Insurance coverage of ABA therapy.
ABA is an intensive one-on-one behavioral therapy that works on the needs of the specific child. There are a few different routes to go if you want to get ABA Therapy. Because of limitations and/or wait lists for each, one may consider pursuing all routes in order to begin services quicker. Please talk to your Case Manager about options that are best suited for your family’s situation.
1. Ryan’s Law – This was passed through the SC legislature in 2007 to require certain types of businesses to cover ABA therapy through their insurance plans. The following is a summary of the law. Ryan’s Law applies to children diagnosed with Autism at age 8 or younger and continues to apply up to the age of 16. It requires most state-regulated group insurance policies to provide coverage for the treatment of Autism as prescribed by the insured’s treating medical doctor in accordance with a treatment plan. Plans must provide at least $50,000 of coverage per year for behavioral therapy (including applied behavioral analysis). Employers with at least 51 employees that offer group health insurance coverage are required to offer Autism services for children under the age of 16. As the law stands right now, few employer insurance plans fall under Ryan’s Law. However, advocates are working to expand the coverage. Full text of the bill can be viewed here.
2. Medicaid – The South Carolina Department of Health and Human Services (SCDHHS) has established an interim process by which Healthy Connections Medicaid members can access Autism services that are identified as medically necessary. Basically if you have Medicaid and a doctor’s prescription for ABA, you can apply directly through Department of Health & Human Services for ABA therapy. Many of the age limits and maximum length of service limits do not apply. For more information, talk to your Case Manager or click here for more information.
Click here to view a list of Medicaid-enrolled Autism Providers.
PDD Waiver – This was previously a Medicaid waiver program that provided ABA therapy to children up to age 11 for a maximum of 3 years or until they turn 11, whichever comes first. Those receiving services through the PDD Waiver are being transitioned to other programs, and no new waiver slots are being assigned.