Does Insurance Cover ABA Therapy in Michigan?

How to find out if your Michigan plan covers ABA, what to ask, and what to do if denied.

State coverageAugust 2, 2026

What Michigan law does and does not do

Michigan has an autism insurance mandate. That means state-regulated plans, the kind you buy on your own or get through a small employer, must cover medically necessary ABA therapy for autism. The law applies to fully insured plans, which are regulated by the state.

But it does not apply to every plan. If your employer self-funds its health plan, meaning the employer pays claims directly instead of buying an insurance policy, then the state mandate does not bind it. Those plans follow federal ERISA rules instead. That is why two families working at the same company can get different answers: one on a fully insured plan gets state protection, the other on a self-funded plan does not.

Many self-funded plans cover ABA anyway, but they are not required to by Michigan law. Your employer gets to choose.

Ask these two questions first

Before you call an ABA agency, find out exactly what your plan covers. The fastest way is to ask two specific questions, one to HR and one to your insurer.

To HR: "Is our health plan fully insured or self-funded?" If they do not know, ask for the plan's Summary Plan Description, which must state it.

To your insurer's benefits line: "Does my plan cover applied behavior analysis for autism? Are there annual or lifetime limits, and do I need a prior authorization?" Write down the date, the representative's name, and their answers.

Ask HR: fully insured or self-funded?
Ask benefits line: ABA covered? Limits? Prior auth needed?
Get the plan name and member ID from your insurance card.

What prior authorization requires

Most plans require prior authorization before ABA starts. That means your provider sends a request to the insurer, and the insurer decides if it is medically necessary.

The request usually needs a formal autism diagnosis, a treatment plan with goals, and sometimes a specific assessment tool like the VB-MAPP or Vineland. Your ABA provider handles this, but you can speed it up by having your child's diagnostic report ready.

Ask your insurer how long the review takes. Many states have prompt-review laws, but the timeline varies. If you do not hear back, call the benefits line and ask for a status update.

What to do if your claim is denied

A denial is not the end. You have the right to appeal, and the process is usually spelled out in your denial letter.

First, read the letter. It will say why the claim was denied and give a deadline to appeal. Miss that deadline and you lose your chance.

You can file an internal appeal with your insurer. If they uphold the denial, you can request an external review by an independent third party. In Michigan, external review is available for fully insured plans. For self-funded plans, you have the right to an ERISA appeal, which has its own deadlines.

Ask your ABA provider for help. They have experience with appeals and can supply clinical documentation. You can also contact the Michigan Department of Insurance and Financial Services (DIFS) with complaints about fully insured plans.

Michigan Medicaid as a route

If your family qualifies for Michigan Medicaid, ABA is covered as medically necessary for children under 21 through the EPSDT benefit. That includes children on Healthy Michigan Plan if they are under 21.

Your child must have a diagnosis of autism spectrum disorder, and the ABA must be prescribed by a doctor. Your Medicaid plan will have a prior authorization process, but coverage is generally available.

The plan name is on your member card. Call the number on the back to ask about ABA coverage and how to find an in-network provider.

Finding ABA providers in Michigan

Michigan has many ABA agencies, but availability varies by county. Our directory lists agencies across the counties we cover.

The largest concentrations are in Wayne County, Oakland County, and Macomb County. If you live outside those areas, you may have fewer options, and some families drive or use telehealth.

When you call an agency, ask if they accept your insurance and if they have experience with your specific plan. Also ask about waitlists, because some agencies have months-long waits.

Michigan listings right now

393 ABA agencies across 43 Michigan counties.

Common questions

Does Michigan law require all insurance plans to cover ABA?

No. The state mandate applies to fully insured plans, which are regulated by Michigan. Self-funded employer plans are exempt under federal ERISA, though many cover ABA voluntarily. Check with HR to know which type you have.

How do I know if my plan is self-funded?

Ask your HR department directly. They must tell you, and the Summary Plan Description will state it. You can also look at your insurance card: if it lists a third-party administrator like Blue Cross or United, that does not mean it is fully insured. Only HR can confirm.

What if my insurance denies ABA coverage?

You have the right to appeal. The denial letter will explain the process and deadlines. File an internal appeal first, then an external review if needed. For fully insured plans, you can also file a complaint with the Michigan Department of Insurance and Financial Services.

Does Medicaid cover ABA in Michigan?

Yes, for children under 21 when ABA is medically necessary. The EPSDT benefit requires coverage of medically necessary services. Your child needs an autism diagnosis and a doctor's prescription. Contact your Medicaid plan for details.

Are there limits on how many hours of ABA I can get?

Limits vary by plan. Some plans cap hours per week or per year, others do not. The state mandate does not set a specific cap, but your plan may. Ask your insurer directly: "Are there any limits on ABA hours or visits?"

How long does prior authorization take?

It varies. Some insurers respond in a few days, others take weeks. Ask your insurer for their standard timeline when you submit. Your ABA provider can also check on the status and push for a decision.