Does Insurance Cover ABA Therapy? State-by-State Guide
Many states have autism insurance laws, but they reach only state-regulated plans. Self-funded employer (ERISA) plans set their own rules and are exempt from state mandates. Ask member services whether your plan is fully insured or self-funded; that answer decides which rules apply to you. For children enrolled in Medicaid, ABA can be covered under EPSDT when a medical-necessity determination supports it. Ask your state Medicaid office what applies to your child. But the details matter: age limits, hour caps, diagnosis requirements, and what "coverage" actually means in practice vary enormously.
Not sure where to start? Ask us →
The short answer: most private plans and every state's Medicaid cover ABA for children when medical necessity is documented - but WHICH rules apply depends on whether your plan is fully insured or self-funded. Find your state below, then call member services and ask one question: "Is my plan fully insured or self-funded?" That answer decides everything else.
What will it cost after coverage? Copays, coinsurance and deductibles are yours to pay. Our free ABA cost calculator estimates your number for your state and hours in about 30 seconds, and the ABA therapy cost guide explains every line of the bill.
Already denied? A denial is the start of the process, not the end of it. The free appeal kit walks you through it, and this companion page covers what to send your insurer so you get covered the first time.
Three Types of Coverage
- Commercial insurance (employer-provided or marketplace): If your plan is fully insured, your state's autism insurance law applies, with the age, hour or dollar limits in the list below. Some states have removed all caps. If your employer self-funds the plan (many large employers do), the state law doesn't apply and the plan sets its own rules. You can't tell which you have from your card. Ask member services.
- Medicaid: Covers ABA in all 50 states under the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) mandate. No age limit for children under 21. Coverage is based on medical necessity, not arbitrary caps. Wait times for providers may be longer.
- TRICARE (military families): Covers ABA for beneficiaries with an autism diagnosis through the Autism Care Demonstration (ACD). A referral to the ACD and pre-authorization are required for all ABA services on every TRICARE plan, and there are no yearly or lifetime caps on the amount of ABA services TRICARE covers (tricare.mil/acd, last updated December 22, 2025). And the part that catches families out: a new referral from your child's ASD diagnosing provider is required every two years, or authorization lapses. Put a reminder in your calendar now. Ask your regional contractor what the referral needs.
What to Do if You Are Denied
- Get the denial in writing. Request the specific reason code and the plan language they are citing. You need to know exactly why they denied before you can appeal.
- Ask your BCBA for a letter of medical necessity. This should document your child's diagnosis, current functioning, treatment goals, and why ABA is medically necessary. Most BCBAs have templates for this.
- File a formal appeal with your insurance company. Follow their specific appeal process (usually described in the denial letter). Include the letter of medical necessity, your child's assessment, and any supporting documentation.
- If denied again, request an external review. Most states allow an independent external review by a third party not affiliated with your insurance company. The reviewer has no relationship with the company that denied you.
- Contact your state insurance commissioner — if your plan is one they regulate. If the external review fails, file a complaint with your state's department of insurance. They can investigate whether the denial violates your state's autism mandate. Two plans they cannot help with: a self-funded employer plan (the state mandate does not apply to it, as above — that appeal runs through the plan's own process under federal ERISA rules), and Medicaid, which the insurance department does not regulate. See the next step.
- On Medicaid, the route is different and the clock is shorter. A Medicaid denial is appealed through a state Medicaid fair hearing, not through the insurance department. Your state must give you a reasonable time to ask for one, and federal rules cap that at 90 days from the date the notice was mailed — a ceiling on what the state may allow, so check the deadline printed on your notice rather than assuming 90. ⚠ If ABA is being reduced or stopped and you want it to continue while you appeal, you generally have to ask before the change takes effect — often about ten days from the notice, not ninety. Ask for the hearing and for services to continue, in writing, and keep the date you sent it. 42 C.F.R. §§ 431.221(d), 431.230, 431.211.
- Consider legal assistance. Organizations like Autism Speaks and the Council of Autism Service Providers maintain legal resources for families fighting insurance denials. Some disability rights attorneys handle ABA coverage cases.
A denial isn't the end. Insurance companies deny claims for many reasons, and not all denials are final. The appeal process exists because first denials are sometimes wrong. Don't accept a denial without appealing, especially if your child has a documented autism diagnosis and the treating clinician has determined ABA is medically necessary. Our free appeal kit has the letter template and the steps.
If you are in the United States, the Funding Finder: government money for autism and disability services lists federal, state and school-district money, who can apply, and when each one closes.
Search Your State
Showing all 51 entries
AL Alabama
Mandate: Full mandate (since 2017)
Law: HB 284 (2017), codified at Ala. Code ch. 27-54A
Age limit: 18 or under
Annual cap: ABA is capped by age band: $40,000/yr (0-9), $30,000/yr (10-13), $20,000/yr (14-18). The cap can be exceeded with prior approval where medically necessary, and it reaches ABA only
Medicaid: Yes (EPSDT). Managed through Alabama Medicaid Agency.
Group-market mandate: employers with at least 51 employees. Non-grandfathered individual and small-group ACA plans are excluded.
✓ Checked against published statutory text on 2026-09-03 — Ala. Code § 27-54A-2. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesAK Alaska
Mandate: Full mandate (since 2014)
Law: HB 163 (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: No dollar cap, and no limit on the number of visits
Medicaid: Yes (EPSDT).
