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Real members of MyAutismTeam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.
A MyAutismTeam Member asked a question 💭
Fairfield, CA

My step daughter is almost 13 and we are "shopping" for health insurance right now. We do not qualify for Medi-Cal and the price is way to high through my husband's work. I applied to Kaiser for her and they want to charge us double for the premium due to her having autism. Someone recently told me that she should be able to get free or low cost health insurance because of having autism. But I haven't really found anything online that has been helpful with answering my questions. I'm wondering… read more

March 26, 2012
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Answer Summary

Members shared detailed guidance on accessing affordable health insurance for children with autism, with many emphasizing that eligibility... Read more

Members shared detailed guidance on accessing affordable health insurance for children with autism, with many emphasizing that eligibility varies significantly by state and often depends on disability status rather than income alone. Several members recommended applying for SSI (Supplemental Security Income) as a critical first step, explaining that approval automatically qualifies children for Medicaid regardless of family income, and others mentioned special Medicaid programs like TEFRA or institutional deeming through Regional Centers that allow middle-class families to secure coverage for their disabled children. A recurring theme was the importance of persistence when navigating denials and appeals, contacting Regional Centers and disability services departments for guidance, and clearly framing autism as a biological brain dysfunction when advocating with insurance companies.

A MyAutismTeam Member

ABA isnt covered under our Private insurance either, OT is limited and Speech was denied....its an ongoing battle

March 26, 2012
A MyAutismTeam Member

This is a tough one, and it varies in all states. SSI is available for children of families that make less than a certain amount each month with few liquid assets, (excluding your home and car to get to work, those do not count) If your child qualifies for SSI then medicaid/medi-cal is an automatic. The amount you're allowed to make is considerably higher than that of medicaids cut off. So the first thing to do is see if your child qualifies for SSI, this is actually a process you can start over the phone. Secondly, your county/state should have a department of dissability services, and I would call them as well as check with a social worker in your area Call the pediatrician for a referrel of needed, and tap into their brains. Dont give up, we must continue the fight!

March 26, 2012
A MyAutismTeam Member

I don't know where you are from but for us my DD got medicaid. You need a diagnosis that shows she is disabled and paperwork to prove it. We then filled out the medicaid application and wrote a letter with it saying she was disabled and needed services to function at home and in society and therefore wanted our income waived so she may get medicaid service coordination. It worked after a little fighting...

March 27, 2012
A MyAutismTeam Member

In our state of Oregon, much of this is covered by the Oregon Health Plan and Medicare so if your child qualifies, your state may offer the same but it isn't easy to find answers, and remember that "autism is a biological brain dysfunction" and this statement is often very important to relay to insurance companies to appeal non coverage...I have had a denial overturned by repeating this to the ins. co. and appealing their decision when it is negative...

April 19, 2013
A MyAutismTeam Member

Can they charge extra for autism? That doesn't seem legal. But I may completely oblivious. The only "free" insurance I can think of is medicaid, if she qualifies for state assistance or SSI. Not sure of what this is called in your state.

April 2, 2012

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