Health Care

Missouri one of few states in nation making sure kids get needed disability therapy

Gov. Mike Parson, an Obamacare critic, signed the bill that builds on Obamacare coverage

A new Missouri law requires insurance companies to cover all medically necessary physical therapy, occupational therapy and speech therapy for children with disabilities. Federal law allows annual limits.
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A new Missouri law requires insurance companies to cover all medically necessary physical therapy, occupational therapy and speech therapy for children with disabilities. Federal law allows annual limits.

Robyn Schelp and her family have logged many miles walking the halls of the Missouri Capitol building to try to convince lawmakers to expand insurance coverage for children with developmental disabilities, like her son Nathan.

Nathan, 11, turned out to be the best advocate for covering services like speech therapy, as he went from talking in single words to stringing whole sentences together over the course of two years.

“He’s just all heart and that really helped make a difference when we were at the Capitol lobbying,” said Schelp, who lives in Columbia. “He was there with me every week, giving high-fives and hugs. … And the confidence just went through the roof once he got the language and the legislators got to see that. He even testified at one of the hearings.”

The miles of advocacy have now paid off, with Gov. Mike Parson signing Senate Bill 514.

The wide-ranging health care bill requires insurance companies to cover physical therapy, occupational therapy and speech therapy for all children 18 and under with disabilities.

Schelp, the president of Missouri Disability Empowerment, said Missouri is one of just three states (the others are New Jersey and Maryland) with the disability coverage mandate.

“We would love to see more states take this on and expand it so all children are getting their needs met,” she said.

The new law, which goes into effect with 2020 insurance plans, builds on coverage mandates written into the federal Affordable Care Act, commonly called “Obamacare.” The ACA required insurers to provide some coverage for such therapies, but gave states latitude to decide how much.

Schelp said that Missouri required coverage of unlimited speech therapy, but only 20 physical therapy and occupational therapy sessions combined per year.

“This just expands it,” Schelp said. “It also puts it into Missouri’s mandates, so if something happens to the ACA, the coverage would still exist.”

Under the new law, which Parson signed Thursday, insurers cannot limit therapy visits without giving patients and doctors a chance to document that more sessions are medically necessary.

Kelli Jones, a spokeswoman for Parson, said via email that that is the key change in the law.

“Families will now be able to take advantage of the consumer protections in this bill which give them the right to appeal those determinations and seek an outside medical review,” Jones said. “Current law does not provide those rights.”

Jones said the governor’s office thanked Rep. Chuck Basye, a Republican from Rocheport, and Missouri Disability Empowerment for bringing the bill forward.

Like many Republicans, Parson has been a critic of Obamacare. Jones said the Missouri bill “has nothing to do with the ACA” and wasn’t an endorsement of the law’s coverage mandates.

“Celebrating this bill is an endorsement to giving children with disabilities more access to physical and occupational therapy services,” Jones said.

The law is expected to increase insurance premiums, but based on past experience, Schelp’s group believes the costs should be minimal. After Missouri passed a similar law specifically for kids with autism in 2010, the average costs of therapies per member went up about 39 cents a month.

Schelp said those costs are likely offset by savings in the public school system and social services as kids with disabilities become more independent.

She’s already seen that in Nathan, who is developmentally delayed because of a genetic condition. He’s cognitively about at the level of a kindergartner but making gains every month.

“I know how hard Nathan has worked and I am proud of his hard work,” Schelp said. “I know he has a lot left to do, but he’ll get there.”

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