Handling Costs for Families of Kids With ASD

For families of children with autism struggling to help their little ones communicate and connect with their peers and environment, the right therapists and support systems can feel like a godsend. But treatment costs add up quickly, especially during the early years when interventions are most intense.

Your FSA can help cover some expenses

If you're lucky enough to have an employer that offers a flexible spending account (FSA) or health savings account (HSA), you can tap into these tax-free funds to cover some of the costs of helping your child.

Autism spectrum disorder (ASD) is a complex brain-development condition that manifests in problems with social interaction, speech, motor control, feeding, and behavior. Restricted interests and repetitive behaviors are a common feature.

For babies and toddlers, developmental delays or differences often trigger a multi-disciplinary evaluation. As the name suggests, ASD symptoms can vary widely, with some kids able to function at a relatively high level and others unable to speak and perform age-appropriate activities of daily living without major assistance.

Whether the disability is mild, moderate or severe, children with autism benefit from prompt, comprehensive treatment. Insurance coverage for ASD has generally improved since 2012 as more states enacted mandates and since the federal Affordable Care Act deemed behavioral health treatment an essential health benefit.

But state laws vary in their stringency — two states still have no autism mandates, and many families face daunting out-of-pocket costs for services.

Early diagnosis and intervention is critical. While school districts provide some support, it can be difficult to access or feel insufficient, depending on your child's needs. Preschool and grade school children typically need to work intensely with a variety of therapists to provide the evidence-based standard of care needed to improve functioning and quality of life.

Your child's doctor will prescribe such therapy, making it for the treatment of a medical condition and thus eligible for coverage by your FSA or HSA. These expenses could include:

  • Applied behavioral analysis (ABA) therapy
  • Occupational therapy
  • Speech therapy
  • Physical therapy
  • Health insurance deductibles
  • Costs of out-of-network healthcare providers
  • Copays for doctors, prescriptions and specialists like developmental pediatricians and neurologists
  • Travel to and from medical and therapy appointments (remember to record your mileage)
  • Specialized gym equipment for home like trampolines, sensory swings and punching bags — such items may be used to improve motor control and coordination, promote emotional regulation, and provide joint pressure
  • Always remember to speak to your FSA administrator to make sure your planned expenses will be covered by your FSA

Try to file claims early

Kristin Jacobson, the founder of the Autism Deserves Equal Coverage Foundation, a nonprofit group in California, used her family's FSA to pay for her child's medication copays and out-of-pocket costs to see specialists. She urges families of kids with autism to file claims early to allow for a margin of error. One year, Jacobson failed to notice a problem with the FSA claim until it was too late.

When families are in crisis mode trying to help a child with autism maintain control, details like filing and appeals deadlines can fall through the cracks, she says. "Having a special needs family, we didn't realize they rejected it in time" and the $2,500 the family had set aside in the FSA was lost. "It was fairly devastating."

Still, with some advance planning, families with an FSA or HSA can gain by taking advantage of the tax breaks, yielding savings on their child's needed services. "You'd never want to turn the help down," Jacobson says.


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