, ,

Does Insurance Pay for ABA Therapy in Arizona?

Part of the Insurance Guide for ABA Therapy

Over the last 20 years, autism in children has been diagnosed at a higher rate than ever.

In 2021, the U.S. Centers for Disease Control and Prevention conducted a study that found the prevalence of autism in children increased from one in 125 people in 2004 (a rate of 0.08%) to one in 44 (2.23%).

There are many different reasons why this could be so, including the fact that medical professionals are better at identifying the signs and symptoms of autism and related developmental disorders.

At the same time, studies have proven that the earlier children are diagnosed with autism, and receive related treatments for it, the more successful the outcomes are.

This is supported by that same CDC study, which found that children who receive a diagnosis of autism spectrum disorder (ASD) by the age of 4 are 50 times more likely to receive supportive services.

Applied behavioral analysis, or ABA therapy, is a leading treatment for autism today. The science-based approach to learning helps children build the social and communication skills they need to succeed.

Luckily, ABA therapy in Arizona is widely available, providing parents, caregivers and family members a choice when they’re searching for the best treatment for their child.

As ABA therapy can be expensive, many parents question whether insurance pays for ABA therapy in Arizona. We’ll discuss that topic in further depth below.

Table Of Contents

Arizona Medicaid Coverage for ABA Therapy

Arizona Medicaid programs provide coverage for eligible individuals to receive ABA therapy. The program is jointly run by the state and federal government, offering medical coverage for families and individuals who meet certain income qualifications.

There are two separate Medicaid programs in Arizona, and each has its own eligibility requirements for all services.

The Arizona Health Care Cost Containment System, or AHCCCS, provides coverage for ABA therapy for individuals who are diagnosed with ASD. The KidsCare program might also provide ABA therapy coverage to children who have ASD.

Eligibility

Children who are 21 years old and younger can receive ABA therapy that’s covered by the Arizona Medicaid program. In all, the program covers additional services including physical, speech and occupational therapy.

To be considered eligible under the Medicaid program, you and/or your child must first meet the eligibility criteria under one of the state’s two programs. If you are unsure, the best thing to do is to reach out to the AHCCCS office directly.

If you’re eligible for Medicaid coverage, the next step is providing them with proof of a formal ASD diagnosis for your child, as well as a statement of medical necessity for the ABA therapy.

When going for an autism evaluation, the therapist and/or facility that you choose for your child must be qualified and licensed, and must be enrolled in Arizona’s Medicaid program. The therapist must provide Medicaid with a detailed plan of action for the ABA therapy as part of the application process.

Once approved, your child can receive as many as 40 hours of ABA therapy per week through the Medicaid program in Arizona.

Is ABA Therapy Covered Under Other Insurance Plans in Arizona?

In early 2008, Arizona lawmakers passed the state’s autism insurance bill. Known as HB 2847, the bill requires all insurance carriers to provide meaningful coverage for autism services.

The law went into effect on June 30 of 2009.

According to the bill, all state employee health plans, individual plans subject to the Affordable Care Act (ACA), all fully insured large group plans and all fully insured small group non-grandfathered plans are subject to the requirements.

Any individual plan specifically exempt from the ACA, as well as all fully insured small group grandfathered plans, are not subject to it.

In addition to behavioral therapy services, Arizona’s autism insurance law also covers an ASD diagnosis.

ABA therapy is included under the law. To qualify, individuals have to be less than 17 years old and be officially diagnosed with ASD. Children who are under the age of 9 qualify for up to $50,000 per year in ABA therapy treatments. Children who are between 9 and 16 years old qualify for up to $25,000 per year in ABA therapy treatments.

Getting the Best ABA Therapy in Arizona for Your Child

As a parent, you want what’s best for your child. At Blue Gems ABA, we only want the best for them to.

We know how important it is that we treat your child exactly how you would want them to be treated — with great care and supported in all ways we can.

Every day, we strive to help children grow and thrive by improving their adaptive, social and communication skills. We wholeheartedly believe that children with autism can lead happy and productive lives that aren’t defined by their special needs.

We have a team of dedicated, experienced and licensed BCBAs who develop personalized ABA therapy programs for every child with whom we work.

We accept most insurance policies in Arizona, helping to reduce the overall cost of ABA therapy.

For more information, please contact us today.

Learn More About Insurance Coverage for ABA Therapy