Does Insurance Pay for ABA Therapy in Maryland?

Part of the Insurance Guide for ABA Therapy

Every year, the number of children who are diagnosed with autism spectrum disorder, or ASD, rises. A 2021 U.S. Centers for Disease Control and Prevention study reported that the prevalence of autism nearly tripled from 2004, going from one in 125 people (0.8%) to one in 44 (2.23%).

The report also pointed out that children who are diagnosed with autism by the time they’re 4 years old are 50 times more likely to receive supportive services for their diagnosis.

Luckily, there are treatment options for children with autism, including ABA therapy, a science-based approach to learning. ABA therapy helps children build social and communication skills that they need to succeed in life.

ABA therapy in Maryland is prevalent throughout the state, giving parents, caregivers and other family members a lot of choice when it comes to getting the treatment for their children.

But, a main question you might have is whether insurance pays for ABA therapy in Maryland. We’ll dive deeper into that topic below.

Learn more about ABA Therapy in the state of Maryland

Table Of Contents

Maryland Medicaid Coverage for ABA Therapy

Maryland Medicaid provides coverage for ABA therapy treatment for all people under the age of 21 who qualify. This is provided under its EPSDT services, also known as Early and Periodic Screening, Diagnostic and Treatment.

In addition to ABA therapy, this section of the state’s Medicaid program provides appropriate coverage for specialty, developmental, mental health, dental and preventative health services. ABA therapy is considered a medically-necessary service under this area of state law for any child who is diagnosed with ASD.

Eligibility

To be covered under Maryland Medicaid for ABA therapy treatment, a qualified healthcare provider must diagnose a child with ASD through a comprehensive evaluation. Next, ABA therapy must be recommended for the child as a treatment plan.

The ASD assessment can be conducted by a primary care provider or a specialist. This evaluation process will also outline that the child needs ABA therapy as a result of the diagnosis.

The assessor and/or ABA therapy provider must then provide Medicaid with a treatment plan for the therapy, which includes specific goals as well as how long the therapy is expected to last.

Medicaid will then consider the application for approval and, if approved, pay for the therapy sessions. Maryland Medicaid says that these sessions can be held in the child’s home, in a clinical setting or somewhere else in the community.

Is ABA Therapy Covered Under Other Insurance Plans in Maryland?

In 2021, Maryland passed Autism Insurance Reform, which changed the Habilitative Services Mandate that was already on the books.

Under the new changes, all individual plans, fully insured large group plans and fully insured small group plans must abide by the regulations contained in it. There are no insurance plans that are exempt from the state’s autism insurance law.

Under the law, no treatment for behavioral health can be denied on the basis that it’s considered “investigational” or “experimental.” This includes ABA therapy.

Other services that are covered under this law psychotherapy, psychological care, direct services, consultative services, physical therapy, speech therapy and occupational therapy.

The Maryland Insurance Administration further set no limits or caps for ABA coverage in the state. Instead, it established a floor for the ABA coverage.

Under this floor, carriers aren’t able to deny services based solely on how many hours of ABA therapy are prescribed. The amount of hours varies depending on how old the child is, and they are consistent with a report issued by the Autism Technical Advisory Group.

Getting the Best ABA Therapy in Maryland 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.

We strive every day 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 Maryland, 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