s health insurance.
      • Approximately 860,000 of these private sector employees were part time employees.  Approximately 97% of these part time employees worked for medium or large employers that offered health insurance, 40% of whom enrolled in the employer’s health insurance.
    • The 68% calculation was approximately 58% including all exempt small private sector employers that offered health insurance.
    • These statistics exclude approximately 1 million government employees, 6.9 million employees of exempt small employers, and 3.7 million unemployed Floridians, and all of their dependants.`
  • In 2005, approximately 650,000 Floridians were covered by such health plans.
  • Small employer plans: Any insurance policy (or HMO) contract purchased by a small employer is specifically exempt from the mandate.  The State of Florida currently offers no benefits to employees of small employers to which the mandate applies.
  • Self-Insured Plans: Self-insured plans are exempt from the mandate because of a Federal law (ERISA) that generally preempts state law mandates applicable to employer sponsored benefit plans (Chapter 6).
  • Individual and individually underwritten health plans: The mandate specifically exempts insurance (or HMO contracts) offered to individuals rather than groups (such as employer sponsored plans) or group insurance (or HMO contracts) that are individually underwritten based on the individuals’ risk characteristics rather than typical risk characteristics of a group.

The mandate specifically includes the state group insurance program for state officers and employees.  We do not yet know whether the mandate applies to health plans offered to other Florida-based government employees.  In 2005, approximately 1 million Florida residents were government employees, including approximately 50,000 military employees).  Florida law permits local governments (including counties, cities, school boards, and special districts) to self-insure any health plan coverage.  If you know more about this subject, please let us know.  We will update this Chapter when we learn more.

Q:  If these exemptions are so extensive, how many Floridians will the autism insurance mandate actually help?

A:  Speaker Rubio estimated that the mandate would cover only 14% of children with an autism spectrum disorder (to watch his speech, click here and fast forward to the end at the 8:49.15 mark).  [this link has been disabled]

Apparently, the Speaker was quoting statistics from the Majority Message Points (posted here – posting date of April 30th at 5:17pm [this link has been disabled]), which promote the comprehensive benefits in House Bill 7153.  The Speaker’s House Select Committee on Autism and Developmental Disorders proposed House Bill 7153 late in the 2008 session as a substitute for House Bill 1291 and the original version of Senate Bill 2654.  These Majority Message Points state that 4,000 of the 30,400 children in Florida with an autism spectrum disorder would be served by the original version of Senate Bill 2654.  The insurance mandate in the final version of Senate Bill 2654, which the House and Senate ultimately approved with modifications, would cover roughly the same number of children as the original version, just less comprehensively.  House Bill 1291 and the original version of Senate Bill 2654 also did not include the proposed compact, which could reduce the scope of the mandate from 14% to as low as 0%.  We discuss the histories of the proposed and final bills in more detail in Chapter 9.

Sadly, based on rough calculations, we think Speaker Rubio’s estimate is an accurate estimate:

  • Estimate of Children Eligible for Benefits Under the Mandate. According to the US Census Bureau, in 2005, of 17.4 million total Floridians, approximately 4.0 million were under the age of 18 (approximately 23%).  Assuming no further population growth, if approximately one in 150 children has an autism spectrum disorder [ratio is now 1 in 110], then approximately 27,000 children in Florida would be eligible for benefits under the autism insurance mandate in 2010 if covered by a health insurance plan that was not exempt.  Based on a 2007 estimate of Florida’s population of approximately 18.7 million [population was 18.8 million in 2010], the number of eligible children would be approximately 29,000, very close to the 2008 estimate of 30,400 in the Majority Message Points mentioned above.
  • Estimate of Employees Enrolled in Covered Health Plans. According to the US Census Bureau, in 2005, there were approximately 17.4 million Floridians.  The Florida civilian labor force included approximately 6.9 million private sector employees and approximately 1.0 million government employees.  If approximately 21% of all Floridians were uninsured, approximately 24.6% worked for small employers, and approximately 68% of Florida’s insured private sector employees were enrolled in self-insured plans offered by all medium and large employers (50 or more employees), approximately 1.3 million Floridians (7.5%) are employees enrolled in employer sponsored health plans that would be required to provide the benefits required by the autism insurance mandate to qualified beneficiaries.   Of course, these statistics do not reflect the family members of these employees who are beneficiaries of these covered health plans.
  • Estimate of Eligible Children Covered by Non-Exempt Health Plans. According to the Florida Office of Insurance Regulation, in 2005, there were approximately 3.5 million primary  beneficiaries and covered dependants insured by health coverage providers subject to insurance regulation in Florida, approximately 2.5 million of which were beneficiaries of insured health plans offered by employers with 51 or more employees.  If approximately 23% of these insurance beneficiaries were under the age of 18 (see above) and approximately one in 150 children has an autism spectrum disorder [ratio is now 1 in 110], then approximately 3,800 children in Florida in 2005 with autism spectrum disorders were insured by health coverage providers subject to insurance regulation in Florida, very close to the 2008 estimate of 4,000 in the Majority Message Points mentioned above.

Based on these statistics, in 2005, approximately 14.2% of the approximately 27,000 eligible children were insured by health plans subject to insurance regulation in Florida.  As a result, we can estimate that at least 86% of the eligible children will receive no benefits under the Florida autism legislation.  Please read Chapter 9 to understand why and Chapter 10 to learn what else we can accomplish.

If you have questions, please comment in the Behavioral Lifeboat blog.

© 2008, 2011 Richard W. Probert

About Behavioral Lifeboat

Behavioral Lifeboat is a nonprofit organization. Our mission is to make evidenced-based behavioral therapy accessible to all by increasing awareness, helping to make comprehensive insurance benefits affordable and meaningful, helping schools provide more effective behavioral therapy programs, and providing grants to make such therapy affordable when other solutions are not available.

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