Private insurance companies often distinguish between habilitative services, which are designed to teach a person new skills and maximize function, and rehabilitative services, used to recover lost skills.  For example, a four year old with a medical condition such as Autism, Cerebral Palsy or Down Syndrome is often denied the physical, occupational and speech therapy services they require to learn fundamental skills, such as walking and talking, because they are considered "habilitative."  In Missouri, most children with special needs who are covered by private insurance do not receive the therapy services recommended by their physician.  However, if a four year old is injured and looses skills such as walking and talking, these "rehabilitative" services are most often covered.

We are asking that private insurance companies be mandated to cover medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan; and coverage of these therapies are not to be denied on the basis that the treatment is not restorative; as recommended by the child's physician.

Medicaid covers habilitative and rehabilitative services for children.  It is the private insurance companies that discriminate against children with special needs by limiting or denying these medically-necessary services.

There is evidence that providing timely treatment leads to improved outcomes for children, and that this is most cost-effective to society.

Other states that have implemented such legislation have experienced minimal cost to private insurance payers for this additional benefit-less than 1% (see data from MD, IL and NJ).

Illinois and Maryland have passed this type of initiative.  Missouri has every reason to do the same.