New Hampshire Autism Insurance Law: A Parent's Guide
In short: New Hampshire's autism insurance law (RSA 417-E) requires many private health plans to cover medically necessary applied behavior analysis (ABA) therapy for children diagnosed with autism spectrum disorder up to age 21. The law applies to most state-regulated group policies, while self-funded employer plans may not be required to offer the same coverage. Families can also access ABA through New Hampshire Medicaid's Autism Waiver if they meet income and eligibility guidelines.
Key takeaways
- New Hampshire's law (RSA 417-E) mandates coverage for medically necessary ABA therapy for children with autism up to age 21.
- The law applies to most state-regulated large group health plans, but not to self-funded ERISA plans or individual policies.
- Covered services include ABA therapy, evaluation, and treatment planning provided by a Board Certified Behavior Analyst (BCBA).
- New Hampshire Medicaid offers the Autism Waiver, which covers ABA and other supports for eligible children.
What Is New Hampshire's Autism Insurance Law?
New Hampshire's autism insurance law, officially known as RSA 417-E: Coverage for Autism Spectrum Disorders, was enacted to ensure that children diagnosed with autism spectrum disorder (ASD) have access to medically necessary treatments, including applied behavior analysis (ABA) therapy. Prior to this law, many families faced significant out-of-pocket costs or outright denials for ABA services. Today, the law provides a baseline of protection for families navigating insurance coverage in the Granite State.
The law applies to health insurance plans issued or renewed in New Hampshire that cover hospital, medical, or surgical expenses for groups of 50 or more employees. It requires these plans to provide coverage for the diagnosis and treatment of autism spectrum disorder, including ABA therapy, up to the age of 21. It is important to note that the law does not apply to self-insured (ERISA) employer plans, which are governed by federal law and may not offer the same mandates. Individual health plans purchased on or off the exchange are also generally not subject to RSA 417-E.
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Who Is Covered Under the Law?
Age and Diagnosis Requirements
The law covers children and youth from the time of diagnosis through age 21. A diagnosis of autism spectrum disorder must be made by a qualified professional, such as a developmental pediatrician, child psychiatrist, or licensed psychologist, using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Once a diagnosis is established, families can move forward with accessing coverage for recommended treatments.
Plan Types and Exemptions
New Hampshire's law applies to state-regulated group health plans with at least 50 employees. This includes plans offered by many employers, both large and small, as well as some insured plans sold through the small business marketplace. However, the law does not cover:
- Self-funded employer plans (ERISA): These plans are governed by federal law and are not required to comply with state insurance mandates. Approximately 60% of employer-based plans in the U.S. are self-funded.
- Individual and family health plans: Plans purchased directly from an insurance company or through the New Hampshire Health Insurance Marketplace are not subject to RSA 417-E, although some insurers may voluntarily offer autism coverage.
- Short-term or limited-duration plans: These typically exclude coverage for autism treatments.
If you are unsure whether your plan is subject to the law, contact your employer's benefits administrator or your insurance company and ask if your plan is fully insured or self-funded. You can also call the New Hampshire Insurance Department for guidance.
What Services Are Covered?
New Hampshire's law requires coverage for medically necessary services related to autism spectrum disorder. The key covered services include:
- Applied Behavior Analysis (ABA) therapy: The law explicitly includes ABA, which is a scientifically validated approach to improving socially significant behaviors. ABA is provided by a Board Certified Behavior Analyst (BCBA) or a licensed behavior analyst.
- Diagnostic evaluation and assessment: Coverage for initial and ongoing assessments used to develop and update treatment plans.
- Treatment planning and supervision: The BCBA's work in designing programs, training therapists (Registered Behavior Technicians or RBTs), and monitoring progress is covered.
- Speech-language pathology, occupational therapy, and physical therapy: These may be covered if deemed medically necessary and prescribed by a physician, but they are not the primary focus of the autism mandate.
It's important to understand that coverage is subject to the terms of your health plan, including deductibles, copayments, coinsurance, and out-of-pocket limits. The law prohibits plans from imposing annual or lifetime dollar limits on autism-covered services, but non-dollar limits such as visit caps or preauthorization requirements may still apply.
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How to Access ABA Coverage Through Private Insurance
Step 1: Confirm Your Plan's Coverage
Start by reviewing your insurance policy documents or calling your insurer directly. Ask specifically:
- Does my plan cover ABA therapy for autism?
- Is there a maximum number of hours per week or per year?
- Do I need a referral or preauthorization before starting services?
- Are there network requirements? Do I have to use an in-network BCBA provider?
Step 2: Obtain a Prescription or Referral
Most insurance plans require a prescription from a physician or a referral from a healthcare provider to initiate ABA therapy. Your child's pediatrician or developmental specialist can provide this. The prescription should specify the diagnosis and the recommended treatment (ABA therapy), and may include an initial number of hours per week.