Employers with 20 or fewer employees are exempt; 21-25 may seek a waiver on a 3% cost-increase showing.
✓ Checked at the official state source on 2026-09-03 — Alaska Stat. § 21.42.397
Full mandateMedicaid: YesAZ Arizona
Mandate: Full mandate (since 2008)
Law: Steven's Law (SB 1263)
Age limit: No age limit. Arizona's mandate is now a non-discrimination rule, not an age-banded benefit
Annual cap: No dollar cap. An insurer may not impose dollar limits, deductibles or coinsurance based solely on an autism diagnosis, and may not deny medically necessary behavioral therapy
Medicaid: Yes (EPSDT) through AHCCCS.
Does not apply to policies issued to an individual or a small employer. The old $50,000/$25,000 age tiers are gone from all three parallel sections - a commercial statutory database still carried them a year after the state's own site stopped.
✓ Checked at the official state source on 2026-09-03 — Ariz. Rev. Stat. §§ 20-826.04, 20-1402.03 and 20-1404.03
Full mandateMedicaid: YesAR Arkansas
Mandate: Full mandate (since 2011)
Law: Act 196 of 2011 (Ark. Code § 23-99-418)
Age limit: Under 18 for ABA. Other required autism treatment carries no age term
Annual cap: $50,000/yr for ABA. Non-ABA treatment has no visit limit and no dollar limit less favorable than for physical illness generally
Medicaid: Yes (EPSDT).
Group and blanket plans; individual major medical plans are excluded.
✓ Checked against published statutory text on 2026-09-03 — Ark. Code Ann. § 23-99-418. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesCA California
Mandate: Full mandate (since 2012)
Law: SB 946
Age limit: No age limit
Annual cap: No dollar cap. Coverage is on the same terms as other mental health conditions
Medicaid: Yes (EPSDT) through Medi-Cal managed care.
New for 2026: a plan may not require a re-diagnosis to keep behavioral health coverage, and may not delay or stop existing treatment while waiting for one.
✓ Checked at the official state source on 2026-09-03 — Cal. Health & Safety Code § 1374.73 (amended eff. Jan 1, 2026)
Full mandateMedicaid: YesCO Colorado
Mandate: Full mandate (since 2014)
Law: SB 14-192 (bill number not yet verified — the code citation below is)
Age limit: No numeric age limit - the statute covers 'a child' and does not define the word
Annual cap: No dollar cap. Coverage may not carry dollar limits, deductibles or coinsurance less favorable than for physical illness generally
Medicaid: Yes (EPSDT).
Short-term limited duration policies and individual grandfathered plans are excluded.
✓ Checked at the official state source on 2026-09-03 — C.R.S. § 10-16-104(1.4)
Full mandateMedicaid: YesCT Connecticut
Mandate: Full mandate (since 2009)
Law: Public Act 09-115 (bill number not yet verified — the code citation below is)
Age limit: Under 21 today - and under 26 from January 1, 2027. The age limits behavioral therapy including ABA; the other covered treatments carry no age term
Annual cap: No dollar cap. Connecticut repealed its cap effective January 1, 2016, and no visit limit may be imposed except for lack of medical necessity
Medicaid: Yes (EPSDT) through CT Medicaid (HUSKY).
SCHEDULED CHANGE: the behavioral-therapy age rises from under 21 to under 26 on January 1, 2027.
✓ Checked at the official state source on 2026-09-03 — Conn. Gen. Stat. §§ 38a-514b and 38a-488b
Full mandateMedicaid: YesDE Delaware
Mandate: Full mandate (since 2012)
Law: HB 55 (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: $36,000 per 12 months for ABA as enacted - the Insurance Commissioner publishes a CPI-adjusted figure by April 1 each year, so the current number is higher. No limit on the number of visits
Medicaid: Yes (EPSDT).
The cap reaches ABA only; payments for other treatment do not count against it.
✓ Checked at the official state source on 2026-09-03 — 18 Del. C. § 3366 (individual); § 3570A (group)
Full mandateMedicaid: YesDC District of Columbia
Mandate: Full mandate (since 2014)
Law: Stevie Sellows Act (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: No dollar cap. Coverage may not be more restrictive than for any other condition
Medicaid: Yes (EPSDT).
Services actually delivered through early intervention or school services need not be reimbursed.
✓ Checked at the official state source on 2026-09-03 — D.C. Code § 31-3272, with ABA brought in by § 31-3171.09(h)
Full mandateMedicaid: YesFL Florida
Mandate: Full mandate (since 2008)
Law: SB 2654 (Steven A. Geller Act)
Age limit: Under 18. Coverage can continue at 18 or older while the person is in high school, but only if the diagnosis was made at age 8 or younger
Annual cap: $36,000/yr as enacted, adjusted every January 1 for the medical CPI - the current figure is higher. There is also a $200,000 LIFETIME maximum
Medicaid: Yes (EPSDT) through FL Medicaid managed care.
Group plans only. Individual-market, individually underwritten and small-employer plans are excluded.
✓ Checked at the official state source on 2026-09-03 — Fla. Stat. § 627.6686 (Steven A. Geller Autism Coverage Act)
Full mandateMedicaid: YesGA Georgia
Mandate: Full mandate (since 2015)
Law: Ava's Law (HB 429)
Age limit: 20 or under
Annual cap: Permissive and ABA-only: a plan MAY limit applied behavior analysis to $35,000/yr. It is not required to, and no limit on the number of visits is allowed. No inflation adjustment
Medicaid: Yes (EPSDT).
