Insurance Resource Center for Autism and Behavioral Health

30/04/2026

ASK THE INSURANCE GURU:

Dear Guru,

My daughter was recently diagnosed with autism, and her ABA provider suggested I apply for MassHealth as secondary insurance to our Harvard Pilgrim plan. I completed the application, but we were denied—and I’m not sure why, especially given her diagnosis. I even noted her autism diagnosis in the “reasonable accommodations” section.
I’ve talked to other parents of children with autism who do have MassHealth, so now I’m wondering… what did I miss?

– Paperwork Patty

Great question—and you’re definitely not alone here.

MassHealth eligibility is usually based on income, but when a disability is involved, a different pathway for coverage may apply. The key step that often gets missed is selecting the “disability indicator” on the application. This tells MassHealth that your child has a condition expected to last more than 12 months and triggers an additional step: the Disability Supplement.
Many families are initially denied based on income, but that’s not always the end of the process. If you’re over the income limits and the applicant has a disability, the next step is to complete the Disability Supplement. After you submit it, Disability Evaluation Services will review the application. If your child meets the disability criteria, she will qualify for MassHealth CommonHealth—even if your income exceeds the standard guidelines (this coverage will involve a monthly premium that is based on family size and income).

Also, the “reasonable accommodations” section is often misunderstood—it’s only for requesting communication supports (like large print or interpreter services), not for determining eligibility.

For step-by-step help applying for CommonHealth, check out this helpful guide:https://massairc.org/wp-content/uploads/2025/03/CommonHealth.pdf

Hope this helps clear things up!

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

29/04/2026

https://umassmed.zoom.us/meeting/register/5gu9eXUbSA6bk-iQ1sRulw

23/04/2026

ASK THE INSURANCE GURU:

"Hi Guru,

My daughter has MassHealth CommonHealth with Premium Assistance based on the family health insurance we receive through my employer. I am in Open Enrollment right now and I want to make sure that we can maintain the Premium Assistance. What do I need to know to make sure it stays in place?

Thanks!"

Great Question!

Premium assistance is reviewed on an annual basis to ensure your employer sponsored plan still meets the criteria for reimbursement. During open enrollment you want to confirm that the plan you select, whether it is the same plan as this year or a new plan, still qualifies for the program. For a family plan, you want to make sure that the in-network family deductible is no more than $6400 and the out-of-pocket max is no more than $20,300.

Next, you want to make sure that Premium Assistance receives the updated information as soon as possible. This would include a completed Premium Assistance Review Form: https://www.mass.gov/doc/premium-assistance-compliance-form/download, and a summary of benefits for the 2026-2027 plan year. Premium Assistance will ask your employer for this information. If they don’t receive it from them, they will ask you for this information. A good tip is when you are speaking with your HR during open enrollment have them complete the review form for you and make sure it is submitted.

Reminder is that Premium Assistance generally matches what you are paying for your employer sponsored insurance, so review all your options. Perhaps there is a more expensive plan that you should consider. If you have questions or would like help in reviewing your options, feel free to reach out to the Insurance Resource Center.

Reminder:
I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

17/04/2026

ASK THE INSURANCE GURU:

"Dear Guru:

My child’s Early Intervention provider suggested that we should seek an autism evaluation for my toddler. I called a few places, but they all have long wait lists, and we are hoping to have him seen sooner. Do you have other suggestions for where we might go?

Concerned Mom"

Dear Concerned Mom:

Thank you for writing to us. Long wait times for evaluations are a common issue and can delay access to care. But there is a new resource in Massachusetts, the MCPAP Early Autism Diagnosis Project, that can help.

The MCPAP Early Autism Diagnosis Project is available to all children in Massachusetts under 6 years of age. MCPAP partners an autism diagnosis specialist with your primary care clinician to assess your child, and, if they are determined to have autism, will provide a diagnosis and referral letter.

Ask your primary care doctor or nurse practitioner to refer you to their MCPAP (Massachusetts Child Psychiatry Access Program) site. MCPAP will call you back to begin the evaluation, usually within ONE business day. In addition to the evaluation, you will be assisted by a family partner to support you after the diagnosis and help connect you to services and resources.

I hope this is helpful. If you have questions or need further information, my colleagues at the Insurance Resource Center would be happy to assist. If you have questions and/or need more information, please reach out to the Insurance Resource Center at 774-455-4056 or email them at AIRC@umassmed.edu

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

14/04/2026

https://umassmed.zoom.us/meeting/register/uSoh8VRUQTyWlo1fOE-fsg

09/04/2026

ASK THE INSURANCE GURU:

"Hello,

How do you get insurance to cover the cost of summer camp? Thanks!

Julie"

Dear Julie:

This is a great question. Summer camps are very important for many individuals with disabilities. However, insurance only covers medically necessary treatments, and it’s unlikely that a traditional summer camp would be eligible. However, if it is a therapeutic or specialized summer camp, it may be possible to get some portion covered. The Guru recommends asking the camp if they can advise you about insurance coverage. It’s a good idea to include the word “therapeutic” when using the internet to find these types of camps. For example, if you Google “therapeutic summer camps Massachusetts”, it should point you in the right direction. The Guru hopes you have a great summer!

Here’s a link to Massachusetts summer camps: https://disabilityinfo.org/fact-sheet-library/recreation/summer-camp-resources-2020/ (Please know this link has been updated for 2026.)

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

06/04/2026

Go A Sub Above for Autism: Share this with the families you serve!

The Doug Flutie, Jr. Foundation for Autism is excited to continue this initiative for families in the autism community by offering complimentary meal at Jersey Mike’s for individuals with autism and their immediate families at SELECT Jersey Mike's locations in New England, Buffalo and Rochester NY and Southeast Florida.
Jersey Mike’s, a steadfast supporter of the autism community, continues to champion inclusivity across its nationwide locations while serving up their delicious subs. This partnership provides families with an opportunity to relax, share a meal, and experience the kindness behind this generous program!

