Getting Autism Therapy Covered by Insurance in Wyoming

Wyoming’s mandate

Wyoming Insurance Department Bulletin No. 01-2019, issued under W.S. § 26-2-109, implementing the Mental Health and Substance Use Disorder Insurance Parity Act (2019 House Enrolled Act 89), enacted 2019, requires state-regulated health plans in Wyoming to cover the diagnosis and treatment of autism spectrum disorder, including applied behavior analysis.

Ages covered: None. Wyoming never passed an autism-specific mandate, so there is no age ceiling written anywhere. The Commissioner instead directed that treatments for autism spectrum disorder cannot be excluded from the mental health services in an insurance policy.

Dollar cap: No autism-specific cap. Benefits for autism spectrum disorder may not be subject to ANY separate cost-sharing requirement or treatment limitation that applies only to mental health and substance use disorder benefits. Deductibles, copayments, and limits on visits or days must be no more restrictive than the predominant limits applied to substantially all medical and surgical benefits in the same classification.

The sentence to quote is the flattest one in the bulletin: excluding ABA therapy for children with autism ON THE GROUND THAT IT IS EXPERIMENTAL OR INVESTIGATIVE 'will not be allowed by the Department'. That single line disposes of the most common denial reason in the country. One condition to check first — the requirement bites on policies that INCLUDE mental health benefits, and the Department acknowledges not all non-ACA plans do. Carriers may still assess medical necessity and review continuing treatment, but only by standards comparable to and no more stringent than those used for substantially all medical and surgical care in the same classification. The bulletin reaches grandfathered and transitional policies, the individual and small group markets, and all individual and group policies offering mental health benefits under the Department's jurisdiction, with effect from 1 July 2019.

Whether the mandate applies to your plan

This is the question to settle first, because the answer decides whether anything above is enforceable for you. State insurance mandates bind fully insured plans. Self-funded employer plans — where the employer pays claims itself and an insurer only administers them — are generally exempt under federal ERISA, and they cover roughly six in ten people with employer coverage.

Ask your HR department, in writing, which type your plan is. If it is self-funded, Wyoming Insurance Department Bulletin No. 01-2019, issued under W.S. § 26-2-109, implementing the Mental Health and Substance Use Disorder Insurance Parity Act (2019 House Enrolled Act 89) does not compel coverage — but federal parity law may still help, and many large self-funded employers cover ABA voluntarily. Ask what the plan actually covers rather than assuming the answer is no.

The Medicaid route

Wyoming Medicaid covers ABA for members under 21 through EPSDT. Wyoming's waiver waits are short by national standards — one to three years — so the Supports Waiver is a more realistic parallel route here than in most states.

How Medicaid waivers work covers the route for families who do not qualify on income alone.

When you are denied

1. Get the denial reason in writing. Insurers must give a specific reason, and the appeal has to answer that reason rather than restate the diagnosis.
2. File the internal appeal within the deadline on the denial letter, with a letter of medical necessity that addresses the stated reason directly.
3. Request external review if the internal appeal fails. Fully insured plans carry external review rights, and an independent reviewer overturns denials more often than families expect.
4. Complain to the Wyoming Insurance Department on 307-777-7402 if you believe Wyoming Insurance Department Bulletin No. 01-2019, issued under W.S. § 26-2-109, implementing the Mental Health and Substance Use Disorder Insurance Parity Act (2019 House Enrolled Act 89) is being violated. Their consumer pages are here.