Great question! Medicaid coverage for ABA therapy can vary depending on the state you live in, but in general, Medicaid is required to cover medically necessary treatments for children under 21 — and ABA therapy often falls into that category.
Here are some key points to keep in mind:
- Most states do cover ABA therapy Show Full Answer
Great question! Medicaid coverage for ABA therapy can vary depending on the state you live in, but in general, Medicaid is required to cover medically necessary treatments for children under 21 — and ABA therapy often falls into that category.
Here are some key points to keep in mind:
- Most states do cover ABA therapy through Medicaid for children with autism
- Coverage for adults with autism can be more limited and varies by state
- Prior authorization is often required, meaning a doctor needs to confirm the therapy is medically necessary
- The number of hours covered may be limited depending on your plan It's worth calling your Medicaid provider directly to ask about your specific plan and state rules. A MyAutismTeam member shared that it sometimes takes a little negotiation with insurance to get coverage approved — so don't be discouraged if it takes a few tries!
A good starting point is asking your doctor to write a letter of medical necessity for ABA therapy, as this can strengthen a coverage request.
October 2
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