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ABA Therapy That Accepts Medicaid Near Me

We have you covered. CrossRiverTherapy accepts Medicaid for all of our autism therapy services, whether it's at-home, our clinic, or online.

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aba therapy covered by medicaid

We accept most insurance plans

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CrossRiverTherapy is a Medicaid Provider

We're proud to provide ABA therapy services covered by Medicaid for children ages 1-21.

From the beginning, our mission has always been to provide high-quality care to children diagnosed with autism.

To make this goal a reality, we participate in Medicaid in every state we serve. CrossRiverTherapy's autism treatment services come at no extra cost if your child's Medicaid plan covers them.

Our team is there to guide you through the insurance process, as your eligibility for Medicaid coverage can change.

our medicaid partners
crossrivertherapy is a medicaid provider

Our Medicaid Partners

At CrossRiverTherapy, we work with all traditional state Medicaid plans and most managed care partners.

We are always expanding our relationships and partnerships. Here is a sample of our partners that cover autism therapy:

  • Medicaid North Carolina
  • Medicaid Mutual
  • Alliance Health
  • Anthem
  • Arizona Complete Health
  • CareSource
  • MercyCare
  • Passport Health Plan
  • WellCare Health Plan
  • MDWise
  • Banner University Family Care
medicaid tips to maximize coverage

Tips For Utilizing Medicaid Coverage For ABA Therapy

At Cross River Therapy, we want you to know the ins and outs of using Medicaid to cover the costs of ABA. It's important to be responsive when it comes to healthcare coverage.

Whether your healthcare-related correspondence comes from CrossRiverTherapy, Medicaid, or your insurer, it's important to be on the lookout for the most cost-effective insurance plans.

Caregivers will remain responsible for the cost if circumstances should change and your Medicaid eligibility changes. We recommend caregivers renew Medicaid immediately upon receiving it in the mail.

As a parent, it's your job to keep your child engaged in the therapy to ensure they will not have any breaks in insurance coverage.

Not only is participation crucial to your child's success and development during ABA, but state Medicaid plans review their attendance. If your child's attendance appears low, it will impact the number of hours they will be allowed to receive therapy.

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What is Medicaid?

Medicaid is a federal program meant to help people who need health care but can't afford to pay it. If your family meets financial guidelines, you could quality right away.

However, if you don't, then you may need to provide proof that one family member has a disability that qualifies them for Medicaid insurance coverage for ABA therapy.

If you're accepted into the Medicaid insurance coverage program, you can get financial assistance for the treatments you or your child needs. 

Medicaid is considered a good form of insurance, and people with Medicaid are able to get coverage equal to or better than what private programs offer.

However, there are some disadvantages to using Medicaid compared to other insurance providers that you should know about as you consider if it's the right provider for your family.

How Does Medicaid Work?

Medicaid can be understood as a project that's shared by federal and state governments. They both contribute money to keep the project going, and both have a say in how the money is used.

Medicaid is based on two guarantees:

  1. Coverage - People who meet financial requirements will get help.
  2. Funding - States pay for qualified services for people who are eligible for Medicaid insurance coverage. The money spent by the states get matched by the federal government. Certain states get a 50/50 match, and others get more or less.

States have the ability to:

  1. Determine what things are covered
  2. Set limits on other types of care

And they must cover certain mandatory populations, including:

  1. Children from low-income families up to age 18
  2. Pregnant women from low-income families
  3. Caregivers or parents from low-income families
  4. Individuals with disabilities or seniors who receive financial assistance through the Supplemental Security Income (SSI) program.

In general, it's important that you must use providers that accept payments from Medicaid. Keep in mind that not all doctors, hospitals, and health clinics are able to accept that form of insurance.

Therefore, if you go further than the network Medicaid uses, you could be stuck in a situation where some or all of the bill needs to paid out of pocket. Now that you know how Medicaid works, you'll now learn about how to apply.

Read More: Financial Assistance For Autism

How to Apply for Medicaid

ABA therapy is the gold standard of treatment for people diagnosed with autism.