Ava's Law was expanded in 2019 from age 6 to age 20 and from $30,000 to $35,000. Does not apply to employers with ten or fewer employees. We read the legislature's own amending text because Georgia's consolidated code is not freely published; four later sessions could not be checked for further amendments.
✓ Checked against published statutory text on 2026-09-03 — O.C.G.A. § 33-24-59.10 (Ava's Law, as amended by SB 118, eff. Jan 1, 2019). We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesHI Hawaii
Mandate: Full mandate (since 2015)
Law: HB 1270
Age limit: Under 14
Annual cap: $25,000/yr for applied behavior analysis, for children aged 13 and under. No inflation adjustment
Medicaid: Yes (EPSDT) through Hawaii Medicaid (Med-QUEST).
Excludes custodial care, services by family or household members, experimental treatment, and services provided outside Hawaii. A '$50,000/yr, $300,000 lifetime' Hawaii figure circulates online; it comes from a bill that never became law.
✓ Checked against published statutory text on 2026-09-03 — Haw. Rev. Stat. § 431:10A-133 (Luke's Law). We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesID Idaho
Mandate: Covered by Department of Insurance bulletin, not by statute (since plan year 2019)
Law: Dept. of Insurance Bulletin No. 18-02 (2 April 2018)
Age limit: None stated in the bulletin
Annual cap: None stated in the bulletin
Medicaid: Yes (EPSDT).
Idaho has no autism-specific statute, which is why a search of the insurance code finds nothing. The requirement lives in a Department of Insurance bulletin instead: treatments for autism cannot be excluded from coverage if rehabilitative or habilitative services are covered. It reaches individual, small-group, large-group and self-funded plans regulated by the Department, for plan years starting on or after 1 January 2019. It sets no age limit and no dollar cap of its own, because it works by forbidding an exclusion rather than by defining a benefit.
✓ Checked at the official state source on 2026-09-12 — Idaho Dept. of Insurance Bulletin No. 18-02, read at the Department's own site. Quoted: treatments “cannot be excluded from coverage if rehabilitative or habilitative services are covered”.
Covered by DOI bulletinMedicaid: YesIL Illinois
Mandate: Full mandate (since 2009)
Law: Public Act 96-0860 (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: $36,000/yr as written, but the statute requires the Director of Insurance to adjust it every year for medical CPI - so the figure in force today is higher. Ask the Illinois Department of Insurance for the current amount. No limit on the number of visits
Medicaid: Yes (EPSDT).
Payments for conditions unrelated to autism do not count against the maximum.
✓ Checked at the official state source on 2026-09-03 — 215 ILCS 5/356z.14
Full mandateMedicaid: YesIN Indiana
Mandate: Full mandate (since 2001)
Law: IC 27-8-14.2 (bill number not yet verified — the code citation below is)
Age limit: No age limit in the statute
Annual cap: No dollar cap. The statute forbids dollar limits, deductibles or coinsurance less favorable than those applying to physical illness generally
Medicaid: Yes (EPSDT).
Indiana's 2001 law is one of the earliest state autism insurance mandates.
✓ Checked against published statutory text on 2026-09-03 — Ind. Code § 27-8-14.2-4. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesIA Iowa
Mandate: Full mandate (since 2016)
Law: SF 2325 (bill number not yet verified — the code citation below is)
Age limit: No age limit in the current Iowa Code text
Annual cap: No dollar cap, and no limit on the number of visits under the state-employee provision
Medicaid: Yes (EPSDT).
IMPORTANT SCOPE LIMIT: Iowa's ABA mandate reaches only employers with more than 50 full-time-equivalent employees, non-state public employee plans, and State of Iowa employee plans. Individual and small-group Iowa plans have no ABA mandate at all - so check your employer size before relying on this.
✓ Checked at the official state source on 2026-09-03 — Iowa Code § 514C.31 (and § 514C.28 for State of Iowa employees)
Full mandateMedicaid: YesKS Kansas
Mandate: Full mandate (since 2014)
Law: SB 282 (bill number not yet verified — the code citation below is)
Age limit: Under 12. Separately, whether a child was diagnosed between birth and age 5 decides which hours tier applies
Annual cap: No dollar cap for commercial plans. Kansas limits ABA by HOURS: 1,300 hours per year for four years if diagnosed between birth and age 5, otherwise 520 hours per year under age 12. The hour limit can be exceeded with prior approval where medically necessary
Medicaid: Yes (EPSDT).
The Kansas state-employee plan is a different statute with a different age (under 19) and real dollar caps ($36,000 and $27,000). Do not apply those figures to a commercial plan.
✓ Checked at the official state source on 2026-09-03 — K.S.A. § 40-2,194 (commercial); § 75-6524 covers state employees separately
Full mandateMedicaid: YesKY Kentucky
Mandate: Full mandate (since 2010)
Law: SB 185 (bill number not yet verified — the code citation below is)
Age limit: No age limit
Annual cap: No dollar cap - the statute forbids any maximum annual benefit limit and any limit on the number of visits
Medicaid: Yes (EPSDT).
Kentucky removed its age and dollar limits effective January 1, 2019. An insurer may not refuse or terminate coverage solely because someone is diagnosed with or treated for autism.
