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Autism and Applied Behavior Analysis (ABA) therapy

Apple Health coverage offers Applied Behavior Analysis (ABA) therapy as a benefit for clients diagnosed with Autism Spectrum Disorder (ASD). Other services, such as physical therapy, speech therapy, and occupational therapy are also covered services a client with autism may receive.

Eligibility and acceptance

In order for a client to be eligible for ABA therapy through Apple Health (Medicaid), a recognized Centers of Excellence (COE) must conduct a comprehensive evaluation, and write an order for Applied Behavior Analysis therapy.

If the COE determines that the client meets medical necessity for ABA services, they will provide the client, caregiver, or family with a copy of their comprehensive evaluation, recommendations, and order for ABA treatment. The client, caregiver, or family is encouraged to contact all of the Medicaid-enrolled ABA providers in their area to be added to the waiting lists. ABA providers require a copy of the COE evaluation and order to ensure clients have completed phase one of the ABA pathway to care.

Participation in ABA services does not preclude other therapies such as speech therapy, occupational therapy, and physical therapy depending on the individual client's needs. It is most essential that treatment providers coordinate and collaborate with one another to maximize resources and ensure positive results for the client.

Information regarding other therapies beneficial to the client which can be done instead of or in conjunction with ABA will be found under habilitative and rehabilitative services.