Insurance Resource Center for Autism and Behavioral Health

04/09/2025

ASK THE INSURANCE GURU:

“Dear Guru,

My employer is having their yearly open enrollment starting in November and I was hoping you could give me some pointers about which plan to choose. I also have MassHealth and Premium Assistance. Do I need to tell them if I decide to change my employer plan?

Any guidance would be appreciated.”

Thank you for reaching out. The IRC is holding a Lunch and Learn on Thursday, September 11th at 12 on this very topic! I encourage you to register for it - https://umassmed.zoom.us/meeting/register/8mS1CzKzTKCt_WuvthgY-g

When looking at the plans your employer is offering it is always good to confirm that your family’s providers and hospitals are in-network. Once you know which plans will take your providers, then you can look at the plan benefits, like the deductible, and out-of-pocket costs.

Where you have Premium Assistance, you will want to make sure that the plan you select still meets Premium Assistance eligibility criteria. For more specifics, feel free to reach out to the Insurance Resource Center. They are more than happy to review your options with you and go over the specific criteria for Premium Assistance. Just contact the IRC early by calling 774-455-4056 or emailing AIRC@umassmed.edu

And yes, if you change your plan during open enrollment you will want to update both MassHealth and Premium Assistance right away. For more information check out this the IRC’s Fact Sheet on Premium Assistance:https://massairc.org/wp-content/uploads/2025/03/MassHealth-Premium-Assistance.pdf

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!

04/09/2025

Register here: https://umassmed.zoom.us/meeting/register/8mS1CzKzTKCt_WuvthgY-g

03/09/2025

We’re lacing up for the Flutie 5K for Autism! 🏃‍♀️💙 Our team, The Gurus & Friends, is running to support the Insurance Resource Center for Autism & Behavioral Health—and we need your help to reach our goal! Every dollar raised goes directly to our vital work. Want to make a difference? Donate today or join us on race day through the link below. Together, we can go the distance! 💪✨

https://runsignup.com/Race/186352/Donate/UGpBpubZ1m0Z0Gc7?fbclid=IwdGRleAMk_CdleHRuA2FlbQIxMQABHpT9LpsVnGfJz-by3nzI5d37RGJNilUhYftFLBVd7q94hEaZOk0MSL9ZHV5O_aem_QtNLvWxs73X_hUqvwf65ow

14/08/2025

Donate to IRC's Flutie 5K Team!

The Insurance Resource Center for Autism and Behavioral Health is proud to be a charity partner of the Flutie Foundation's 5K for Autism: Dougie's Epic Adventure.

Please join our team to walk or run and help raise funds for us.

Click on the link here: https://runsignup.com/Race/186352/Donate/UGpBpubZ1m0Z0Gc7?fbclid=IwQ0xDSwMK089leHRuA2FlbQIxMAABHvJBJQqUFZ07Ea7R3HALqayAD-GebevMC8KBB9Lqs3bRhuuSS4t1OWTgsE6Q_aem_Mh67lPJEO1W4QF6WowMrOQ

08/08/2025

ASK THE INSURANCE GURU:

Dear Guru,

My daughter was recently diagnosed with autism, and her ABA provider suggested I apply for MassHealth as secondary insurance to our Harvard Pilgrim plan. I went to the Massachusetts Health Connector website, clicked "Apply Now," set up my profile, and completed the MassHealth application. However, we were denied, and I’m confused as to why, especially since she has a disability. I even mentioned her autism in the reasonable accommodations section so that MassHealth would be aware. I’ve spoken with other parents who have children with autism, and they didn’t have the same issue—many of them have MassHealth. What am I missing?

Sincerely,
Ima Puzzled

Dear Ima,

Thank you for your question—it’s one I hear often. MassHealth eligibility is primarily based on income, but if the applicant has a disability, as indicated on the application, there are no income guidelines. The key part of the application to focus on is the "disability indicator" question, which is sometimes overlooked but is crucial when applying for benefits.
The disability indicator question asks whether the applicant has an illness, injury, or disability that is expected to last more than 12 months. This is where you should check the box next to your daughter’s name. By selecting this box, you’re informing MassHealth that there will be an additional part of the application to complete.

The first part of the MassHealth application process involves filling out the main application, which you’ve already done. Many people are initially denied due to income; however, by indicating a disability that is expected to last more than 12 months, you will need to complete a second part of the application, called the Disability Supplement. Checking this box alerts MassHealth that your application isn’t complete, and they will send you the disability supplement to fill out.

Once submitted, the Disability Supplement will be reviewed by Disability Evaluation Services. If your income exceeds MassHealth Standard guidelines but you meet the criteria for a disability, you will qualify for MassHealth CommonHealth, which requires a monthly premium based on family size and income.

Regarding the "reasonable accommodations" section, that part of the application is asking whether the person needs specific modifications or adjustments for a disability, such as larger print or hearing assistance when communicating with MassHealth or the Health Connector.
The IRC has a fact sheet about applying for CommonHealth with step-by-step instructions on their website. Here’s the link…https://massairc.org/wp-content/uploads/2025/03/CommonHealth.pdf

I hope this clears things up!

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!

05/08/2025

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.