ABA therapy and Medicaid

What is usually covered

Under the federal EPSDT rule, Medicaid must cover medically necessary treatment for children under 21, and that includes ABA where a clinician has documented the need. This holds in every state, though each state runs its own program with its own name, its own managed care plans, and its own prior authorization paperwork.

The question that actually matters

Ask your employer or plan administrator whether your plan is self-funded or fully insured. Fully insured plans follow your state's autism mandate. Self-funded plans follow federal ERISA rules and are not bound by it. Many self-funded plans cover ABA anyway, but that single answer tells you which rulebook applies to you.

Before your first session

• Confirm the provider is in network, not merely willing to bill your plan.
• Ask what your authorization covers: how many hours, over what date range.
• Ask what your copay per session is, and whether the deductible applies.
• Get the reauthorization date in writing and diarise it a month early.

Finding agencies

Which plans a provider accepts is not in the federal registry, so it is not published on unclaimed listings here. The fastest route is to open your county page, then call and ask directly. It is a two minute question.