How can I fund ABA services for my child in California?

ABA services can be expensive when paid for out of pocket. Luckily, according to Disability Rights California, multiple funding options are available for families. These include:

Private insurance

• In 2012, Governor Jerry Brown signed Senate Bill 946 into law, requiring that private insurance in California cover behavioral health services for children with autism or other “pervasive developmental disorders.” ​​​​​​
  • The law applies to plans classified as commercial but does not apply to all employer-based plans. ​​​​​​
• To receive coverage, your child will need a prescription from their doctor or psychologist who has determined that ABA is medically necessary.​​​​​​
• If you have insurance through your employer that is self-insured or self-funded, ABA services may not be covered. Contact your Human Resources Office or your plan’s member services department to see if your plan will cover behavioral health services.
  • Undivided’s Director of Health Plan Advocacy, Leslie Lobel, tells us that some families buy a secondary private individual plan just for their child to access ABA funding if their primary insurance is a self-insured plan.
• Your insurance provider must process your claim within thirty days. If you are denied coverage, you can submit an appeal through your member services department.

Medi-Cal​​​​​​

• Medi-Cal will cover behavioral health services under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Medicaid benefit for beneficiaries under twenty-one years old.
• To receive coverage, your child will need a prescription from a doctor or psychologist who has determined that ABA is medically necessary.
• The process will look different depending on the child’s Medi-Cal plan. According to California’s Department of Health Care Services, “Fee-for-Service (FFS) beneficiaries who are eligible for Regional Center services receive BHT services coordinated through their local Regional Center.” However, a new program called CalAIM will soon require that recipients with FFS Medi-Cal enroll in a managed care plan (for people with SSI-linked Medi-Cal, this change will happen on January 1, 2022). You can read more about this important change here.
• Beneficiaries already enrolled in a Medi-Cal managed care plan will receive services through their plan.
• If your child has dual coverage, ABA services will be primarily funded through the private plan; however, Medi-Cal can be used to offset other costs, such as copayments.
• If ABA services are denied or changed and you disagree with the decision, you can request a Fair Hearing.

Regional Center

• Regional Center is a payer of last resort, but may fund ABA services if you receive a rejection from private insurance or Medi-Cal.​​​​​​​
• Your Regional Center can also coordinate services and provide evaluations and assessments at no cost to those who are eligible.

Your child’s school​​​​​​​

• If your child requires ABA to receive a free, appropriate public education (FAPE), the service can be written into your child’s IEP.