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Does Insurance Pay for ABA Therapy in Nebraska?

An increasing number of children are being diagnosed with Autism spectrum disorder (ASD) every year. A report issued by the U.S. Centers for Disease Control and Prevention in 2021, for instance, highlighted that the prevalence of autism had increased more than twofold from 2004 — from one in 125 people to one in 44.

Among the other findings in the report was the fact that children who receive an autism diagnosis by the age of 4 are 50 times more likely to receive associated services.

Today, one of the most effective treatments for autism in children is known as applied behavior analysis, or ABA therapy. Using a science-based approach to learning, ABA therapy helps children with ASD improve their communication and build the skills they need to succeed in life.

While ABA therapy in Nebraska is prevalent throughout the state, many parents question how they are going to afford to pay for it. To that point, many people question whether insurance pays for ABA therapy in Nebraska.

Learn more about how much ABA therapy costs

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Nebraska Medicaid Coverage for ABA Therapy

Nebraska Medicaid provides coverage for ABA therapy treatment for individuals who are diagnosed with autism. To that end, the plan considers ABA therapy to be a covered benefit.

The coverage that’s included provides families with access to the behavioral treatment plans they need to help them improve communication, develop skills they need and improve their quality of life.

The program is funded by both the state and federal government, and is available to families who meet certain criteria, including income requirements. There are multiple ways to qualify for Nebraska Medicaid, so check out the program’s website for more information.

Eligibility

To receive ABA therapy as a covered service under Nebraska Medicaid, individuals have to meet eligibility criteria. This includes being diagnosed with ASD and meeting age requirements.

Nebraska, Medicaid requires individuals or families seeking coverage for ABA therapy to obtain prior authorization. This means they need approval before starting treatment to ensure it’s covered by insurance. As part of this process, they must provide documentation, such as a comprehensive evaluation from a qualified healthcare professional, confirming the diagnosis. This documentation serves to demonstrate that the therapy is medically necessary for the patient, thus facilitating the authorization process.

You may also need to submit other supporting documentation as you apply.

Is ABA Therapy Covered Under Other Insurance Plans in Nebraska?

Under state law, Nebraska requires that “meaningful coverage for autism” be provided by all state-regulated plans. The autism insurance bill in Nebraska was passed in 2014 and went into effect in 2015.

The law applies to all individual grandfathered plans, all fully insured large group plans, and all fully insured small group grandfathered plans. It does not, however, apply to individual non-grandfathered plans or to fully insured small group non-grandfathered plans.

Under the law, services that are covered include autism diagnosis, pharmacy care, psychiatric care, psychological care, therapeutic care and behavioral health treatments, which includes ABA therapy in Nebraska.

Nebraska’s law states that the coverage is limited only to individuals who have autism and are less than 21 years of age.

The Autism Legal Resource Center provides a wealth of additional information about insurance coverage for autism in Nebraska and all other states in the U.S.

Getting the Best ABA Therapy in Nebraska for Your Child

As the parent of a child with autism, you only want what’s best for them. That’s the same way we approach everything we do at Blue Gems ABA. Our mission is to help children grow and thrive by improving communication, social and adaptive skills.

We believe children with autism can lead a happy and productive life that is not defined by special needs. Our team of dedicated and experienced BCBAs develop programs that fit each child’s specific needs.

Our 4 Nebraska locations aim to help every child dealing with the challenges of autism:

  1. Omaha NE ABA Clinic
  2. Omaha NE In-Home ABA
  3. Lincoln NE In-Home ABA
  4. Autism Diagnosis in NE

We accept most major insurances in Nebraska, which can help to reduce the cost of ABA therapy to you. For more information on what we do and how we can help your child, please contact us today.

Learn More About Insurance Coverage for ABA Therapy