Parents in Timonium often call us with one question before any other: will Medicaid pay for my child’s therapy?
It’s a fair place to start. Applied behavior analysis (ABA therapy) is one of the most recommended supports for children with autism spectrum disorder (ASD), and it usually takes place several days a week.
Maryland Medicaid does cover ABA therapy for children who meet the state’s requirements.1 Most of the work for families comes down to having the right paperwork and keeping coverage active.
In this article, we’ll discuss how Medicaid pays for ABA therapy in Timonium, Maryland, and what you’ll need to use it.
Key Takeaways
- Maryland Medicaid covers medically necessary ABA therapy for eligible children and young adults under 21.
- Families generally need documentation of an autism diagnosis, an ABA assessment, and an approved treatment plan.
- Medicaid-covered ABA therapy may take place at home or in a center when medically necessary.
- Keeping Medicaid enrollment active and renewing ABA authorizations helps prevent interruptions in therapy.
How Does Medicaid Coverage for ABA Therapy Work in Maryland?
Maryland added ABA therapy to its Medicaid program in 2017.2 The benefit is open to children and young adults under 21 who have an autism diagnosis and live at home or in the community.3 It pays for assessments, individual therapy, group sessions and parent training.4
Timonium is in Baltimore County, and the rules are the same in every Maryland county. If your child isn’t enrolled in Medicaid yet, you can apply at any time of year through Maryland Health Connection.5
Every ABA service has to be approved before it starts. Those approvals go through Carelon Behavioral Health, the company Maryland uses to manage behavioral health care for Medicaid members.6 The process is the same no matter which Medicaid plan is printed on your child’s card.
Cost is what parents worry about most. Under Maryland’s rules, ABA providers may not collect additional payment from Medicaid families for covered services.7
What Paperwork Does Medicaid Need Before ABA Therapy Can Start?
Approval depends on a short stack of documents.8 Some come from your child’s doctor, and the rest come from your ABA provider. Gathering them early is the surest way to avoid a slow start.
| Document | What It Is | How Blue Gems ABA Helps |
|---|---|---|
| Medicaid card | Proof that your child is enrolled in Maryland Medicaid | Our insurance specialists verify your child’s ABA benefits |
| Comprehensive diagnostic evaluation | A report confirming autism, based on observing your child, interviewing you and reviewing their history | Our intake team reviews the report as a first step |
| Referral for ABA therapy | A written order from a qualified health professional stating that ABA is medically necessary | We let you know if anything is missing before it’s submitted |
| ABA assessment | A meeting where a Board Certified Behavior Analyst (BCBA) measures your child’s current skills | One of our BCBAs completes it face to face |
| Treatment plan | Your child’s goals, recommended weekly hours and a plan for parent training | We write the plan and send the authorization request to Carelon |
Several kinds of professionals can complete the diagnostic evaluation, including your child’s pediatrician or a clinical psychologist. The same provider can usually write the referral.
If you already have a diagnosis report, share it with us before scheduling anything new. An older report may still work as long as it includes what Medicaid looks for.
Where Can Your Child Receive Medicaid-Covered ABA Therapy?
Maryland Medicaid pays for ABA therapy at home and in community settings, which includes a center when it’s medically necessary.9 The setting is written into your child’s treatment plan.
Many families like having both options. Home sessions let your child practice skills where daily routines happen. A center adds room to move and other children to learn alongside. Your BCBA will recommend the mix that fits your child’s goals.
Our Timonium center at 1306 Bellona Avenue has a sensory gym with a trampoline, a playroom with a climbing wall and craft stations for quieter activities. It’s a short drive from Towson, Cockeysville, Lutherville and Hunt Valley.
School is handled differently. Medicaid approves ABA therapy during the school day only in limited situations,10 so most families schedule sessions after school or at home.
Parent training has more flexibility. Medicaid allows it by video visit,11 which helps when work or younger siblings make it hard to travel.
How Do You Keep Medicaid Coverage Going Once Therapy Starts?
Two dates matter once therapy is underway.
The first is your child’s ABA authorization, which lasts up to 180 days.12 Before it ends, the BCBA reassesses your child and asks Carelon to approve the next period. You can help by attending parent training and telling the team what you’re seeing at home.
The second is your Medicaid renewal, which comes up every 12 months. Maryland sends a notice by mail or to your online account when it’s time. You can renew through Maryland Health Connection or by calling 1-855-642-8572.
Keep your address and phone number current so that notice reaches you. Tell your ABA provider, too, if your child’s Medicaid plan or ID number changes. A lapse in Medicaid can interrupt your child’s sessions, and restarting takes time.
Blue Gems ABA Works with Medicaid Families in Timonium
Using Medicaid for ABA therapy takes some paperwork, and the steps are manageable when someone guides you through them.
At Blue Gems ABA, our therapists support children on the autism spectrum at our Timonium center and in homes throughout Baltimore County. We work with Maryland Medicaid plans, and our insurance specialists handle the benefit check and authorization request for you.
To get started, call our Timonium team at (443) 656-9050 or contact us today.
Frequently Asked Questions
Does Maryland Medicaid cover ABA therapy in Timonium?
Yes. Maryland Medicaid covers medically necessary ABA therapy for eligible children and young adults under 21, including those living in Timonium.
Do I need an autism diagnosis before Medicaid will approve ABA therapy?
Yes. Maryland Medicaid requires documentation of an autism diagnosis and other clinical information before ABA services can be authorized.
Can my child receive Medicaid-covered ABA therapy at a center?
Yes. Maryland Medicaid allows medically necessary ABA therapy in home and community settings, including approved centers.
What happens if my child’s ABA authorization expires?
Your child’s provider must request continued authorization for services. Starting the reassessment and renewal process early can help avoid interruptions.
Can Blue Gems ABA help with Medicaid paperwork?
Yes. Blue Gems ABA helps families verify benefits, review documentation, and submit authorization requests for ABA therapy.
References
- Maryland Department of Health. Applied Behavior Analysis Program. Maryland Medicaid ABA Coverage.
- Maryland Department of Health. Behavioral Health Administrative Services Transition Report. View Report.
- Centers for Medicare & Medicaid Services. Early and Periodic Screening, Diagnostic, and Treatment. EPSDT Coverage.
- Maryland Department of Health. Maryland Medicaid ABA Provider Manual. ABA Provider Manual.
- Maryland Health Connection. How to Enroll in Medicaid. Medicaid Enrollment.
- Maryland Department of Health. Applied Behavior Analysis Program Administration. Maryland ABA Program.
- Maryland Department of Health. Medicaid Billing Rules and Patient Protections. Provider Billing Information.
- Maryland Department of Health. Maryland Medicaid ABA Provider Manual. Documentation and Authorization Requirements.
- Maryland Department of Health. COMAR 10.09.28, Applied Behavior Analysis Services. Maryland ABA Regulations.
- Maryland Department of Health. Maryland Medicaid ABA Provider Manual. Covered Services and Limitations.
- Maryland Department of Health. Maryland Medicaid ABA Provider Manual. Telehealth Requirements.
- Maryland Department of Health. Maryland Medicaid ABA Provider Manual. ABA Reassessment and Authorization.