How It Works
If your families are interested in participating, here are the simple steps:
1. Click the link here: or use the button below.
2. Pick a day that works for your family.
3. Fill out the necessary information to secure your complimentary meal.

Once submitted, our team will handle the rest! Meals will be prepared 24-48 hours in advance, and families can pick them up at their selected Jersey Mike’s location.

Program Details
• Meals include: Up to 4 regular-size subs from a pre-set selection.
• Eligibility: One free meal per family, per year. This program is exclusively for individuals with autism and their immediate families.
• Order Notes: Special orders and modifications are not possible at this time.
• Availability: This program is available through April 30, 2026

We encourage you to share this opportunity with the families you support, so they can enjoy a meal on us while celebrating the incredible inclusivity promoted by Jersey Mike’s.
Thank you for helping us spread the word about this exciting program!

Please click the link to complete this form.

02/04/2026

Register for Autism Advocacy Day, Safeguarding our Future from 10:00-11:30am on Wednesday April 8th at the Massachusetts State House.

Through advocacy, programs that promote inclusion, and engaging the community, The Arc creates tangible changes in the community and in the lives of people with disabilities.

02/04/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I remember you saying that we could reach out to you if we come across acronyms and don’t know what they stand for. Can you please provide a list of acronyms that I might see now that I decided to apply for MassHealth."

I am so glad you asked. There are a lot of acronyms related to MassHealth coverage, but I will pick a few of my favorites that you might see while applying for coverage. When I say that there are a lot of acronyms that you might see, I am not exaggerating!

ARD (Authorized Representative Designation Form): This is a form that needs to be completed for you to speak to MassHealth about someone other than yourself or your minor child(ren). It designates the person chosen to act on someone’s behalf.

DES (Disability Evaluation Services): MassHealth has contracted with Disability Evaluation Services to assist with disability evaluations. They verify disabilities, allowing members to qualify for certain types of MassHealth coverage.

ESI (Employer Sponsored Insurance): Health insurance through your employer. If you have access to ESI, MassHealth needs to know about it. ESI that meets certain requirements can make you eligible for an additional benefit called Premium Assistance.

MAGI (Modified Adjusted Gross Income): When you apply for MassHealth coverage, they will look at your Modified Adjusted Gross Income (i.e, your current monthly income, less certain pretax deductions) for eligibility/ premium purposes. MassHealth tries to verify your reported income in state and federal data hubs and if it is close, you are good. If it doesn’t match closely, you may be asked to provide proof of income, which is often two recent pay stubs for each person who works.

Good luck working on your application and please reach out to my colleagues at the IRC if you need help or have questions.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

31/03/2026

https://umassmed.zoom.us/meeting/register/ZiQpnhiwSEy3d-XukXy_cQ

26/03/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My son was just diagnosed with autism. I am getting all kinds of instructions about what to do (talk to my school, apply for secondary insurance, start services, etc.) and I am very confused by some of the acronyms that have been used. When I see these acronyms written down later, I don’t remember what they mean. Can you give me a list of common acronyms that I should know about autism?

Thank you."

Sure, I can provide some commonly used acronyms that you might see after receiving a diagnosis:

1. ASD (Autism Spectrum Disorder) A neurodevelopmental disorder that can impact social, emotional and communication skills.

2. ABA (Applied Behavioral Analysis) Common therapy/treatment for ASD. Applying psychological principles of learning in a systematic way to modify behavior.

3. EI (Early Intervention) Services and supports available for infants and toddlers up to age 3 to address developmental delays and disabilities. Provided by the Department of Public Health.

4. IEP (Individualized Education Plan) A written educational plan addressing services and supports to meet a child’s learning needs at school.

5. IFSP (Individualized Family Service Plan) The Early Intervention team works with the family to develop a plan that defines goals and services that need to be addressed.

6. ISP (Individualized Service Plan) Picks up where IEP leaves off. Adult planning, 22+. Provides written details of supports and resources needed to achieve personal goals.

There are many other acronyms related to ASD (Acronym #1!). If you, or anyone else, has a specific acronym that you would like me to explain, please let me know. If you don’t know what an acronym stands for, don’t be afraid to ask. I bet many others don’t know either. And remember, I am always happy to help!

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

19/03/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My son has been experiencing disruptive behaviors and home and school. I read on social media about a new MassHealth program called FIT.

What does it stand for and can you tell me more about the program?"

Family Intensive Treatment (FIT) in Massachusetts is an in-home, crisis-stabilization program for youth (under 21 with MassHealth) and families, offering 24/7 clinical support, therapeutic mentoring, and skill-building to prevent hospitalizations.

Key Aspects of Massachusetts FIT Programs:
• Target Audience: Primarily youth under 21 with MassHealth experiencing mental health or behavioral crises.
• Services Provided: Intensive, in-home, clinical support, 24/7 availability, and peer support.
• Goal: To keep youth in their homes, improve communication, and prevent emergency room visits.
• Providers: JRI (Justice Resource Institute), Behavioral Health Network (BHN), Eliot Community Human Services, and Bay State Community Services

If you are going to make the referral to FIT for your son, the provider will complete the referral over the phone or accept the referral form and then follow up with you. If a provider is making the referral, the CBHI provider will either: a. Accept the completed referral form and follow up with you, or b. You will complete the referral with the provider over the phone. Then the provider will follow up with you. In both cases, the accepting referral agency will contact you to review the referral and discuss the appropriate level of care, and will obtain consent if applicable. Once consent is received, your son will be scheduled for an intake appointment or added to a waiting list for the appropriate CBHI or other behavioral health service.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.