ARICA requires insurance to cover treatment for individuals who live and/or work in Massachusetts, regardless of where the policy is issued. However, some out-of-state insurers refuse to recognize this. Because they are not licensed or regulated in Massachusetts, it can be difficult for our state to enforce this with an out of state insurer.

If your insurance will not agree to cover treatment under ARICA, there are several alternatives outlined below. We recommend contacting us for assistance and advice on what might be the best alternative for you:

1. Find out if the state in which your policy is issued has an autism insurance mandate. Explore whether it will cover the treatment you need. Currently 36 other states have mandates, and you may have access to coverage. We can provide information on specific laws and what restrictions (i.e. age limits and/or dollar caps) they may have.
2. If there are other diagnoses in addition to autism, explore with your clinician the feasibility of obtaining treatment for that condition. For example, a plan that is not subject to ARICA may not cover speech therapy for autism. But if a person also has a diagnosis of apraxia, speech therapy may be covered for the apraxia.
3. Explore obtaining an alternative policy that is subject to ARICA. There may be options through a spouse’s employment, or through the Connector open enrollment.
4. For a child receiving services through Early Intervention, options should be reviewed well before the child turns 3. Otherwise, ARICA coverage may not be in place when the child graduates from EI, and there could be a wait of up to a year until the next open enrollment opportunity.

If you need any further assistance please contact the Autism Insurance Resource Center.