Does Medi-Cal Cover ABA Therapy?

March 28, 2022

For qualified individuals under 21, Medi-cal covers any medically required Behavioral Health Therapy (BHT). Autism learning partners could use the preferred insurance plan for Applied Behavior Analysis therapy.

California's Medicaid coverage is designated as Medi-cal. This is a federal-run healthcare program that helps low-income families with children, the elderly, people with a disability, adopted children, pregnant women, and people with special conditions like TB, cancer, or HIV/AIDS get the treatment they need.

Benefits of Medi-cal's behavioral therapy coverage plans

  • If the family’s primary insurance plan does not cover ABA, beneficiaries will need a refusal letter from their insurance carrier to use the Medi-cal plan.
  • At Medi-cal, the state and federal governments split the cost of the insurance cover.
  • BHT services will be provided to children with fee-for-service Medi-cal through their local regional center.
  • A professional physician or psychologist provides the diagnosis
  • A Board Certified Behavior Analyst (BCBA) develops the individualized treatment plan.
  • The insurance provider will engage with members and communicate directly with their physicians through their comprehensive case management framework to coordinate therapy and services for high-risk members.
  • The Medi-cal recipients have their care navigator, a customer support specialist, a free 24-hour nurse support line, health programs, a caseworker, and other services are available.

You will need to produce a written diagnosis from a medical doctor, psychologist, or psychiatrist that contains a referral for ABA therapy to be authorized by Medi-cal. 

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