As a parent, you might enroll in Medicaid to pay for that care, which can cost $120 per hour if paid out of pocket. There is a gray area for families to have ABA covered in some states.

Therefore, you should confirm that a particular type of therapy is covered by Medicaid before you commit.

Doing so will help prevent financial hurtles in the future.

To apply for Medicaid in your state, choose one of the two methods listed below, which are recommended by The Centers for Medicare and Medicaid Services to use:

  1. The Health Insurance Marketplace. This is the website families use to purchase insurance. It comes with subsidies from the federal government, and it's an online application where you must answer several questions. You will find out right away if you qualify.
  2. Your state Medicaid agency. Some families might be uncomfortable using computers to fill out important forms, and if that's the case, you should contact the Medicaid agency in your state. Meet with a qualified expert to discuss your eligibility for insurance coverage.

Warning: Be careful when applying for Medicaid, because if you qualify, you can't decline the offer and ask for subsidized health insurance. Insurance experts say that the program doesn't work that way.

Overall, applying for Medicaid should be a straight-forward process if you follow these steps, and your family will receive significant financial assistance from the insurance provider if you qualify.

How Do States Use Medicaid for Applied Behavior Analysis?

Coverage varies widely depending on which state you live in. Here's a breakdown of how a few states deal with requests to cover autism therapy:

  1. North Carolina: The Medicaid authority in North Carolina recognizes that ABA could be right for some people, but the organization states that some people could benefit from other forms of treatment. Therefore, in this state, coverage isn't guaranteed.
  2. Texas: In 2019, the governor signed a budget bill that mandated Medicaid coverage for ABA therapy, including other forms of autism care.
  3. Washington: Here, ABA therapy is covered by Medicaid for people ages 2-20.
  4. Utah: In this state, there are available ABA benefits. However, they must be provided by someone who is specifically trained to provide autism treatment.

There is a comprehensive list of all state offices on medicaid.gov. For more information on how ABA therapy is covered in your state, you can contact the department in your state.

Medicaid Limitations

Here are the most common limits when using Medicaid as your insurance provider:

  1. Denials - The plan won't cover therapies that aren't delivered by a certain type of professional, or your state may cover only one type of treatment for autism.
  2. Political battles - Treatment providers must accept Medicaid payments, but sometimes, families aren't able to find anyone to care for their autistic children because of the low reimbursement rates offered by Medicaid.
  3. Age limits - Once people celebrate their 21st birthday, most benefits we've discussed end. Even when adults still qualify for Medicaid, they don't have access to comparable programs as children ages 1-21 do.

Medicaid Benefits For Autism Therapy

To conclude, insurance coverage through Medicaid is worthwhile and beneficial for qualifying families. The biggest benefits of coverage your family could experience are:

  1. Family members can return the workforce, which could give your family a big economic boost.
  2. Family members can receive good health care.
  3. Family members with Medicaid coverage have a lower risk of paying large out-of-pocket expenses compared to people with private insurance coverage.

Find More ABA Therapy Insurance Articles

Insurance Coverage For ABA Therapy
Financial Assistance For Parents Of Autistic Children
ABA Therapy That Accepts Medicaid
Does Aetna Cover ABA Therapy?
Does Anthem Cover ABA Therapy?
Does United Healthcare Cover ABA Therapy?
Does Cigna Cover ABA Therapy?
Does Blue Cross Blue Shield Cover ABA Therapy?

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Frequently Asked Questions

Does Medicaid cover ABA therapy?

Yes, as of February 2022, all 50 states have implemented their Medicaid autism treatment coverage.

How much does ABA therapy cost without Medicaid?

ABA therapy costs around $120 per hour. This seems like a lot at first glance, but most insurance plans will cover this therapy, so the cost can largely be decreased by insurance coverage.

How much does Medicaid pay for ABA therapy?

The amount of coverage Medicaid gives varies based on your location and qualifications. However, most insurance plans, including Medicaid, will cover the cost of ABA therapy.

Does Medicaid cover autism evaluation?

Yes, if you qualify for Medicaid, your family could get financial assistance for autism evaluation services.