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Does  Molina Healthcare Medicaid Cover ABA Therapy?

If your child has been diagnosed with autism spectrum disorder (ASD), you’re likely searching for the best possible treatment and support plan for them. It’s also likely that you’ve come across applied behavior analysis, or ABA therapy, which is considered to be the gold standard treatment plan for children on the autism spectrum.

There are many reasons why ABA therapy is so highly regarded. It’s a personalized treatment plan that is very flexible, with plans crafted to each individual’s unique strengths and challenges. It is based on scientific evidence, with proven strategies, tools and methods to help children build the social and communication skills they may face challenges with, while also helping them to modify certain behaviors.

ABA therapy is also very intensive, with many children requiring multiple hours per day of treatment for multiple days per week. This can all add from a cost standpoint, of course.

Luckily, there are many options for families to help them pay for their child’s ABA therapy. One of those is Molina Healthcare Medicaid. Below, we’ll discuss what this is and whether it can cover your child’s ABA therapy.

Learn more about insurance coverage for ABA therapy

Table Of Contents

What is Molina Healthcare?

Molina Healthcare is a company that provides managed health care services under both the Medicare and Medicaid programs as well as through Marketplace plans in some states. They are a Fortune 500 company, and serve roughly 5.1 million members.

Molina Healthcare provides health insurance coverage through the Medicaid programs by partnering with some state governments. They also offer plans through the State Children’s Health Insurance Program.

There are 18 states in which Molina Healthcare offers a Medicaid plan, including Wisconsin, Washington, Virginia, Utah, Texas, South Carolina, New York, New Mexico, Ohio, Mississippi, Michigan, Massachusetts, Kentucky, Illinois, Idaho, Florida, California and Arizona.

There are certain income limits that Molina Healthcare’s Medicaid plans must adhere to, just like all other Medicaid plans.

Note: Coverage details may vary by specific plan and location. Always contact Molina Healthcare directly for the most accurate and up-to-date information for your state.

State Medicaid ABA Coverage Available? Notes
Arizona Yes Check regional requirements
California Yes Often extensive coverage
Florida Yes May require prior authorization
Idaho Yes Coverage based on COE evaluation
Illinois Yes Copay or deductible may apply
Kentucky Yes Dependent on family income
Massachusetts Yes High service availability
Michigan Yes Includes evaluation services
Mississippi Yes May be limited in rural areas
New Mexico Yes Confirm with local provider
New York Yes Strong ABA network
Ohio Yes Must follow 5-step process
South Carolina Yes Varies by plan
Texas Yes Prior approval often needed
Utah Yes Intake assessment required
Virginia Yes COE referral required
Washington Yes Typically generous coverage
Wisconsin Yes Some plans may differ

Does Molina Healthcare Medicaid Cover ABA Therapy?

The short answer is, yes, Molina Healthcare Medicaid does cover ABA therapy. Exactly what the plans cover, how much they cover and for whom, though, depends on the state in which you live as well as your specific family situation and the health insurance plan you have chosen.

Most of the company’s plans will cover up to so many ABA therapy sessions in a calendar year. They may also cover up to a certain percentage of the overall cost of each individual ABA therapy session.

There are some Molina Healthcare Medicaid plans that will have a copay or a deductible that you will be responsible for covering before any coverage from the plan starts. Some other plans have no such out-of-pocket expenses for families.

Since what is covered and how much is covered can vary so greatly, it’s very important to find out the details of your specific plan, as well as how it applies to your family. This will help you better budget possible costs for your child’s ABA therapy.

Coverage Feature What to Expect
Number of Sessions Covered Varies by state and plan; typically a set number of sessions per calendar year
Percentage of Costs Covered Some plans cover a percentage of costs; others may offer full coverage
Copays Some plans may have copays, while others may not
Deductibles Certain plans require meeting a deductible before coverage starts
State-Specific Variability Coverage rules differ significantly depending on the state
Out-of-Pocket Costs May include copays or deductibles, or be fully covered

Are There Requirements to Qualify for ABA Therapy Coverage?

Beyond meeting certain income limits to qualify for a Molina Healthcare Medicaid program, there are some other steps you must take in order for your child’s ABA therapy to be covered by your plan.

There are five steps that you must take in order to have the ABA therapy covered, according to the company. This includes …

  1. Getting an official recommendation for an autism evaluation
  2. Being referred for that autism evaluation to a Center of Excellence (COE)
  3. Receiving qualification approval for ABA therapy based on the comprehensive COE evaluation
  4. Going through an intake assessment as well as treatment planning for your child’s ABA therapy
  5. Having an official ABA provider make a request for services

If you have a Molina Healthcare Medicaid plan and are interested in having your child’s ABA therapy treatment covered by your plan, make sure to contact the company so you can follow all the steps properly.

Step Description
1 Get an official recommendation for an autism evaluation
2 Be referred for that evaluation to a Center of Excellence (COE)
3 Receive qualification approval based on the comprehensive COE evaluation
4 Complete intake assessment and develop a treatment plan for your child’s ABA therapy
5 Have an official ABA provider submit a request for services

Blue Gems ABA Provides Comprehensive ASD Evaluations and Treatment

Molina Healthcare Medicaid is one of the many health insurance plans that offer coverage for ABA therapy to children who have been officially diagnosed with ASD. As mentioned above, it’s important to follow the company’s procedures for how to get their treatment covered, so you can reduce the financial burden on you and your family.

At Blue Gems ABA, we provide comprehensive ASD evaluations and ABA therapy treatment programs through our experienced team of clinical psychologists and BCBAs, respectively.

To learn more, please contact us today.