Medicaid ABA Coverage in Washington

How to get ABA therapy paid for by Apple Health, step by step.

State coverageAugust 2, 2026

What Apple Health Covers

Washington's Medicaid program, Apple Health, covers medically necessary ABA therapy for enrollees under 21 through the federal EPSDT benefit. EPSDT stands for Early and Periodic Screening, Diagnostic and Treatment, and it requires states to cover any medically necessary service that corrects or improves a condition. ABA qualifies when a doctor or other qualified professional says it's needed.

There is no set dollar cap or visit limit written into the state's autism mandate for ABA. Instead, coverage depends on your specific Medicaid plan and what it considers medically necessary for your child. The exact question to ask your plan is: "What are the medical necessity criteria for ABA therapy under EPSDT?"

Who Qualifies

Your child must be under 21 and enrolled in Apple Health. You also need a formal diagnosis of autism spectrum disorder from a qualified professional, usually a developmental pediatrician, child psychologist, or psychiatrist. The diagnosis must be current and based on standard assessment tools.

In addition to the diagnosis, you'll need a treatment plan. This is a written document that outlines the specific ABA goals, the number of hours per week recommended, and how progress will be measured. The treatment plan is typically created by a Board Certified Behavior Analyst (BCBA) after an initial assessment.

How to Get Prior Authorization

Before ABA can start, your Medicaid plan must approve it. This is called prior authorization. You or your ABA provider will submit a request to your managed care plan, which includes the diagnosis, the treatment plan, and sometimes additional documentation like school records or previous therapy notes.

Your managed care plan's name is printed on your child's member card. Call the number on the back and ask for the behavioral health or prior authorization department. They will tell you exactly what forms to fill out and where to send them. Keep a log of who you spoke to and when, and ask for a reference number for every call.

What to Do When a Provider's Panel Is Closed

Many ABA agencies in Washington have limited spots and may close their waitlist or stop taking new patients. If an agency says their panel is closed, don't give up. Ask to be put on their waitlist, and also contact your managed care plan. Your plan has a network of providers and can help you find an agency that has openings.

If you still can't find a provider, ask your plan about a "gap exception" or "network adequacy" process. This lets you request coverage for an out-of-network provider if the plan can't offer a timely in-network option. You'll need to document your attempts to find care, so keep emails and notes from every call.

Where ABA Agencies Are Located

We list ABA agencies across many Washington counties. The largest concentrations are in King County, Pierce County, and Snohomish County. If you live outside these areas, you may have fewer options, but there are still agencies in many other counties.

When you contact an agency, ask if they accept Apple Health and if they have any current openings. Also ask if they have a waitlist and how long it typically takes. Some agencies have multiple locations, so even if one is full, another might have space.

What About Employer Plans

If your child is on your employer's health plan instead of Apple Health, the rules are different. Washington state has an autism insurance mandate, but it only applies to fully insured plans. If your employer has a self-funded plan, which is common with large companies, the state mandate does not apply because of a federal law called ERISA.

However, many self-funded plans still cover ABA voluntarily. Check your plan's summary of benefits or call the customer service number on your insurance card. Ask directly: "Does this plan cover applied behavior analysis for autism?" If they say yes, ask about any limits or prior authorization requirements.

Washington listings right now

258 ABA agencies across 19 Washington counties.

Common questions

Does Apple Health cover ABA therapy for my child?

Yes, if your child is under 21 and has a medical need for ABA. Apple Health covers medically necessary ABA through the EPSDT benefit. You'll need a diagnosis and a treatment plan.

How do I find an ABA provider that accepts Apple Health?

Start with your managed care plan's provider directory. You can also use our directory of agencies across Washington. Call each agency and ask if they accept Apple Health and if they have openings.

What if no ABA provider has openings?

Ask to be put on waitlists and tell your managed care plan. If the plan can't find you a timely in-network provider, you may be able to get approval for an out-of-network provider through a gap exception.

How many hours of ABA will Apple Health pay for?

There is no fixed limit. The number of hours is based on what your child's treatment plan says is medically necessary. Your managed care plan reviews the plan and approves a specific number of hours.

Do I need a referral from my child's doctor?

Not always, but it helps. Some plans require a referral or a prescription for ABA. Check with your managed care plan to see if a referral is needed before starting the prior authorization process.

My child is over 21. Does Apple Health still cover ABA?

No, EPSDT only covers children under 21. After that, ABA is generally not covered by Apple Health, unless your plan has a separate benefit. Check with your plan for any adult ABA coverage.