States are making health insurers pay for autism-related services that should be handled by government safety-net programs, a think tank says.

At least 23 states mandate some amount of coverage for the treatment of autism, and the mandates vary widely, according to Victoria Bunce and J.P. Wieske, staffers at the Council for Affordable Health Insurance, Alexandria, Va., an organization that promotes a free-market approach to health insurance regulation.

In many cases, advocates for children with autism want to require health insurance to cover rehabilitation and behavioral modification services, such as speech therapy services and play therapy services, that appear to be educational rather than medical in nature, the CAHI staffers write.

A federal law already requires public special education programs to help children with autism, but those programs meet the needs of only about 3% of children with autism, the staffers write.

“Legislators want insurers to cover more of the costs simply so the state doesn’t have to,” the staffers contend.

One problem with that approach is that the typical autism mandate already increases the total cost of health coverage for all insureds by 1%, and more comprehensive mandates could increase the cost as much as 3%, the staffers write.