Does Insurance Pay for ABA Therapy in Missouri?

Part of the Insurance Guide for ABA Therapy

The prevalence of autism is increasingly seemingly every year in the United States. A 2021 study conducted by the U.S. Centers for Disease Control and Prevention, for instance, found that the rate of autism diagnoses among children increased substantially from 2024, from 0.08% (one in 125) to 2.23% (one in 44).

According to the report, children who receive a diagnosis of autism spectrum disorder (ASD) by 4 years old are 50 times more likely to receive the supportive services that their diagnoses requires.

Today, applied behavioral analysis, or ABA therapy, is the leading treatment for children with ASD. Using a science-based approach to learning, ABA therapy can help children build the communication and social skills they need in life.

ABA therapy in Missouri is available throughout the state, which gives parents and caregivers plenty of choice to get the appropriate treatment their children need.

That being said, ABA therapy can be expensive, prompting many parents and caregivers to question whether insurance pays for ABA therapy in Missouri. We’ll discuss this topic below.

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Missouri Medicaid Coverage for ABA Therapy

In Missouri, Medicaid provides coverage for ABA therapy through MO HealthNet. This is because it’s widely recognized as a treatment that’s based in evidence to help children who have autism.

Eligibility

Those who wish to receive ABA therapy coverage under Missouri Medicaid must meet certain criteria. First, a child must be diagnosed with ASD by a healthcare professional, including a neurologist, child psychologist or developmental pediatrician, for instance.

Children in Missouri can be covered for ABA therapy under Medicaid up to a certain age. The Medicaid program in the state prioritizes early intervention programs for children with ASD.

Medicaid in the state typically also requires different documentation for a child to be considered for coverage. This includes a comprehensive evaluation and Medicaid insurance coverage.

After Medicaid reviews the application, it will determine whether the child is eligible for coverage for ABA therapy, as well as whether there are any restrictions on that coverage, such as limiting the number of sessions or hours per week that are allowed.

Is ABA Therapy Covered Under Other Insurance Plans in Missouri?

Missouri lawmakers passed two separate bills in 2010 — HB 1311 as well as HB 1341 — which both went into effective at the start of 2011. Then, in 2019, the state Legislature passed another bill, SB 514, that expanded coverage to those who have developmental and physical disabilities.

In Missouri, the autism insurance law applies to fully insured large group plans, individual non-grandfathered plans and fully insured small group plans. A mandated offering is also required of all individual grandfathered plans.

While the law in Missouri doesn’t require private insurers to provide coverage for autism treatment in individual plans, but it does require that all insurers offer the coverage. In other words, Missouri requires that all insurers include a “mandated offering.”

ABA therapy is included under the law, in the habilitative or rehabilitative care category. Other services that are covered under Missouri’s autism insurance law include diagnosis, pharmacy car, psychiatric care, psychological care and therapeutic care such as physical, occupational and speech therapy.

Getting the Best ABA Therapy in Missouri for Your Child

If you’re a parent or caregiver of a child with autism, you only want what’s best for them. At Blue Gems ABA, we feel the same way, and it’s reflective in how we approach every patient.

We strive to always help children thrive and grow by helping them improve their communication, social and adaptive skills. We truly believe that children who are diagnosed with ASD can lead a fulfilled life that is happy, productive and not defined by their special needs.

Our team of dedicated and experienced BCBAs develop personalized therapy programs to fit each child’s unique and personal needs.

We accept most insurance plans in Missouri and in our Kansas City ABA Location, helping to reduce the cost of ABA therapy for you.

For more information, please contact us today.