ABA therapy aims to help your child replace disruptive or unwanted behaviors that may be harmful or interfere with their learning or socialization. It is a vital service necessary for your child to thrive. The process of finding the information and services your child needs can be both stressful and challenging when first receiving their diagnosis of autism. With overwhelming amounts of information to sort through, appointments to schedule, and accommodations to make, insurance may now be one less thing to lose sleep over. After years of tireless advocating, improvements to health insurance coverage for services, including ABA therapy, are being made. Determining whether ABA therapy coverage is a part of an insurance plan may be essential in making financial decisions for many families. So, where should you begin?

Two people reviewing insurance paperwork

Your Insurance and ABA

Begin by checking on the type of insurance plan your family has. This information is essential in determining which services for autism require coverage by your provider. Full coverage plans have set requirements, providing your child with benefits state laws direct. Other plans, including self-funded insurance plans, do not have this requirement, as they follow federal regulations.

Autism Insurance Reform

All fifty states now follow government requirements to provide coverage for your child’s ABA therapy. While all states require “meaningful coverage” for the services and treatment of autism in state-regulated health plans, you may find your plan has limitations. The standard benchmark for “meaningful coverage” is to provide with you ABA therapy coverage. Unfortunately, some insurance plans may impose caps on:

  • Number of ABA therapy sessions
  • Monetary amount
  • Age of child

Some families may be responsible for over twenty thousand dollars per year if ABA therapy is not a part of their plan.

Know the In’s and Out’s of Your Insurance Plan’s Loopholes

Not everyone is aware that full insurance plans may be subject to abide by laws in the state of issuance. This means coverage for your child’s ABA therapy may not necessarily be where the beneficiary lives

Some states may offer an incomplete plan by allowing autism insurance laws to exempt plan types from specific coverage requirements. By citing fiscal impacts, some state legislatures do not mandate coverage for your child’s autism treatments. In other states, exemptions include the size of your group and the date of issuance.

My Insurance Plan Doesn’t Provide Necessary Coverage

If you find your plan does not offer the coverages your child needs for ABA therapy and additional services for autism:

  • Ask your employer if other self-funded plans are available.
  • What coverage will they provide for autism services?
  • Ask if your company provides options for fully insured plans.
  • Be sure to ask which state regulates this option to ensure your coverage.
  • Ask if this is a large or small group plan.

Medicaid for ABA Therapy Coverage

Public health insurance, for children with an autism diagnosis, is available through the Centers of Medicare and Medicaid. Every state receives funds with specific guidelines from the federal government, and federal law states that Medicaid shall pay for the following autism services:

  • Screening
  • Diagnosis
  • Treatment, including ABA therapy

It is essential to look closely at your state’s Medicaid program, as all states have different administration guidelines.

At Blossom Children’s Center, our team is here to provide your family with guidance through this challenging time. We are available to walk you through our all-encompassing services and assist with your insurance coverage questions. For more information on our ABA therapy and additional services, contact us today. 

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