Does Insurance Cover ABA Therapy in Mississippi?
Find out what Mississippi parents need to know about ABA coverage, from state mandates to self-funded plans.
The Short Answer
In Mississippi, your ABA coverage depends on the type of insurance plan you have, not just the state you live in. The state's autism mandate applies to fully insured plans, but many employer plans are self-funded and follow federal ERISA rules instead.
That's why two families working for the same company can get completely different answers about ABA coverage. One might have a plan that covers it, the other might not, even though they live in the same city and work for the same employer.
Fully Insured vs. Self-Funded Plans
A fully insured plan means your employer buys an insurance policy from an insurance company, and that policy must follow Mississippi's autism mandate. If your plan is fully insured, you likely have ABA coverage, but the details vary by plan.
A self-funded plan means your employer pays for your healthcare directly, and they hire an insurance company just to administer the plan. These plans are governed by ERISA, a federal law, and are not required to follow Mississippi's mandate. Many self-funded plans still cover ABA, but it's not guaranteed.
To find out which type you have, ask your HR department: "Is our health plan fully insured or self-funded?" If they don't know, ask for the plan document or call the number on your insurance card and ask the same question.
Ask the Right Questions
Write down the answers, including the date and the name of the person you spoke with. If you get a denial later, this record helps.
Prior Authorization and Denials
Most plans require prior authorization before ABA therapy starts. This means your doctor or the ABA agency must submit a treatment plan to your insurance company for approval. The plan usually needs a diagnosis of autism, a prescription for ABA, and a detailed treatment plan with goals.
If your claim is denied, you have the right to appeal. The denial letter will explain why and give you a deadline to appeal, often 180 days. Ask the ABA agency to help you with the appeal; they have experience with this.
If the first appeal fails, you can request an external review by an independent third party. Your insurance company must tell you how to do this in the denial letter.
Mississippi Medicaid
If your family qualifies for Mississippi Medicaid, your child under 21 can get medically necessary ABA therapy through EPSDT, a federal program that requires states to cover necessary services. This is a separate path from private insurance.
To find out if you qualify, contact the Mississippi Division of Medicaid or apply online. Your child's doctor can also help you start the process. Once enrolled, call the number on your Medicaid card and ask for ABA coverage details.
Finding Providers in Mississippi
There are ABA agencies across Mississippi counties. The largest concentrations are in DeSoto County, Harrison County, and Hinds County. If you live in a rural area, you may need to travel or find a provider that offers telehealth.
When you call an agency, ask if they accept your insurance and if they have experience with prior authorizations for your specific plan. They can also tell you if they have a waitlist and how long it typically is.
Mississippi listings right now
74 ABA agencies across 23 Mississippi counties.