RD88 - Evaluation of House Bill 657: Mandated Coverage of Habilitative Services for Children With Developmental Delays


Executive Summary:
House Bill 657 of the 2006 General Assembly Session would mandate coverage for medically necessary habilitative services for persons younger than 19 years of age with developmental delays. Habilitative services are defined as health and social services directed at either increasing or maintaining the physical, intellectual, emotional, and social functioning of developmentally delayed individuals. Similar legislation has previously been proposed. Advocates for the proposed mandate believe the medical needs of such children are not adequately met through private insurance policies or schools. Under federal law, schools are obligated to provide services to children with developmental disabilities, but they do not provide all medical services needed. Also, many private insurers do not include habilitative services in standard policies.

The proposed mandate is consistent with the role of insurance because it may positively impact public health, encourage preventative treatment, and shield some families from a major financial burden for health care expenses. There also appears to be a need for habilitative services for children with developmental delays. However, the costs of the proposed mandate are unclear, making it difficult to determine whether the costs would justify the benefits. Clarifying language in the proposed mandate and gathering additional data would be useful for further evaluation of HB 657.