Insurance Resource Center for Autism and Behavioral Health

05/08/2025

04/08/2025

ASK THE INSURANCE GURU:

"Hi Guru,

I have a friend who always seems to know about things happening at the Insurance Resource Center. She gets emails when there are events and other happenings, and I think she even gets a monthly newsletter. Can you tell me how I can get this information too?

Thanks.

Hungry For IRC Information"

Dear Hungry,

I am glad that you are learning about IRC happenings through your friend, but it is easy for you to get this information directly from the IRC. The IRC maintains a mailing list for people who wish to be notified about events and other communications. You will find instructions about how to get on their mailing list below. It is a super easy process, and you can always reach out to the Center if you need assistance.

How to get on the IRC mailing list:

• Visit our website: https://www.massairc.org

• Scroll down the home page until you find a blue banner that shows “Subscribe to our mailing list for updates & announcements.”
• Click on the “Subscribe Now” button.
• Enter your name and email address.
• Make sure to check the box which says you agree to receive our email communications.
• Click the “Subscribe” button.

Hope this helps!

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

24/07/2025

ASK THE INSURANCE GURU:

“Dear Guru,

My child who has autism was referred for IHT, or in-home therapy.

I called two providers and was told he isn’t eligible because his primary diagnosis is autism.

I am confused…what does this mean?”

Dear Confused,

IHT is one of the CBHI/behavioral health benefits offered through MassHealth for youth through age 21. IHT works with the whole family, not just the referred individual, by providing intensive family therapy to assist families in overcoming past trauma and coping with symptoms of mental health conditions.

It is a service for an individual whose primary diagnosis is due to a mental health condition and not autism. For individuals with autism, it is recommended they seek out IHBT which is called in-home behavioral therapy. This is behavior-based and can provide the therapy individuals with autism and their families need when in crisis.

The two-benefits sound similar so it can be confusing when you are trying to get help for your loved one.

Please note: you cannot have both ABA and IHBT at the same time. If your child is receiving ABA, he or she cannot also receive IHBT. Vice versa if you child is receiving IHBT, you must wait until the therapy is finished before he or she receives ABA.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

24/07/2025

17/07/2025

Greetings friends, I am the Autism Insurance Guru. I am not answering a specific question for today’s post, but I will instead go over a few more commonly used acronyms.

This week I am going to include acronyms that pertain to behavioral health services. These services may be available under your employer sponsored health plan. If your plan does not include them, then you may be able to access similar services through MassHealth.

BHCA (Behavioral Health for Children and Adolescents): BHCA refers to behavioral health benefits for children-adolescents that are required to be included in fully insured plans issued for sale in Massachusetts (e.g., employer pays monthly premium to insurer.) Coverage is provided up to age 18.

CBHI (Children’s Behavioral Health Initiative): If a plan excludes BHCA benefits, MassHealth will cover similar benefits through CBHI. This coverage is provided up to age 21 and is intended to support MassHealth children and families who have mental health, behavioral, and emotional care needs.

BHCA and/or CBHI should cover the following services:

CBAT (Community Based Acute Treatment): Mental health services provided in a staff-secure setting 24/7, providing intensive therapeutic services.

FS&T (Family Support and Training): Services teach parents/caregivers how to help their children reach treatment goals. (Individuals providing these services have personal experience with these types of issues.)

ICBAT (Intensive Community Based Acute Treatment): Provides same services as CBAT but at a higher intensity; more frequent evaluation and treatment and more intensive staffing and service delivery

ICC (Intensive Care Coordination): Targeted case management for children with serious emotional disturbance to meet comprehensive medical, behavioral, and psychosocial needs of an individual and their family. (Eligibility requires more than an autism diagnosis.)

IHBS (In-Home Behavioral Services): Services that help parents/caregivers learn how to address challenging behaviors. (Similar to ABA and cannot be used at the same time.)

