Nearly 1,000 families have successfully received the coverage & funding they need.
Over the last decade, tremendous progress has been made for children with autism with respect to health insurance coverage for services.
Our insurance team specializes in getting families the coverage they need. They work with you to gather all the necessary information and identify services covered in your specific insurance plan, and then coordinate with the insurance company on your behalf to obtain approval for requested services including ABA therapy.
View location specific insurance information
The first step in navigating the insurance maze is to make sure you have a written diagnosis from a medical or licensed mental health professional.
Not all plans are regulated the same.
Every policy’s scope is different. What are your co-pays, deductibles, and out-of-pocket maximums? Do you need a referral? What providers are “in-network”? Knowledge is power - understanding your policy will help you avoid confusion down the road.
Not all ABA providers are created equal. You and your family will be spending a significant amount of time with the provider, so find an organization you are comfortable with and understands ABA treatment.
Remain positive...there is a light at the end of the tunnel!
Each state may have different services, names for these systems, and ease of access, but there are autism resources available to help. Although each state has their variations as to what is offered and how it is implemented, each state must follow the basic framework as described by the Individuals with Disabilities Education Act (IDEA).
For more information about the type of supports offered by your state, we recommend contacting your local Autism Society chapter. We have found them to be an excellent resource for up to date, local information for parents.
Questions on this?
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In general, though, “appropriate” means that education programs must be designed to meet their individual needs to the same extent that the needs of non-disabled students are met. The supports and services should be provided in the general education setting to the extent possible.
The National Academy of Sciences Committee on Educational Interventions for Children with Autism recommends a minimum of 25 hours per week of intervention, adding, This 25-hour minimum is not only deemed critical but appropriate.
Research shows that ABA intervention, occupational therapy (OT) and speech therapy are appropriate for children with autism. Work with your school district to find out what supports and services are appropriate for your child to create an Individual Education Program (IEP) that is right for your child.
This has led to the most significant increase in access to treatment we have ever seen. Despite national recognition and direction that each state Medicaid plan should fund ABA treatment some states still have not enacted coverage. Additionally, those that have are inconsistent in how services are funded. Waivers, managed care organization, EPSDT regulations play different roles in each state and can lead to a complicated system for a family to navigate.
In some states every family may have the same option for coverage whereas others may have different options for each county. Some states have created robust networks of BCBA allowing families to choose their provider, while others may have limited choices and significant waitlists.
Regardless of these differences, they can all be subject to change both at the state and federal level. It is critical for families educate themselves on their local Medicaid system and to work with an ABA provider that not only understands the system, but is able to be flexible if and when changes occur.
Generally, your local chapter of the Autism Society of America will have resources regarding the Medicaid funding in their community. Also, ABA providers should have intake and authorizations teams prepared to answers your questions.
Questions about medicaid and how it could work for you?