✓ Checked at the official state source on 2026-09-03 — KRS § 304.17A-142
Full mandateMedicaid: YesLA Louisiana
Mandate: Full mandate (since 2008)
Law: Act 648 (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: $36,000/yr, applying to the whole autism benefit rather than to ABA alone. No limit on the number of visits, and no inflation adjustment
Medicaid: Yes (EPSDT).
Does not apply to individually underwritten guaranteed-renewable policies or to limited-benefit policies. There is no lifetime cap in the statute.
✓ Checked at the official state source on 2026-09-03 — La. Rev. Stat. § 22:1050
Full mandateMedicaid: YesME Maine
Mandate: Full mandate (since 2011)
Law: HP 1127 (bill number not yet verified — the code citation below is)
Age limit: 10 or under
Annual cap: Permissive: a plan MAY limit ABA to $36,000/yr. It is not required to, and no limit on the number of visits is allowed
Medicaid: Yes (EPSDT) through MaineCare.
Maine's age 10 is genuinely low. Note some secondary summaries cite 24-A M.R.S. § 2765 for Maine autism coverage; that section is about dental hygienists.
✓ Checked at the official state source on 2026-09-03 — 24-A M.R.S. § 2847-T (group); §§ 2768 and 4259 are the individual and HMO counterparts
Full mandateMedicaid: YesMD Maryland
Mandate: Full mandate (since 2012)
Law: SB 300 (Autism Waiver expanded) (bill number not yet verified — the code citation below is)
Age limit: Covered at least until the end of the month in which the child turns 19 - and that is a floor, not a ceiling on what a plan may offer
Annual cap: No dollar cap
Medicaid: Yes (EPSDT).
Maryland covers autism through its habilitative-services mandate rather than a separate autism section. Services actually delivered through early intervention or school services need not be reimbursed.
✓ Checked at the official state source on 2026-09-03 — Md. Code, Insurance § 15-835 (habilitative services)
Full mandateMedicaid: YesMA Massachusetts
Mandate: Full mandate (since 2010)
Law: ARICA (Chapter 207) (bill number not yet verified — the code citation below is)
Age limit: No age limit
Annual cap: No dollar cap and no limit on the number of visits
Medicaid: Yes (EPSDT) through MassHealth.
Full parity mandate. There is no age word anywhere in the section.
✓ Checked at the official state source on 2026-09-03 — M.G.L. c. 175, § 47AA
Full mandateMedicaid: YesMI Michigan
Mandate: Full mandate (since 2012)
Law: PA 99 and PA 100 of 2012 (SB 414, SB 415)
Age limit: An insurer MAY stop treatment coverage after age 18. Nothing requires it to, and diagnosis coverage is not age-limited
Annual cap: The tiers are permissive: an insurer MAY cap ABA at $50,000/yr (through 6), $40,000/yr (7-12), $30,000/yr (13-18). A plan with no cap is fully compliant
Medicaid: Yes (EPSDT).
Michigan's figures are a ceiling on what an insurer may impose, not a floor on what it must pay. Ask what your plan actually does.
✓ Checked at the official state source on 2026-09-03 — MCL § 500.3406s
Full mandateMedicaid: YesMN Minnesota
Mandate: Full mandate (since 2013)
Law: SF 1328 (bill number not yet verified — the code citation below is)
Age limit: Under 18
Annual cap: No dollar cap in the statute
Medicaid: Yes (EPSDT) through MN Medical Assistance.
SCOPE LIMIT: this mandate reaches only plans issued to a LARGE EMPLOYER. It is not a general Minnesota mandate.
✓ Checked at the official state source on 2026-09-03 — Minn. Stat. § 62A.3094
Full mandateMedicaid: YesMS Mississippi
Mandate: Partial mandate (since 2015)
Law: Miss. Code Ann. § 83-9-26 (2015 session; effective for policies issued or renewed on or after 1 January 2016) (bill number not yet verified — the code citation below is)
Age limit: Under 22 for the mandate as a whole. Applied behavior analysis specifically is not required beyond age 8 — but everything else this section covers runs to 22
Annual cap: No dollar cap. The statute forbids dollar limits, deductibles or coinsurance less favorable than those applied to substantially all medical and surgical benefits. The one exception is an HOURS limit on ABA: 25 hours a week, of which no more than 10 may be with a licensed behavior analyst — and a plan above 25 hours must be covered where your physician or psychologist finds it medically necessary
Medicaid: Yes (EPSDT).
The limit on ABA is HOURS, not dollars, and it is not a hard ceiling: above 25 hours a week the statute requires coverage where a licensed physician or psychologist determines it is medically necessary. The insurer may review the treatment plan every six months and must pay for that review itself. This section does not apply to non-grandfathered individual and small-group plans that are already required to include essential health benefits.
✓ Checked at the official state source on 2026-09-04 — Miss. Code Ann. § 83-9-26
Partial mandateMedicaid: YesMO Missouri
Mandate: Full mandate (since 2010)
Law: SB 654 (bill number not yet verified — the code citation below is)
Age limit: Through 18 for ABA. All other required autism coverage is free of the age and dollar limits
Annual cap: $40,000/yr for ABA as enacted, inflation-adjusted with the current value published in the Missouri Register each January. The cap can be exceeded with prior approval where medically necessary
Medicaid: Yes (EPSDT).
Covers ABA for ASD diagnosis.