IHT (In-Home Therapy): Counselors work with family helping to resolve conflicts, teach new ways to do things, etc.

MCI (Mobile Crisis Intervention): 24/7 help when child/teen is having a crisis. Trained clinical team will come help with emergency behavioral health issues.

TM (Therapeutic Mentoring): Mentor works with child to improve social, communication and life skills.

If you think your child/adolescent might benefit from any of these additional behavioral health services, you should reach out to your health plan. If you aren’t sure how to begin or have questions, my colleagues at the IRC are happy to help. You can also find more information about Behavioral Health Benefits here: Behavioral Health Care for Children and Adolescents (BHCA) fact sheet.pdf

And rest assured there are still a lot more acronyms to learn about.

03/07/2025

The Guru is on vacation for Fourth of July weekend but they will be back next week to answer your insurance related questions! 🇺🇸🎇🎆

26/06/2025

ASK THE INSURANCE GURU:

"Dear Guru,

I remember you saying that we could reach out to you if we come across acronyms and don’t know what they stand for. Can you please provide a list of acronyms that I might see now that I decided to apply for MassHealth."

I am so glad you asked. There are a lot of acronyms related to MassHealth coverage, but I will pick a few of my favorites that you might see while applying for coverage. When I say that there are a lot of acronyms that you might see, I am not exaggerating!

ARD (Authorized Representative Designation Form): This is a form that needs to be completed for you to speak to MassHealth about someone other than yourself or your minor child(ren). It designates the person chosen to act on someone’s behalf.

DES (Disability Evaluation Services): MassHealth has contracted with Disability Evaluation Services to assist with disability evaluations. They verify disabilities, allowing members to qualify for certain types of MassHealth coverage.

ESI (Employer Sponsored Insurance): Health insurance through your employer. If you have access to ESI, MassHealth needs to know about it. ESI that meets certain requirements can make you eligible for an additional benefit called Premium Assistance.

MAGI (Modified Adjusted Gross Income): When you apply for MassHealth coverage, they will look at your Modified Adjusted Gross Income (i.e, your current monthly income, less certain pretax deductions) for eligibility/ premium purposes. MassHealth tries to verify your reported income in state and federal data hubs and if it is close, you are good. If it doesn’t match closely, you may be asked to provide proof of income, which is often two recent pay stubs for each person who works.

Good luck working on your application and please reach out to my colleagues at the IRC if you need help or have questions.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

20/06/2025

The Campus to Community Respite Program is a fantastic way for families to access much-needed support right at home—without the typical barriers of cost or long waitlists. Because UMass Amherst students live across the state, families simply need to be within 30 minutes of a participating student to qualify. That means families from many parts of Massachusetts can receive free, home-based respite care tailored to their needs, offering caregivers a meaningful break while building connections with compassionate, trained students who want to give back to their communities. It’s flexible, local, and a truly accessible way to support both children and caregivers.

The Campus to Community Program offers undergraduate students the opportunity to provide weekly respite care to a local family raising a child, adolescent or adult with an intellectual or developmental disability. StudentsEarn college credits and make a difference in someone’s life. LEARN MORE F...

18/06/2025

ASK THE INSURANCE GURU:

"Dear Guru,

My son was just diagnosed with autism. I am getting all kinds of instructions about what to do (talk to my school, apply for secondary insurance, start services, etc.) and I am very confused by some of the acronyms that have been used. When I see these acronyms written down later, I don’t remember what they mean. Can you give me a list of common acronyms that I should know about autism?

Thank you."

Sure, I can provide some commonly used acronyms that you might see after receiving a diagnosis:

1. ASD (Autism Spectrum Disorder) A neurodevelopmental disorder that can impact social, emotional and communication skills.

2. ABA (Applied Behavioral Analysis) Common therapy/treatment for ASD. Applying psychological principles of learning in a systematic way to modify behavior.

3. EI (Early Intervention) Services and supports available for infants and toddlers up to age 3 to address developmental delays and disabilities. Provided by the Department of Public Health.

