As of June 2017, Texas is one of 46 states with mandates requiring health insurance carriers to cover applied behavior analysis (ABA) services for children with a diagnosis of autism spectrum disorder (ASD). Fully-funded health insurance plans and Affordable Care Act health insurance plans are included in the mandate. Self-funded health insurance plans may exclude benefits for ABA, however, some employers have voluntarily included benefits for ABA services in their employee’s self-funded plans. Health insurance does not typically cover ABA services for children who are neurotypical or have diagnoses other than autism. If you are a family without insurance coverage for ABA services, please contact us about grant resources, our sliding fee schedule, payment plans, and free local and online resources.
We are in-network with the following providers:
- Anthem
- Blue Cross Blue Shield of Texas (BCBS)
- Cigna
- Magellan
- Medicaid (Amerigroup, Baylor Scott & White, BCBS, Superior, United Healthcare)
- Seton Insurance Company
- ValueOptions/TRICARE
- Call to inquire about other insurers— we may be in-network. If not, we may be able to serve you as an in-network provider through a single-case agreement with your health insurance.
Complementary Verification of ABA Benefits
We verify eligibility and benefits for ABA services as a courtesy to all potential clients. Our billing department determines your eligibility and benefits for ABA services by contacting your health insurance carrier. Verification of benefits for ABA services does not commit potential clients to services through Baucom Behavioral. To determine your eligibility and benefits for ABA services, complete the Benefits Verification Form below.
Medicaid and ABA Benefits
It’s official – Texas Medicaid includes ABA benefits! As of February 1, 2022, Texas Medicaid includes ABA benefits for individuals diagnosed with autism. In July 2014, the Centers for Medicare & Medicaid Services (CMS) mandated that Medicaid cover medically-necessary services for individuals diagnosed with ASD under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services statute. ABA is a medically-necessary treatment for autism and can help to efficiently and effectively teach communication, coping, self-help, leisure, social, and other important adaptive skills. As of February 1, 2022, Texas Medicaid is in compliance with the 2014 CMS mandate.
Thanks to lobbying efforts of the TxABA Public Policy Group and their supporters, HB1 passed the House, the Senate, and was signed into law by the Governor during the 2019 legislative session. HB1, the state budget plan for 2020-2021, included an additional provision to fund intensive behavioral intervention (IBI; aka ABA). Though Medicaid was projected to rollout ABA benefits summer of 2020, it was after the 87th legislative session in 2021 that loose ends began to sort out.
To begin pre-authorization paperwork for Medicaid to approve ABA services:
- get a copy of your child’s diagnostic evaluation from their doctor or psychologist to document the autism diagnosis (if diagnosis is older than 3 years, must have a doctor reconfirm the diagnosis on a signed and dated document)
- get a signed referral prescribing ABA services from your doctor (MD, PhD, PsyD) dated within 60 days