Step 3: Find a BCBA-Led ABA Provider
Finding a qualified provider who is in-network can be a challenge. ABA Therapy Now offers a free matching service that connects your family with vetted, BCBA-led providers across New Hampshire, including in cities like Manchester, Nashua, Concord, Portsmouth, and Lebanon. We work with a range of insurance plans, including those subject to RSA 417-E as well as self-funded plans. Simply provide your information and we will match you with providers who have availability and accept your insurance.
Step 4: Initiate Authorization and Start Services
Once you've selected a provider, they will typically handle the preauthorization process with your insurance company. This includes submitting a treatment plan with goals and a recommended number of hours. After approval, ABA therapy can begin, often in-home, in a clinic, or in a school setting.
New Hampshire Medicaid and the Autism Waiver
For families who qualify for New Hampshire Medicaid, the Autism Waiver provides an alternative path to accessing ABA therapy and other supports. The waiver is a Home and Community-Based Services (HCBS) waiver that covers:
- Applied behavior analysis (ABA) therapy
- Respite care
- Care coordination
- Parent training and support
- Community integration services
Eligibility for the Autism Waiver is based on both medical necessity and financial criteria. Children must be diagnosed with autism spectrum disorder and be under age 21. The waiver has a limited number of slots, so there may be a waiting list. Families are encouraged to apply early and stay in contact with the Bureau of Family Services or their local Area Agency.
If your child is approved for the Autism Waiver, ABA therapy is fully covered without copays or deductibles. Many BCBA providers in New Hampshire accept Medicaid, and ABA Therapy Now can help you find those providers if your child is enrolled in the waiver.
What to Do If Your Insurance Denies Coverage
It is not uncommon for families to face initial denials for ABA therapy, even when the law requires coverage. Common reasons for denial include:
- The plan claims ABA is experimental or not medically necessary.
- The plan argues your child's condition does not meet their definition of autism.
- The plan asserts that ABA is a habilitative service and not subject to the mandate.
If you receive a denial, do not give up. New Hampshire law provides a robust appeals process:
- Internal appeal: File a written appeal with your insurance plan within the time frame specified in the denial letter (usually 180 days). Include a letter from your child's doctor or BCBA explaining medical necessity, along with any supporting studies.
- External review: If the internal appeal is denied, you can request an external review by an independent third party through the New Hampshire Insurance Department. The insurer is bound by the external reviewer's decision.
- Contact the Insurance Department: The New Hampshire Insurance Department's consumer services division can help you understand your rights and assist with filing a complaint if needed. Their website provides a complaint form and a helpline.
Throughout the process, keep copies of every correspondence, including emails, letters, and notes from phone calls. Document dates, names of representatives, and what was discussed. If you need guidance, ABA Therapy Now's team can offer resources and connect you with advocates who specialize in autism insurance appeals.
Practical Tips for Navigating New Hampshire's Autism Insurance Law
Mistakes to Avoid
- Assuming coverage is automatic: Even if your plan is subject to RSA 417-E, you still need a diagnosis, prescription, and preauthorization. Don't start services without confirming coverage.
- Ignoring network restrictions: Out-of-network ABA providers may not be covered or may have much higher copays. Use an in-network provider whenever possible.
- Forgetting to track benefits: Know your plan's deductible, copay, and out-of-pocket maximum. ABA therapy can be intense, and understanding your financial responsibility is crucial.
Record-Keeping Tips
- Create a binder or digital folder for your child's autism diagnosis, insurance policy, authorizations, progress reports, and any correspondence with your insurance company.
- Save all provider notes from BCBA sessions, as these may be needed for treatment plan updates and reauthorizations.
- Keep a log of calls with insurance representatives, noting the date, time, representative's name, and summary of the conversation.
How ABA Therapy Now Supports Your Journey
We understand that navigating insurance and finding the right therapist is overwhelming. That is why ABA Therapy Now offers a free, no-obligation service to match your family with vetted, BCBA-led ABA providers in New Hampshire. Whether you have private insurance subject to RSA 417-E, a self-funded plan, or Medicaid through the Autism Waiver, we can help you find a provider that fits your needs. Our platform saves you hours of research and phone calls, so you can focus on supporting your child. Start today by visiting abatherapynow.com.
Looking Ahead: Changes on the Horizon
Advocacy continues in New Hampshire to expand coverage for autism treatment. Bills have been introduced in recent sessions to lower the age limit exclusions, extend coverage to individual plans, and increase the number of ABA providers in the state. While the current law provides a strong foundation, staying informed about legislative updates can help you plan for the future. Joining organizations such as the Autism Society of New Hampshire or the NH Council on Autism Spectrum Disorders can keep you connected to advocacy efforts and resources.
Remember that you are not alone. Thousands of families in New Hampshire access ABA therapy through their insurance each year, and with the right support, your child can benefit from these services too. If you have questions about your specific situation, reach out to ABA Therapy Now for personalized assistance.