4. IEP (Individualized Education Plan) A written educational plan addressing services and supports to meet a child’s learning needs at school.

5. IFSP (Individualized Family Service Plan) The Early Intervention team works with the family to develop a plan that defines goals and services that need to be addressed.

6. ISP (Individualized Service Plan) Picks up where IEP leaves off. Adult planning, 22+. Provides written details of supports and resources needed to achieve personal goals.

There are many other acronyms related to ASD (Acronym #1!). If you, or anyone else, has a specific acronym that you would like me to explain, please let me know. If you don’t know what an acronym stands for, don’t be afraid to ask. I bet many others don’t know either. And remember, I am always happy to help!

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

12/06/2025

Greetings Friends,

Today I would like to highlight that it is my birthday! 4 years ago, I began my journey with all of you, families, providers, et all, providing my insights on autism health insurance services and information. But we at the Insurance Resource Center for Autism and Behavioral Health cannot do this without your readership and support, so for my birthday, my wish is to consider donating to the IRC in order for us to continue our work as well as give you the best high quality autism health insurance information we can provide. Thank you!

Ways to Donate:

Credit Card: Through our secure online giving form https://bit.ly/DonateAIRC or phone at 508-856-5615. Please choose Other UMMS Funds, and type Autism Insurance Resource Center in the Search Box.

Check: To make your gift by check, please make it payable to the UMass Medical School Foundation – Autism Insurance Resource Center, and mail to: UMass Chan Medical School, Office of Advancement, 333 South Street, Shrewsbury, MA 01545

Donor Advised Fund UMass Memorial Foundation Tax ID -04-3108190. Specify Autism Insurance Resource Center in your Memo

12/06/2025

ASK THE INSURANCE GURU:

"Dear Guru:

After being on several wait lists, I have finally found an ABA provider for my son. I have heard really good things about the company from other parents, but I’m having an issue with one of the zillion forms they are making me fill out.
The specific form asks me to agree to be responsible for balances remaining after they’ve billed my insurance, and to provide a credit card they can charge these to. But our only insurance is MassHealth, which doesn’t have any co-pays. I’m a single mom and I’m very concerned about my credit card getting charged for fees that I won’t be able to afford.

Can you advise me what I should do?"

Thank you for writing, and I’m glad you found an ABA provider. MassHealth’s contracts with providers include rules that the providers cannot bill members for outstanding balances. So even if you sign this form, the provider shouldn’t ever be billing you. Thus, we don’t think you should have to give them a credit card. My recommendation is to not complete the form, or put “N/A – MassHealth Standard Coverage”, and/or discuss your concerns with the provider. If the provider insists on your completing the form, and/or won’t move forward with services, please reach out to my colleagues at the Insurance Resource Center, and they will be happy to assist you.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

05/06/2025

ASK THE INSURANCE GURU:

"Dear Guru:

After being on several wait lists, I have finally found an ABA provider for my son. I have heard really good things about the company from other parents, but I’m having an issue with one of the zillion forms they are making me fill out.
The specific form asks me to agree to be responsible for balances remaining after they’ve billed my insurance, and to provide a credit card they can charge these to. But our only insurance is MassHealth, which doesn’t have any co-pays. I’m a single mom and I’m very concerned about my credit card getting charged for fees that I won’t be able to afford.

Can you advise me what I should do?"

Thank you for writing, and I’m glad you found an ABA provider.

MassHealth’s contracts with providers include rules that the providers cannot bill members for outstanding balances. So even if you sign this form, the provider shouldn’t ever be billing you. Thus, we don’t think you should have to give them a credit card. My recommendation is to not complete the form, or put “N/A – MassHealth Standard Coverage”, and/or discuss your concerns with the provider.

If the provider insists on your completing the form, and/or won’t move forward with services, please reach out to my colleagues at the Insurance Resource Center, and they will be happy to assist you.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!