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ARICA (An Act Relative to Insurance Coverage for Autism), is a law passed in 2010, requiring private health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder.
The legislation affects only certain types of health care policies, so coverage under ARICA depends on the type of policy you have. Private insurers, employees and retirees under the state plan, hospital service plans and HMOs are all required to comply with the mandate. Many employers have “self-funded” plans, which are regulated under a federal law and not subject to ARICA. However, a majority of “self-funded” plans in Massachusetts are covering autism treatments.
Contact your employer or insurer to ask if your policy is self-funded or not. Even if your plan is self-funded, your company may provide coverage under ARICA, and/or cover autism therapies.
If your plan doesn’t provide coverage for therapies, there are options for obtaining insurance through MassHealth and/or the Health Connector to access coverage. Important: If a child is transitioning out of Early Intervention and will need alternate coverage, it’s important to plan this well before the child turns 3, as some of the alternatives can be accessed only during specific enrollment periods.
If your employer doesn’t provide coverage for autism treatment, our Center can help you advocate with your employer and advise you on alternative ways to access coverage.
ARICA applies only to state regulated private insurance, but MassHealth covers many of the same treatments:
No. There are no age limits. Per ARICA “The diagnosis and treatment of Autism Spectrum Disorders is not subject to any annual or lifetime dollar or unit of service limitation on coverage which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions.”
The law covers the following care prescribed, provided, or ordered for an individual diagnosed with one of the Autism Spectrum Disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary:
Yes, subject to medical necessity criteria.
ARICA does not affect educational services provided under an IFSP, IEP or ISP. Insurers are not required to pay for in-school services. Conversely, schools may not require parents to access private insurance for services that a child is entitled to receive through school. Additional information can be found here.
For further information, contact an information specialist at 774-455-4056 or e-mail us at email@example.com,
Last updated October 13, 2015
For the most current version, please check our website http://www.disabilityinfo.org/arica/
The Autism Insurance Resource Center is a division of INDEX/UMass Medical School Shriver Center. Partial funding for the Center is provided through grants from the Massachusetts Developmental Disabilities Council (MDDC), Massachusetts Department of Developmental Services (DDS), Massachusetts Department of Public Health (DPH), and the Massachusetts Department of Elementary and Secondary Education (DESE). The Nancy Lurie Marks Family Foundation, and the Doug Flutie Jr. Foundation for Autism. INDEX is a state-wide information and referral service for people with disabilities. Online access to comprehensive resources is available at http://disabilityinfo.org/.
EK Shriver Center /UMass Medical School, 55 Lake Avenue N., S3-301, Worcester, MA 01655
Copyright ©2014 Autism Insurance Resource Center – All Rights Reserved
The primary mission of the Nancy Lurie Marks (NLM) Family Foundation is to help people with autism lead fulfilling and rewarding lives. The Foundation is committed to understanding autism from a scientific perspective, increasing opportunities and services available to the autism community and educating the public about autism.
The goal of the Flutie Foundation is to help families affected by autism live life to the fullest.
Through our programs and partnerships, we help people with autism get access to care; lead more active lifestyles; and grow toward adult independence.