The number of children who are diagnosed with autism spectrum disorder (ASD) is rising every year. Over the last 20 years, the prevalence of autism has nearly tripled, in fact.

According to a 2021 U.S. Centers for Disease Control and Prevention study, the rate of autism increased from one in 125 people in 2004 (0.8%) to one in 44 people in 2021 (2.23%).

There are a number of reasons why this could be the case, from changes in the environment and diet, the fact that the average age of parents is increasing, or the simple fact that doctors and practitioners are getting better at identifying and diagnosing ASD.

The CDC report also pointed out that children who are diagnosed with autism by the age of 4 are 50 times more likely to receive the supportive services they need.

Today, one of the leading supportive services is called applied behavioral analysis. ABA therapy, as it’s better known, takes a science-based approach to learning, helping children build the communication and social skills they need to succeed in life.

Luckily, ABA therapy is prevalent across the country, which gives parents, caregivers and family members many options in regard to getting the supportive treatment their children need.

ABA therapy can be expensive, though, leaving many parents to wonder how they’re going to afford it — and whether insurance pays for it. Below, we’ll discuss those topics and more.

Does Insurance Pay for ABA Therapy?

There are two ways that ABA therapy services might be covered under insurance policies — either through a private insurance plan or through a state-provided Medicaid program.

Let’s discuss each separately.

Medicaid Coverage for ABA Therapy

Every state has its own Medicaid program, which allows each to create certain rules and regulations for not only what is covered under the program but also who is eligible. That being said, all have to follow the general rules that the federal government has set for Medicaid programs.

Generally speaking, Medicaid is catered toward people from lower income levels or who have limited resources. In some states, children may qualify for a Medicaid program even if their parents don’t.

Those who qualify for Medicaid will receive either full or nearly full coverage for preventative care services as well as ongoing support services such as ABA therapy.

Each state’s Medicaid program not only sets the requirements for qualification but also any limits on ABA therapy, in terms of providers and maximum coverage limits.

Across the board, Medicaid programs will require children to be officially diagnosed with ASD by a licensed healthcare provider before they can qualify for ABA therapy.

From there, what you need to do to qualify depends on your state’s Medicaid program.

Private Insurance Coverage for ABA Therapy

A majority of people in the country have private insurance coverage, whether that be through their employer or through one of the healthcare marketplaces. While autism support services weren’t a common thing to be covered under these plans as recently as 10 or 20 years ago, today, 200 million people enjoy health coverage for ABA therapy, thanks to many advocacy efforts by organizations such as Autism Speaks.

In recent years, states have taken a more active and hands-on role in regulating what private insurance companies must cover. These rules and regulations vary greatly from state to state, but fortunately, every state provides a mandate for at least some autism support service coverage.

At the same time, the benefits that are mandated do vary greatly from state to state. For example, ABA therapy isn’t explicitly covered under Indiana’s autism law, though it is in Utah — with nearly no limits on the amount of coverage in a year or a lifetime.

Much progress has been made in this arena in recent years, and an increasing number of states are expanding and extending coverage for autism services including ABA therapy every year.

If your child has been diagnosed with ASD and needs ABA therapy — or if you want to get your child evaluated for autism — check your state’s insurance laws and what your insurance plan must cover.

Get the Best ABA Therapy for Your Child

All parents want what’s best for their children, in all situations. At Blue Gems ABA, we approach all of our patients with that same thought in mind.

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

Our team of dedicated and experienced clinical psychologists conduct autism evaluations every day, and our BCBAs develop personalized ABA therapy programs that fit each child’s unique needs.

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

For more information, please contact us today.