ABA therapy and Medicaid

What is covered

Medicaid must cover medically necessary ABA for children under 21 in every state. Each state runs its own program, with its own prior authorization paperwork.

Every state runs its own Medicaid program under a different name, and each sets its own prior authorization paperwork. ABA for children is covered through the federal EPSDT benefit, which requires states to pay for medically necessary treatment for enrollees under 21.

Ask them: Which managed care plan am I enrolled in, and what does it need to authorize ABA?

Self-funded or fully insured?

Ask your employer which yours is. Fully insured plans follow your state's autism mandate; self-funded plans follow federal rules instead. Many cover ABA either way.

Before your first session

• Confirm the agency is in network, not just willing to bill.
• Ask how many authorized hours, over what dates.
• Ask your copay per session.
• Get the reauthorization date in writing.