Who pays for autism treatment?

He refused to cuddle, flapped his arms and stared into space a lot. On occasion, he picked at his nose until it drew blood and, with it, smeared the walls of the family's Pasadena town house.

It was nearly a year, Guillermo Arce said, before Kaiser Permanente, the family's healthcare provider, confirmed their fears. The diagnosis wasn't much help, though. Kaiser refused to provide most of the treatment that specialists said Andrew needed -- until the state ordered it to in April.

Last month, Andrew, now 2 1/2 years old, began getting the disputed treatment -- including individual training in how to eat and play.

"He is still young," his father said. "He will always be autistic, but maybe he could be fully functioning."

Guillermo Arce's battle is a window on a political and legal struggle playing out across the country amid a surge in diagnoses of autism. Parents, insurers and the government are tussling over who is going to pay for treatment.

"It's health plans versus schools versus regional centers," said Diane Anand, executive director of the Lanterman Regional Center in Los Angeles, one of 21 state-funded centers that serve the developmentally disabled. "It's going to take years to sort this out."

Autism is a disorder that impairs communication and socialization and is often marked by repetitive behaviors such as rocking and head banging. Although there are many theories, its cause remains unknown. There is no cure.

Treatment is mainly behavioral training, teaching such skills as dressing. There is wide agreement that the sooner treatment begins, the more effective it is, and that early intervention pays off in the long run by developing self-reliance.

But it costs money -- as much as $70,000 a year per child. The state spent $320 million last year, up from $50 million a decade earlier. Nationwide, the tab is $90 billion annually, a figure expected to double in a decade.

Parents, in growing numbers, say insurers aren't doing their part. Proposed class-action lawsuits -- including one filed in April by Arce against Kaiser and another filed late last month against Anthem Blue Cross -- allege that California's largest health plans are shirking their duties to autistic members.