✓ Checked at the official state source on 2026-09-03 — Mo. Rev. Stat. § 376.1224
Full mandateMedicaid: YesMT Montana
Mandate: Full mandate (since 2019)
Law: HB 489 (bill number not yet verified — the code citation below is)
Age limit: 18 or younger
Annual cap: The tiers are permissive: coverage MAY be limited to $50,000/yr (age 8 or younger) and $20,000/yr (ages 9-18). A plan with no cap is compliant
Medicaid: Yes (EPSDT).
This is the group disability insurance section; we have not verified an individual-market counterpart.
✓ Checked at the official state source on 2026-09-03 — Mont. Code Ann. § 33-22-515
Full mandateMedicaid: YesNE Nebraska
Mandate: Full mandate (since 2014)
Law: LB 254 (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: No dollar cap - dollar limits less favorable than for general physical illness are prohibited and there is no visit limit. The only ceiling is on HOURS: 25 hours per week of behavioral health treatment including ABA, until age 21
Medicaid: Yes (EPSDT).
Nebraska's limit is hours per week, not dollars. Do not read the 25 as an hourly rate.
✓ Checked at the official state source on 2026-09-03 — Neb. Rev. Stat. § 44-7,106
Full mandateMedicaid: YesNV Nevada
Mandate: Full mandate (since 2009)
Law: AB 162 (2009)
Age limit: Under 18, or until 22 if enrolled in high school
Annual cap: The actuarial equivalent of $72,000 per year for ABA. In the individual market the same figure is a FLOOR rather than a ceiling
Medicaid: Yes (EPSDT).
A separate clause makes the insurer accept a diagnosis made under the statewide standard through age 21; that 21 is NOT an eligibility limit. The individual-market section requires only that coverage be OFFERED.
✓ Checked at the official state source on 2026-09-03 — Nev. Rev. Stat. §§ 689B.0335, 695C.1717, 689A.0435
Full mandateMedicaid: YesNH New Hampshire
Mandate: Full mandate (since 2010)
Law: HB 569 (bill number not yet verified — the code citation below is)
Age limit: No age limit. New Hampshire removed its age ceiling effective September 23, 2022
Annual cap: No dollar cap. Full parity: coverage on terms no less extensive than for any other physical illness
Medicaid: Yes (EPSDT).
An age or dollar figure published for New Hampshire today would be repealed law.
✓ Checked at the official state source on 2026-09-03 — N.H. RSA 417-E:1, III(h) and RSA 417-E:2
Full mandateMedicaid: YesNJ New Jersey
Mandate: Full mandate (since 2010)
Law: P.L. 2009 c.115 (A2238, enacted 2009)
Age limit: No age limit for screening, diagnosis, or OT/PT/speech therapy. ABA is covered under 21
Annual cap: No cap on OT/PT/speech. ABA has a $36,000 base maximum that is CPI-adjusted every year and published in the New Jersey Register by February 1 - the current figure is higher, and an insurer is free to pay above it
Medicaid: Yes (EPSDT) through NJ FamilyCare.
Covers ABA for ASD.
✓ Checked against published statutory text on 2026-09-03 — N.J.S.A. 17B:27-46.1ii. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesNM New Mexico
Mandate: Full mandate (since 2013)
Law: HB 461 (bill number not yet verified — the code citation below is)
Age limit: No age limit. The statute forbids denying coverage on the basis of age
Annual cap: No cap. Coverage may not be subject to annual or lifetime dollar limits
Medicaid: Yes (EPSDT).
New Mexico removed its age limit and its dollar caps in 2019. Older summaries still circulate the age-19 and $36,000 figures; they are superseded.
✓ Checked against published statutory text on 2026-09-03 — NMSA 1978 § 59A-22-49. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesNY New York
Mandate: Full mandate (since 2011 (expanded))
Law: Multiple statutes + regulation (bill number not yet verified — the code citation below is)
Age limit: No age limit
Annual cap: No dollar cap. The former $45,000 ABA maximum has been repealed - it is now a lettering gap in the statute. Parity governs instead, and no visit limit may apply to autism alone
Medicaid: Yes (EPSDT).
An insurer may not terminate or refuse coverage solely because someone is diagnosed with or treated for autism.
✓ Checked at the official state source on 2026-09-03 — N.Y. Ins. Law § 3221(l)(17); § 3216(i)(25) for individual policies
Full mandateMedicaid: YesNC North Carolina
Mandate: Full mandate (since 2015)
Law: SB 676 (Autism Insurance Act) (bill number not yet verified — the code citation below is)
Age limit: Permissive, and only for adaptive behavior treatment: an insurer MAY limit it to 18 or younger. Screening, diagnosis and other care carry no age limit
Annual cap: Permissive and CPI-indexed: an insurer MAY cap adaptive behavior treatment at $40,000/yr base, and the Commissioner posts the indexed amount by April 1 each year
Medicaid: Yes (EPSDT).
Covers ABA for ASD.
✓ Checked at the official state source on 2026-09-03 — N.C. Gen. Stat. § 58-3-192
Full mandateMedicaid: YesND North Dakota
Mandate: No autism-specific mandate found
Law: None located
Age limit: No autism-specific insurance mandate found in North Dakota law
Annual cap: No autism-specific mandate, so no statutory cap. A general mental-disorder mandate exists but does not name autism
Medicaid: Yes (EPSDT).
We searched the insurance chapters and the Century Code catchline index with a positive control. Federal parity rules and your plan terms may still require coverage - ask your plan and the ND Insurance Department. One thing this search could not see: a state can require autism coverage through an insurance-department BULLETIN instead of a statute, and a search of the statute books will not find it - that is exactly what Idaho turned out to have. We have not confirmed a bulletin here either way, so ask the ND Insurance Department directly rather than reading our 'not in the statutes' as 'not covered'.
