ABA Therapy in Santa Cruz County, California

How ABA coverage works in California

Medicaid

Medi-Cal. Under the federal EPSDT rule, Medicaid must cover medically necessary treatment for children under 21, which includes ABA where a clinician has documented the need. Prior authorization is normally required.

Under age 3

Start with Early Start, which runs under Part C of IDEA. It is separate from insurance, low or no cost, and does not require a diagnosis to request an evaluation.

Ages 3 and up

Your school district handles educational services through an IEP under Part B of IDEA. That is separate from insurance-funded ABA, and many families use both at once.

Commercial plans

Every state requires state-regulated health plans to cover autism services, though the specifics differ. Check your plan documents, or ask the agency.

The exception

Self-funded employer plans follow federal ERISA rules rather than state mandates, so a state requirement may not apply. Many cover ABA regardless. Ask HR whether your plan is self-funded or fully insured.