Meet Kevin, a 6th Grader with Autism & a Picture of Healthcare Savings

Special Needs Support for Working Parents

When Kevin was two years old, his parents Joe and Meg Walsh were concerned that he was still slow to talk, reluctant to make eye contact, and he rarely initiated play with others. At his next wellness check, Kevin's pediatrician recommended that he be seen by a specialist who diagnosed him with an Autism Spectrum Disorder.

For the next several years, the Walsh's lives were a haze of therapies; there wasn't even time to enroll him in preschool. Kevin had Applied Behavioral Analysis (ABA) five days a week, Occupational Therapy for sensory issues three days a week and Speech Therapy twice a week.

The Financial and Family Stress of Special Needs Therapies

In addition to the considerable stress this created for the family, the cost, upwards of $60,000 per year and primarily financed by Joe's employer's health insurance, was astronomical. While this was a significant benefit to the Walsh family it contributed to a rapidly escalating cost for Joe's employer. This is often the case, as 12 percent of children with the most needs who are enrolled in health plans  account for 50 percent of child-related healthcare costs1.

How can Joe's employer continue to provide care for Kevin, now in sixth grade, while still achieving financial relief on the healthcare front?

Time for a Different Type of Special Needs Intervention

It turns out that the Walsh's were unaware that, assuming Kevin is found eligible, the very same therapies financed through insurance are not only available but legally mandated in the education system. In fact, 66 percent of children with special needs who begin receiving these services through schools do not pursue additional medical services2.

If the Walsh family had known both what was available at school and how to navigate the eligibility process on Kevin's behalf, Joe's employer would have saved considerably, Kevin would have begun receiving services in a more integrated way at school, and Joe and Meg would have taken less time off to drive Kevin to therapies.

Given that one in five children now struggles with special or exceptional needs3, and about 50 percent of employees care for children or young adults4, the impact is significant to any employer. Bottom line: When children have options, parents have peace of mind and their employers profit.

1, 2National Health Policy Forum/NIH, 2005; 3CDC, 2013; 4Labor Project for Working Families, 2000, EES Research, 2013