✓ Checked at the official state source on 2026-09-03 — No autism mandate located in N.D. Cent. Code chs. 26.1-36, 26.1-18.1, 26.1-36.3, 26.1-36.6 or 26.1-47
No autism-specific mandate foundMedicaid: YesOH Ohio
Mandate: Full mandate (since 2017)
Law: HB 463 (2017)
Age limit: No age limit on the mandate. Age 14 appears only as the boundary of the statutory MINIMUM benefit tiers, not as a cut-off
Annual cap: No dollar cap. Coverage may not carry dollar limits, deductibles or coinsurance less favorable than for substantially all medical and surgical benefits. Minimums below age 14 include 20 visits/yr each for speech and OT, 20 hours/week of clinical therapeutic intervention, and 30 outpatient visits/yr
Medicaid: Yes (EPSDT).
Reporting Ohio as 'covered to age 14' would be wrong - 14 bounds the minimum floors, not the mandate.
✓ Checked at the official state source on 2026-09-03 — Ohio Rev. Code § 3923.84 (and § 1751.84)
Full mandateMedicaid: YesOK Oklahoma
Mandate: Full mandate (since 2016)
Law: SB 870 (bill number not yet verified — the code citation below is)
Age limit: No age limit. Oklahoma's 2016 age-9 rule was removed by later amendments
Annual cap: No dollar cap and no visit limit. The 2016 $25,000 ABA cap is gone
Medicaid: Yes (EPSDT).
An insurer may not terminate or refuse coverage solely because someone is diagnosed with or treated for autism.
✓ Checked at the official state source on 2026-09-03 — 36 O.S. § 6060.21
Full mandateMedicaid: YesOR Oregon
Mandate: Full mandate (since 2013)
Law: SB 365 (bill number not yet verified — the code citation below is)
Age limit: Two rules. General autism coverage runs under 18. For ABA the 9 is a treatment-START threshold, not a cut-off: if treatment began or was first requested before age 9, coverage continues
Annual cap: No dollar cap. The ABA limit is 25 hours per week, and coverage above 25 hours or starting at 9 or older remains available under Oregon's other autism and parity provisions
Medicaid: Yes (EPSDT) through Oregon Health Plan.
Do not read Oregon as 'ABA covered under 9'. Starting before 9 preserves coverage, and other routes stay open regardless of age.
✓ Checked at the official state source on 2026-09-03 — ORS 743A.190, plus the uncodified ABA mandate at 2013 Or. Laws ch. 771 § 2, and parity at ORS 743A.168
Full mandateMedicaid: YesPA Pennsylvania
Mandate: Full mandate (since 2008)
Law: Act 62 (bill number not yet verified — the code citation below is)
Age limit: Under 21
Annual cap: $36,000/yr as enacted, adjusted annually for CPI-U by the Insurance Commissioner and published in the Pennsylvania Bulletin by April 1 - so the current figure is higher. No limit on the number of visits
Medicaid: Yes (EPSDT). PA also has IBHS program.
Payments for conditions unrelated to autism do not count against the maximum.
✓ Checked at the official state source on 2026-09-03 — 40 P.S. § 764h (Act 62 of 2008)
Full mandateMedicaid: YesRI Rhode Island
Mandate: Full mandate (since 2012)
Law: H 5275 Sub A (2011), effective 2012; expanded by H 7165 Sub A (2012)
Age limit: Under 15
Annual cap: No dollar cap in the statute. Maximums are allowed only at parity with other conditions
Medicaid: Yes (EPSDT).
The widely repeated $32,000 Rhode Island cap is not in the statute. GROUP plans only - individual and small-employer plans are expressly excluded.
✓ Checked at the official state source on 2026-09-03 — R.I. Gen. Laws § 27-20.11-3
Full mandateMedicaid: YesSC South Carolina
Mandate: Full mandate (since 2007)
Law: Ryan's Law
Age limit: Under 16, and the child must have been diagnosed at age 8 or younger to be eligible
Annual cap: $50,000/yr as enacted, adjusted every January for CPI since 2008 - the current-year figure is higher. Ask the SC Department of Insurance for this year's number
Medicaid: Yes (EPSDT).
The diagnosis-by-age-8 rule is an eligibility test, not a deadline for treatment. It decides whether a child is in the mandate at all.
✓ Checked at the official state source on 2026-09-03 — S.C. Code § 38-71-280 (Ryan's Law)
Full mandateMedicaid: YesSD South Dakota
Mandate: Full mandate (since 2019)
Law: SB 100 (bill number not yet verified — the code citation below is)
Age limit: No stand-alone age cap. Age appears only as the tier structure of the benefit floor, running through 18
Annual cap: These are MINIMUMS an insurer may not go below, not caps: at least $36,000/yr through age 6, $25,000/yr ages 7-13, $12,500/yr ages 14-18
Medicaid: Yes (EPSDT).
Non-grandfathered individual and small group ACA plans, and the State of South Dakota employee plan, are excluded.
✓ Checked at the official state source on 2026-09-03 — S.D. Codified Laws §§ 58-17-154 to 58-17-162
Full mandateMedicaid: YesTN Tennessee
Mandate: Full mandate (since 2018)
Law: SB 1820 (bill number not yet verified — the code citation below is)
Age limit: Under 12
Annual cap: No dollar cap in the statute
Medicaid: Yes (EPSDT) through TennCare.
