Does Insurance Pay for ABA Therapy in Utah?

Part of the Insurance Guide for ABA Therapy

The prevalence of autism throughout the country is on the rise. The U.S. Centers for Disease Control and Prevention reported in 2021 that the rate of autism increased from one in 125 people in 2004 to one in 44 in 2021 — a major jump from a rate of 0.8% to 2.23%

The report also highlighted that children who receive an autism spectrum disorder (ASD) diagnosis by the age of 4 are 50 times more likely to receive the essential supportive services they need.

Today, the leading treatment for ASD is known as applied behavioral analysis, or ABA therapy. It’s a science-based approach to learning that helps children build social and communication skills that they need to be successful.

Luckily, ABA therapy in Utah is prevalent around the state, which gives parents, caregivers and family members plenty of choice to get the treatment their children.

While ABA therapy can be expensive, there are some options for insurance coverage in Utah. We provide more details on how it’s covered in the state below.

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Utah Medicaid Coverage for ABA Therapy

Utah Medicaid provides coverage for ABA therapy to those who qualify under its CHEC program. Known as the Child Health Evaluation and Care program, it covers children up to the age of 21 as long as they and their family meet certain conditions.

The program provides preventative dental and medical care for children who are on Medicaid. CHEC’s main focus is providing typical medical services for children that their parents may otherwise not be able to afford.

Utah uses the same CHEC criteria to determine whether an individual would qualify for ABA therapy through its Medicaid program.

Eligibility

To have ABA therapy covered under the Medicaid program in Utah, a child must be formally diagnosed with ASD by a licensed healthcare provider. The process will not only diagnose your child but will also outline that the child needs ABA therapy as a result of the diagnosis.

This information must be presented to the Medicaid program before it will provide coverage. Then, the ABA therapy in question must be provided by a licensed and certified ABA therapist and/or facility who is enrolled in the state’s Medicaid program.

Is ABA Therapy Covered Under Other Insurance Plans in Utah?

Utah first passed its autism insurance bill, known as SB 57, in 2014. However, that law was quite restrictive both in terms of the ages that insurance plans had to provide coverage for, as well as how many hours of ABA therapy were allowed on an annual basis.

Only children between 2 and 10 years old qualified for coverage, and they could only receive 600 hours of ABA therapy per year, which equated to roughly 11.5 hours each week.

In 2019, though, the state passed SB 95, which eliminated those caps on age and hours.

Today, the state’s autism insurance law covers all individual plans and fully insured large group plans. Fully insured small group plans are not subject to the law.

Under the law, these insurance plans must cover a diagnosis of ASD, as well as pharmacy, psychiatric and psychological care. In addition, insurers must cover ABA therapy and other behavioral health treatments, as well as physical, occupational and speech therapy.

As mentioned, there is no cap on coverage in Utah.

Getting the Best ABA Therapy in Utah for Your Child

Parents of children with autism only want what’s best for them. At Blue Gems ABA, that’s the same way we approach all of our patients.

Every day, we strive to help children grow and thrive by improving their adaptive, social and communication skills. We wholeheartedly believe that children with ASD can lead a life that is productive, happy and not defined by their special needs.

We have a team of experienced and dedicated BCBAs who develop personalized ABA therapy program that fit each child’s unique needs.

At Blue Gems ABA, we accept most insurances in Utah, which can help to reduce the cost of ABA therapy for you.

For more information, please contact us today.

Learn More About Insurance Coverage for ABA Therapy