Applied Behavior Analysis (ABA) is one of the frequently prescribed therapies for people with autism. Private insurance began covering ABA therapy in 2011, under a Massachusetts law known as ARICA. Following passage of the Autism Omnibus Bill in 2014, MassHealth began covering ABA in 2015.
How does someone access coverage?
How long will this process take?
Are there limitations on coverage?
Are Social Skills Groups covered?
My child receives ABA through Early Intervention (EI) – are they eligible?
My child receives ABA through Early Intervention (EI) – what happens when they turn 3?
I have private insurance, but it doesn’t cover ABA. Can I get ABA through MassHealth?
I have private insurance and CommonHealth. Will MassHealth cover my co-pays for ABA?
How are education services under my child’s IEP affected?
Can I also apply for the Children’s Autism Medicaid Waiver?
I am an ABA therapist and want to provide services through MassHealth. What should I do?
ABA is available to children diagnosed with autism under 21 enrolled in MassHealth Standard and CommonHealth; and to children under age 19 enrolled in MassHealth Family Assistance.
How does someone access coverage?
The child’s clinician (usually a developmental pediatrician, neurologist, psychologist), recommends ABA. The family then locates an ABA provider through their MassHealth Managed Care Entity (MCE). Depending on your MCE, ABA may be covered through another plan- see below:
| Managed Care Entity (MCE) | ABA covered through: |
|---|---|
| Mass Behavioral Health Partnership (MBHP) | Mass Behavioral Health Partnership (MBHP) |
| Health New England (HNE) | Mass Behavioral Health Partnership (MBHP) |
| BMCHP | Beacon Health Options |
| Fallon Community Health Plan | Beacon Health Options |
| Neighborhood Health Plan (NHP) | Beacon Health Options |
| Tufts Health Public Plans | Tufts Health Public Plans |
The provider requests authorization for ABA from MassHealth, performs an initial evaluation, and develops a treatment plan.
How long will this process take?
The length of time to access services is dependent on how long it takes to locate a provider with availability, how long it take them to complete the initial evaluation and receive authorization for the treatment plan. Families should ask specific providers they are thinking of using for an estimate of how long it might take to start services.
Are there limitations on coverage?
Coverage is based on the plan’s medical necessity criteria. There are no annual or lifetime dollar or unit of service limitations on coverage.
Are Social Skills Groups covered?
Yes, subject to medical necessity criteria.
My child receives ABA through Early Intervention (EI) – are they eligible?
Children receiving In-Home Behavioral Services or services similar to ABA in Early Intervention (EI) would be eligible for this coverage if they meet medical necessity criteria, as long as they are not receiving duplicative services through EI.
My child receives ABA through Early Intervention (EI) – what happens when they turn 3?
If your child is receiving ABA in EI, MassHealth will cover ABA after they turn 3 if they meet medical necessity criteria. We recommend you start working with your team as early as possible to make sure access to ABA continues after your child turns 3.
I have private insurance, but it doesn’t cover ABA. Can I get ABA through MassHealth?
Yes, as long as your child is also enrolled in MassHealth (usually CommonHealth). Information about CommonHealth and how to enroll can be accessed by contacting the Center. MassHealth CommonHealth Fact Sheet (pdf)
I have private insurance and CommonHealth. Will MassHealth cover my co-pays for ABA?
MassHealth may cover the co-pays, but it is dependent on your provider’s contracts with MassHealth. We recommend checking with your provider, and contacting us if you need additional assistance.
I purchased a plan from the Health Connector that covers my child’s ABA therapy. Do I need to cancel this plan?
No. You are not required to cancel your Connector plan. However, it is your option to cancel your Connector plan and access ABA through MassHealth.
How are education services under my child’s IEP affected?
This coverage should not affect your child’s IEP services.
Can I also apply for the Children’s Autism Medicaid Waiver?
Families covered by MassHealth with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through DDS. But if your child receives In-Home Behavioral Services through this program, he or she will not also be able to access ABA directly through MassHealth until after they transition out of the program.
I am an ABA therapist and want to provide services through MassHealth. What should I do?
Providers should contact the Managed Care Entities who are administering the ABA benefit through MassHealth: MBHP, Beacon Health Strategies and Tufts/Network Health
For more information or assistance, please contact our Center at 774-455-4056 or e-mail us at AIRC@umassmed.edu.
