Does Insurance Pay for ABA Therapy in Georgia?

Part of the Insurance Guide for ABA Therapy

There is a big debate about why it is so, but there’s no denying the fact that autism in children is increasing every year. According to a study conducted in 2021 by the U.S. Centers for Disease Control and Prevention, the prevalence of autism more than double from 2004, increasing from a rate of 0.08% (one in 125 people) to 2.23% (one in 44).

Children who are diagnosed with autism spectrum disorder (ASD) can live very fulfilling lives, but they often need additional supportive services that typically-developing children don’t.

The CDC report highlighted that children who are diagnosed with autism by 4 years old are 50 times more likely to receive these important services.

Today, one of these leading services is applied behavioral analysis. Known as ABA therapy, it is a science-based approach to learning that helps children build communication and social skills that are necessary for them to succeed in life.

With ABA therapy in Georgia being widely available, parents, caregivers and family members can choose the right treatment at the right facility for their child.

This therapy can often be expensive, though, prompting many to question whether insurance pays for ABA therapy in Georgia.

Below are all the details to answer that question, and more.

Table Of Contents

Georgia Medicaid Coverage for ABA Therapy

Unlike some other states, Georgia offers three types of Medicaid programs.

Medicaid for Families and Children is for families who have children under 19 years old and provides services including prescriptions drugs, doctor’s visits and hospital care.

Aged, Blind and Disabled Medicaid provides similar services but is catered toward individuals who are older, are blind or have a certified disability. It also provides other services such as long-term care in a nursing home.

Georgia Medicaid also includes a Community Care Services Program that provides support services so people can remain in their homes.

All three Medicaid programs have specific eligibility requirements, based on factors such as income. All three also provide coverage for ABA therapy.

Eligibility

Eligibility for ABA therapy under Medicaid in Georgia is based on a few factors.

First, your child will need to be formally diagnosed with ASD and receive a recommendation that ABA therapy is medically necessary for them.

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

If approved, Georgia Medicaid programs will provide coverage for ABA therapy of up to 40 hours per week for children under the age of 6, and up to 25 hours per week if they’re older than that.

Is ABA Therapy Covered Under Other Insurance Plans in Georgia?

The state of Georgia passed Ava’s Law in 2015, the first major step in having certain therapies covered for people with autism. A few years later, SB 118 was signed into law, which increasing coverage limits for ABA therapy.

Georgia’s autism insurance law applies to individual grandfathered plans, fully insured large group plans and fully insured small group grandfathered plans. Individual non-grandfathered plans and fully insured small group non-grandfathered plans are not subject to the law.

The law states that all applicable insurance plans must cover the diagnoses and treatment of ASD; rehabilitative or habilitative services (including ABA therapy); counseling that’s provide by a clinical social worker, professional counselor, or licensed psychologist or psychiatrist; and physical, occupational and speech therapy.

These services are available to individuals up to the age of 21. There is an annual cap on ABA therapy coverage of $35,000.

Getting the Best ABA Therapy in Georgia for Your Child

All parents want the best for their children, whether or not they’re diagnosed with autism. At Blue Gems ABA, we know how important it is that your child is taken care of and supported in all ways.

We strive every day to help children thrive and grow by improving their communication, social and adaptive skills. We believe wholeheartedly that children who have autism can lead lives that are happy and productive — and not defined by their special needs.

Our dedicated team of experienced and licensed BCBAs develop a personalized ABA therapy program for each and every child with whom we work.

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

For more information, please contact us today.