ARLINGTON -- Tarrant County prosecutor Leticia Martinez delivered a powerful argument Tuesday -- only this time she wasn't before a judge or a jury.
She was in front of an insurance co-op, fighting on behalf of her 4-year-old autistic daughter, Analisa.
Last year, the Public Employee Benefits Cooperative, which administers health benefit plans for Tarrant, Dallas, Denton and Parker counties and the North Texas Tollway Authority, switched to a solely self-funded insurance plan and chose not to cover Applied Behavioral Analysis, an intensive type of therapy used to treat autistic children.
It's also the type of treatment Analisa receives and, until last year, had been covered by Martinez's insurance.
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"Why is it that autism is being excluded? What reason is there?" Martinez asked the board. "Our society is judged by how we treat the weak -- and children with autism qualify. Why are they going to be put at the bottom of the list?"
After Martinez's presentation, Tarrant County Commissioner Marti VanRavenswaay, who is a co-op board member, indicated that the co-op will research the matter and consider a plan change for 2012. But no matter what the co-op decides as a unit, VanRavenswaay said, it doesn't preclude each member entity from independently providing coverage for ABA therapy.
After the hearing, Martinez said she was glad for the opportunity to be heard.
"I've been trying to be heard for quite some time," she said. "Given the amount of information they received today, for them not to provide coverage -- knowing all they know now -- would just defy all logic and common sense."
A long fight
For 22 months, Martinez and her husband, Jeffrey Cureton, a federal magistrate judge, have been fighting to get their insurance to cover ABA therapy and to close a loophole in state law. The couple said they were shocked to learn that Texas mandates ABA coverage from private, fully funded insurance plans but not from self-funded plans.
Cureton's employer -- the federal government -- also provides self-funded insurance, which doesn't cover ABA.
In October, Martinez took her case to Tarrant County commissioners, who seemed willing to help but didn't exactly know how, since amending the plan would require approval from the co-op's board and its employer groups.
On Tuesday, at Tarrant County's request, a special meeting was held for Martinez to address the co-op board, marking the first time in its 12-year history that an employee had made a personal plea.
During her presentation, Martinez explained that her daughter was diagnosed with autism spectrum disorder in February 2009 and was prescribed 25 to 40 hours a week of ABA.
The therapy, which costs $3,000 to $5,000 a month, was covered until January when Tarrant County decided to offer only self-funded plans in which ABA was not included on the basis that it was "educational."
Martinez pointed out that, while ABA was excluded, there is coverage for drug abuse, smoking addiction and relationship counseling.
"If we have coverage for that, how are these children being excluded?" Martinez asked. "These children didn't do anything to cause their condition."
Martinez noted that 23 states require health plans to provide ABA coverage and that numerous private and self-insured companies provide ABA. The therapy, she said, has been endorsed by the surgeon general and the American Academy of Pediatrics.
Bolstering her argument was Dr. Joyce Mauk, medical director of the Child Study Center in Fort Worth and an expert in Applied Behavior Analysis, who told the board that she has no vested interest in the case except to educate them about ABA.
"From a medical perspective, denying a treatment for a brain-based neurologic disorder is the same as saying, 'We're not going to treat the seizures that are caused by a brain-based neurologic disorder,'" Mauk said.
State District Judge Tom Lowe also made an impassioned plea before the board. Lowe, a Tarrant County civil court judge, also has an autistic son whose ABA therapy is not being covered.
"Children with autism who are unable to function in society won't die," Lowe said. "But if they are not able to be functional, they can't live."