State Mandate for Insurance Coverage of ABA Treatment
Many states across the nation now have mandates for employers and insurance plans to cover services for individuals with autism including ABA. Here is a little information on the state mandate in Texas:
(2007) House Bill 1919 was passed that required insurance plans in Texas recognize autism spectrum disorders and covers services related to autism spectrum disorders up to the age of seven.
(2009) House Bill 451 was passed that expanded the mandate to include services for autism spectrum disorders up to the age of ten.
(2013) Senate Bill 1484 removed the age cap from the mandate in Texas.
Important Information about Your Health Plan
Not all plans fall under state mandates to cover services for individuals with autism as not all plans are regulated by the state mandate. You need to know if your company’s health plan is considered fully funded or self-funded. You can typically find this information by contacting your company’s human resources department.
Only fully funded plans fall under the state mandate as self-funded plans fall under federal law. At this time there is no federal mandate for coverage of ABA, so companies that have self-funded health plans can elect to include or exclude these services. The good news is that today we see many companies include coverage of services for individuals with autism in their health plans.
Each state that has a current mandate to cover ABA services may be a little different. If your health plan is not based in Texas you will need to know a little about your state’s mandate. You can find out more information by using the Insurance Link on Autism Speaks’ website.
If you are unsure if your plan covers ABA services, click ‘Get Started’ to complete a short application and we can help you determine your plan’s benefits.
Medicaid in some states will cover funding for ABA services for autism. At this time, Medicaid in Texas does not cover ABA. If you have any form of Medicaid in Texas you will need to secure alternate funding to cover ABA services.
Lack of Coverage
Below are resources to utilize if your health plan does not cover ABA services or you have Medicaid:
- Contact an insurance broker to secure an individual insurance plan that covers autism and ABA services
- Autism Speaks Self-Funded Employer Tool Kit https://www.autismspeaks.org/advocacy/insurancelink
- Scholarships/Grants (not a comprehensive list)
- Other resources for information on insurance laws and funding sources: