Great News for Medicaid Members!

Yes, Medicaid covers ABA therapy.

Applied Behavior Analysis (ABA) therapy is a widely recognized and effective treatment for individuals with Autism Spectrum Disorder (ASD). Given the importance of early intervention and the substantial costs associated with long-term therapy, insurance coverage for ABA therapy is a critical concern for many families. 

Medicaid provides coverage for ABA therapy, but understanding the specifics of this coverage is essential for beneficiaries.

Maryland Medicaid covers ABA therapy under its Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services.

This program ensures that individuals under the age of 21 receive appropriate preventive, dental, mental health, developmental, and specialty services. ABA therapy falls within this spectrum as a medically necessary service for children diagnosed with ASD. 

To qualify for coverage, a comprehensive evaluation and diagnosis by a qualified healthcare provider are required, followed by a recommendation for ABA therapy.

The coverage process involves several steps. 

First, the child's primary care provider or a specialist must conduct a thorough assessment to confirm the ASD diagnosis and the need for ABA therapy. 

Next, a treatment plan outlining the specific goals and duration of therapy must be submitted to Medicaid for approval. 

Once approved, Medicaid will cover the costs of therapy sessions, which can be conducted at home, in a clinic, or within the community. It’s important for families to work closely with their healthcare providers to ensure all necessary documentation is complete and accurate to avoid delays in coverage.

While Medicaid’s coverage of ABA therapy in Maryland is comprehensive for eligible children, it is important to note that coverage for adults with ASD can be more complex. 

Adults over 21 may not receive the same level of coverage for ABA therapy, as Medicaid’s EPSDT services are specifically designed for individuals under 21. 

However, there may be other Medicaid programs or waivers available to assist adults with ASD in accessing necessary services and supports.

Navigating Medicaid coverage for ABA therapy can be challenging, but resources are available to help families understand and utilize their benefits. 

Organizations such as the Maryland Department of Health and advocacy groups for individuals with ASD can provide valuable guidance and support. 

Additionally, many ABA therapy providers have experience working with Medicaid and can assist families in the application and approval process.

All Star ABA is here to help you navigate your coverage and ensure you receive the necessary support for your child's therapy needs.

Contact us and start your journey today.