Will insurance pay for ABA in my child's private school?

There is no hard and fast rule for medical insurance, especially Medi-Cal, to cover ABA therapy that takes place at school.

The primary responsibility for behavioral support is on the school district. If the district isn’t paying for the private school, then parents could maybe argue for Medi-Cal to pay for ABA. However, if the private school is funded by the district, then the ABA should be too. Part of the issue here is that Medi-Cal and private insurance are paying for medically necessary services while school services are to access the curriculum. Medi-Cal won't provide educationally related benefits, so it may be helpful to focus the purpose of the ABA on health and safety and not curriculum/school. Families can submit and see what Medi-Cal says; if Medi-Cal denies it, they can try appealing, but school support is not something insurance will typically do.

The ABA provider should be able to submit billing to Medi-Cal when there is a denial from primary insurance, or if primary pays some then Medi-Cal should pay the difference.

According to DHCS All Care Plan 23-010 page 5, where it’s not included in the IEP, the managed care plan should be coordinating medically necessary ABA regardless of setting.

This might count as custodial care if it’s for safety and could be done by a non-ABA provider. Different school districts and health plans will do things differently, so you may want to work with an attorney or advocate to figure out a solution.

Find more information about funding ABA in our article Common Behavioral Interventions and Therapies (and How to Fund Them).