Who is eligible
- Enrolled in Maryland Medicaid
- Under age 21
- A confirmed diagnosis of autism spectrum disorder (ASD) from a qualified health care professional
- A referral and a determination that ABA is medically necessary
ABA is covered through Medicaid’s EPSDT benefit, which provides comprehensive care for members under 21.
The diagnosis requirement
Maryland Medicaid requires a comprehensive diagnostic evaluation from a qualified professional, such as a developmental pediatrician, pediatric neurologist, child psychiatrist, psychologist, neuropsychologist, pediatrician, or nurse practitioner. The evaluation includes a caregiver interview, a review of your child’s developmental history, direct observation, and a written diagnosis. No diagnosis yet? See our guide to getting an autism diagnosis in Maryland, and reach out. Our team can help coordinate an evaluation.
Prior authorization
All ABA services require prior authorization from Carelon Behavioral Health, which administers behavioral health services for Maryland Medicaid. After the diagnosis, a BCBA completes an ABA assessment and writes a treatment plan, and we submit it for approval. Authorizations last up to 180 days and are renewed with a reassessment for as long as your child needs services. Our intake team prepares and submits this paperwork for you.
What is covered
- ABA assessments and reassessments
- One-on-one ABA therapy
- Caregiver training, with or without your child present
- Treatment planning and supervision by a BCBA
Services are generally delivered in the home and community. Some services, such as caregiver training, may be provided by telehealth.
Cost to families
For covered services, Maryland Medicaid’s payment is payment in full. Providers may not charge families for covered services.
Commercial insurance
Maryland law requires many state-regulated health plans to cover habilitative services for children with autism under age 19. Self-funded employer plans follow federal rules and may differ. Commercial plans can include copays, coinsurance, or a deductible. We verify your benefits and explain expected costs before services begin.
Common questions
Does Maryland Medicaid cover ABA therapy?
Yes. Maryland Medicaid covers medically necessary ABA services for eligible members under age 21 who have an autism spectrum disorder diagnosis.
Will we have to pay anything?
For services covered by Maryland Medicaid, Medicaid’s payment is payment in full, and providers may not bill families for covered services. Our team explains your coverage before services begin.
How long does approval last?
Authorizations last up to 180 days. Before each period ends, your child is reassessed and the treatment plan is updated and resubmitted.
This page is general information, not legal or insurance advice. Coverage rules can change; our team will confirm the details of your child’s plan. Source: Maryland Department of Health, Applied Behavior Analysis Provider Manual.