Age 12 limit in the 2006 statute. TennCare provides broader Medicaid coverage. IMPORTANT: the Tennessee Department of Commerce and Insurance published a bulletin dated 1 August 2019 (tn.gov/content/dam/tn/commerce/documents/insurance/bulletins/8-1-19-Bulletin.pdf) and published reports say it requires coverage of medically necessary autism care including applied behavior analysis, beyond what the 2006 statute says. We confirmed that document exists on the Department's own site but could NOT read it - it is a scanned image - so we have not confirmed its contents and are not restating them here. If your child is over 12, do not stop at the statute: ask the Department whether that 2019 bulletin applies to your plan.
✓ Checked against published statutory text on 2026-09-03 — Tenn. Code § 56-7-2367. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesTX Texas
Mandate: Full mandate (since 2007)
Law: HB 1919 (2007), amended by HB 451 (2009) and SB 1484 (2013)
Age limit: No age limit on coverage, but the autism diagnosis must be in place before the child's 10th birthday
Annual cap: No cap before age 10. From age 10, ABA only is capped at $36,000/yr; speech, OT and PT are not capped by the statute
Medicaid: Yes (EPSDT).
Texas does NOT cut coverage off at age 10. The 10th birthday is the deadline for getting the diagnosis, not the end of coverage.
✓ Checked against published statutory text on 2026-09-03 — Tex. Ins. Code § 1355.015. We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesUT Utah
Mandate: Full mandate (since 2014)
Law: HB 62 (bill number not yet verified — the code citation below is)
Age limit: No age limit. The old 2-to-under-10 band applied only to plans renewed between 2016 and 2019
Annual cap: No dollar cap and, for plans renewed on or after January 1, 2020, no limit on the number of hours. Limits are set by commissioner rule at parity with other illnesses
Medicaid: Yes (EPSDT).
The mandate names the individual market and the large group market; small group is not named.
✓ Checked at the official state source on 2026-09-03 — Utah Code § 31A-22-642
Full mandateMedicaid: YesVT Vermont
Mandate: Full mandate (since 2012)
Law: Act 157 (bill number not yet verified — the code citation below is)
Age limit: Birth until 21
Annual cap: No dollar cap. Amount, frequency and duration are set by medical necessity, with cost-sharing at parity
Medicaid: Yes (EPSDT) through Green Mountain Care.
Extends to Medicaid and other state public health care assistance programs. The old § 4088i citation is dead.
✓ Checked at the official state source on 2026-09-03 — 8 V.S.A. § 4082 (recodified from § 4088i, eff. Sept 1, 2025)
Full mandateMedicaid: YesVA Virginia
Mandate: Full mandate (since 2011)
Law: HB 2467 (bill number not yet verified — the code citation below is)
Age limit: No age limit (since January 1, 2020)
Annual cap: $35,000/yr for ABA, unless the plan chooses to cover more
Medicaid: Yes (EPSDT).
One flat ABA cap at any age, not a sliding scale. Virginia removed its age limit effective January 1, 2020.
✓ Checked at the official state source on 2026-09-03 — Va. Code § 38.2-3418.17
Full mandateMedicaid: YesWA Washington
Mandate: Parity-based coverage (no autism-specific statute) (since 2014)
Law: Mental Health Parity Act + O.S.T. v. Regence (2014) (bill number not yet verified — the code citation below is)
Age limit: No autism-specific mandate, so no statutory age limit. Coverage rests on Washington's Mental Health Parity Act as applied to autism by the state Supreme Court
Annual cap: No autism-specific cap. Parity forbids treatment or financial limits on mental health services unless the same limits apply to medical and surgical services
Medicaid: Yes (EPSDT) through Apple Health.
Bills that would create a Washington autism mandate are indexed online and read like law. They are not law. Coverage here comes from parity, not from an autism statute.
✓ Checked at the official state source on 2026-09-03 — RCW 48.21.241 and parallel parity sections; O.S.T. v. Regence BlueShield, 181 Wn.2d 691 (2014)
Parity-based coverage (no autism-specific statute)Medicaid: YesWV West Virginia
Mandate: Full mandate (since 2013)
Law: SB 551 (bill number not yet verified — the code citation below is)
Age limit: 18 months to 18 years, AND the child must have been diagnosed at age 8 or younger to be eligible at all
Annual cap: $30,000/yr for ABA for three consecutive years from the start of treatment, then $2,000 per month until 18. No inflation adjustment
Medicaid: Yes (EPSDT).
A child first diagnosed at 9 falls outside this mandate even if within the age band. Does not apply to employers averaging 25 or fewer eligible employees.
✓ Checked at the official state source on 2026-09-03 — W. Va. Code § 33-16-3v (and §§ 33-24-7k, 33-25A-8j)
Full mandateMedicaid: YesWI Wisconsin
Mandate: Full mandate (since 2009)
Law: Act 218 (bill number not yet verified — the code citation below is)
Age limit: No age limit in the current text
Annual cap: These are statutory MINIMUMS, not caps: at least $50,000/yr for intensive-level services and at least $25,000/yr for non-intensive, both adjusted annually for medical CPI and published in the Wisconsin Administrative Register. No limit on the number of treatment visits
Medicaid: Yes (EPSDT) through BadgerCare Plus.
