New Law Affects Regional Center Funding of Co-Pays, Co-Insurance, and Deductibles

Despite the collective efforts of the autism community, Governor Brown’s trailer bill has passed, which means that a new law will take effect on July 1, 2013, limiting regional center funding of co-pays and co-insurance and eliminating regional center funding of deductibles.

What does this mean for you?

First, review the table below to see if your income jeopardizes any support that you may be receiving from your regional center.  If your income is not greater than the income indicated in the far-right column, then any co-pay and/or co-insurance payments that you are currently receiving  from your regional center should continue.  Unfortunately, the new law expressly precludes regional centers from paying insurance deductibles, regardless of your income.

If your income exceeds 400% of the federal poverty guideline, then the new law requires regional centers to stop funding your co-pays and/or co-insurance.  We anticipate that most regional centers will leave existing co-pay funding in place until they complete means testing to determine your income.  In a few extraordinary circumstances, the new law does allow regional centers to fund co-pays and/or co-insurance for families whose income exceeds 400% of the poverty guideline.  The exceptions noted in the law include:

(1) The existence of an extraordinary event that impacts the parents’ ability to meet the care and supervision needs of the child or impacts the ability of the parent, or adult consumer with private insurance, to pay the copayment.

(2) The existence of catastrophic loss that temporarily limits the ability of the parents, or adult consumer having private insurance, to pay and creates a direct economic impact on the family or adult consumer. For purposes of this paragraph, catastrophic loss may include, but is not limited to, natural disasters and accidents involving major injuries to an immediate family member.

(3) Significant unreimbursed medical costs associated with the care of the consumer or another child who is also a regional center consumer.

We expect very few exceptions to be made.  If your co-pays and/or co-insurance represent a financial hardship, we suggest that you challenge any decision by your regional center which adversely affects you, including a decision to stop co-pays or co-insurance, by completing and returning the Fair Hearing Request form that is required to accompany the Notice of Action. While no reduction in your funding should occur during this process, you have the ability to request “aid paid pending” on your Fair Hearing Request form to keep your current funding in place while your case is adjudicated.  Disability Rights of California offers great guidance regarding this process on its website.

If you face new challenges as this law takes effect, we hope that you’ll share these experiences with Governor Brown and your state senator and assemblymember.  Many of them are in a position to make a difference if we make them aware of the problem that this legislation has caused. Additionally, when the time comes for you to make health insurance choices, whether you purchase your own insurance or are part of an employer plan, you may want to consider this latest law in determining the cost effectiveness of each plan option.