Wisconsin's figures are a floor on what a plan must provide, not a ceiling on what it may pay.
✓ Checked against published statutory text on 2026-09-03 — Wis. Stat. § 632.895(12m). We could not fully confirm it is the current version, so treat it as good but not final and check the note above.
Full mandateMedicaid: YesWY Wyoming
Mandate: No autism mandate found
Law: None located
Age limit: No autism insurance mandate found in Wyoming law as of the 2025 session
Annual cap: No autism-specific mandate, so no statutory cap
Medicaid: Yes (EPSDT).
We read all 989 pages of Title 26 with a positive control. Federal parity rules and your plan terms may still require coverage - ask your plan and the Wyoming Insurance Department. One thing this search could not see: a state can require autism coverage through an insurance-department BULLETIN instead of a statute, and a search of the statute books will not find it - that is exactly what Idaho turned out to have. For Wyoming specifically there are credible published reports that the Insurance Department issued exactly such a bulletin on 19 April 2019 - barring plans that cover mental health from excluding evidence-based autism treatment, with compliance required by 1 July 2019. We have NOT been able to read that bulletin at the Department's own site, so we are not stating it as fact here. Ask the Wyoming Insurance Department directly whether a 2019 autism bulletin applies to your plan - and do not read our 'not in the statutes' as 'not covered'.
✓ Checked at the official state source on 2026-09-03 — No autism provision located in Wyo. Stat. Title 26 (Insurance Code)
No autism mandate foundMedicaid: Yes
How current is this, honestly: the state figures on this page were compiled in March 2026 from publicly available summaries, not from the statutes themselves. On September 3, 2026 we began checking them one state at a time against each state's actual insurance code. Every state we have checked so far is marked with the statute, the date we read it, and which of two ways we checked it — at the state's own official source, or against published statutory text we could not confirm is the current version. A state we have not checked at all says so in the same place. We would rather tell you exactly how far we got than let a row look more verified than it is.
We are publishing the corrections as we make them rather than waiting until all fifty-one are done, because the errors we have found so far all pointed the same way: they made coverage look narrower than the law actually is. In several states the age limit or the dollar cap we had printed did not exist. If you read this page earlier and concluded your child had aged out or hit a cap, please check your state again.
Two things that are true in every state: the figures below are the minimum a state requires of a fully-insured plan — your plan may cover more, and many do. And an age or a dollar figure in any table, this one included, is never by itself a reason not to ask. The only authorities on your coverage are your plan document and your state insurance department.
Special Learning isn't an insurance provider or a legal authority on insurance law. For legal guidance on a denial, consult a disability rights attorney in your state.
We are publishing the corrections as we make them rather than waiting until all fifty-one are done, because the errors we have found so far all pointed the same way: they made coverage look narrower than the law actually is. In several states the age limit or the dollar cap we had printed did not exist. If you read this page earlier and concluded your child had aged out or hit a cap, please check your state again.
Two things that are true in every state: the figures below are the minimum a state requires of a fully-insured plan — your plan may cover more, and many do. And an age or a dollar figure in any table, this one included, is never by itself a reason not to ask. The only authorities on your coverage are your plan document and your state insurance department.
Special Learning isn't an insurance provider or a legal authority on insurance law. For legal guidance on a denial, consult a disability rights attorney in your state.
Free Resources for Families
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Related: How Much Does ABA Therapy Cost? | ABA Cost Calculator | ABA Insurance Appeal Kit | How to Get ABA Covered (and Appeal a Denial) | How to Choose a Provider | Resources for Parents | What Is an RBT? | ABA Glossary
Questions families ask about ABA and insurance
Does insurance cover ABA therapy?
It depends on your plan. Many states have autism insurance laws, but they reach only state-regulated plans. Self-funded employer (ERISA) plans set their own rules and are exempt from state mandates. Ask member services whether your plan is fully insured or self-funded; that answer decides which rules apply to you. For children enrolled in Medicaid, ABA can be covered under EPSDT when a medical-necessity determination supports it. Ask your state Medicaid office what applies to your child. However, coverage details (age limits, hour caps, diagnosis requirements) vary significantly by state and by plan. Always verify with your specific insurance carrier.
How much does ABA therapy cost with insurance?
What you pay depends on three things: your plan's copay or coinsurance, whether you have met your deductible, and how many hours your child is approved for. National averages hide the only number that matters, which is yours. Our free ABA cost calculator estimates it for your state and your hours in about 30 seconds, and our ABA therapy cost guide explains every line of the bill.
What if my insurance denies ABA therapy?
You have the right to appeal. Steps: (1) Get the denial in writing with the specific reason, (2) Ask your BCBA to write a letter of medical necessity, (3) File a formal appeal with your insurance company, (4) If denied again, request an external review, (5) Contact your state insurance commissioner for assistance - but they do not regulate Medicaid or self-funded employer plans. A Medicaid denial is appealed through a state Medicaid fair hearing instead; your state sets the deadline and federal rules cap it at 90 days from the notice, and if you want ABA to continue while you appeal you generally must ask before the change takes effect, often about ten days from the notice. A denial can be appealed, and our free ABA insurance appeal kit shows you how, step by step.
Does Medicaid cover ABA therapy?
Yes. Medicaid covers ABA therapy for eligible children in all 50 states under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandate. Coverage details and provider availability vary by state. Wait times for Medicaid-funded ABA are often longer than for commercial insurance.
