State-by-State Guide to Insurance Laws Covering the Treatment of ASD with Applied Behavior Analysis

Over the past decade applied behavior analysis (ABA) has become widely-recognized as the most effective therapy for addressing the behavioral issues associated with autism. Thanks to the tireless efforts of applied behavior analysts and other therapists, along with the advocacy groups that work on their behalf, state legislators heard the appeals and responded overwhelming in support of autism insurance reform.

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To make these services fully accessible to families with autistic children and young adults, state legislators throughout the nation moved to classify ABA as a medically necessary form of therapy. This has brought the assurance that medical insurance providers would be required to cover the cost of ABA therapy, brining comfort to families with autistic children.

Amid the groundswell of support and resulting legislation in recent years, insurance laws have been enacted that differ widely from state to state in terms of age restrictions, coverage and visitation limits, and even the qualifications that ABA practitioners must hold in order for their services to be reimbursed.

We understand how important it is for ABAs to have a clear understanding of the insurance laws in their state. This quick reference guide uses clear language to provide the key points most relevant to ABAs and their clients, as well as links to the laws exactly as they were drafted by each state’s legislature.

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Applies to all insurance plans that are delivered to employers with at least 51 employees for at least 50 percent of working days
Coverage is limited to $36,000 maximum per year
No visitation limits
Applies to individuals nine years of age or younger
Practitioner must be a board-certified behavior analyst (BCBA®)

Applies to all insurers in the state, except for fraternal benefit societies or insurers providing insurance to a small employer in the group market with 20 or fewer employees
Coverage limit is subject to copayment, deductible, and coinsurance provisions included in individual health insurance policy
No visitation limits
Applies to individuals 21 years of age or younger
Practitioner must be state licensed and/or nationally certified as a board-certified behavior analyst (BCBA®)

Applies only to certain health insurers in the state
Coverage limit is $50,000 a year for individuals age nine and under; $25,000 for individuals 9-16
No visitation limits
Applies to individuals 16 years of age and younger
Practitioner must be state licensed and/or nationally certified as a board-certified behavior analyst (BCBA®).

Applies to all health benefit plans in the state
Coverage limit is $50,000 annually
No visitation limits
Applies to individuals 18 years of age and younger
Practitioner must be a board-certified behavior analyst (BCBA®) or supervised by a BCBA® and licensed by either Arkansas’s Division of Developmental Disabilities Services of the Department of Human Services or the Arkansas Board of Examiners in Counseling

Applies to all disability insurance plans and all health care service plans that provide hospital, medical, or surgical coverage in the state
Coverage limit may not exceed ABA coverage provided by the Patient Protection and Affordable Care Act
No visitation limits
No age restriction
Practitioner must be licensed or certified by a national entity, such as the Behavior Analyst Certification Board

Applies to all health benefit plans in the state
No coverage limit
No visitation limits
No age restriction
Practitioner must be a licensed physician, psychologist or psychiatrist, hold a doctoral degree in behavior health science and have one year of behavioral therapy experience, or hold the board-certified behavior analyst certification (BCBA®), or hold the board-certified assistant behavior analyst certification and practice under the supervision of a BCBA®

Applies to specified group health insurance policies
No coverage limits
Visitation and non-dollar limits established by individual policies
Applies to individuals 15 years of age and younger
Practitioner must be a board-certified behavior analyst (BCBA®), a licensed psychologist, a licensed physician, or supervised by a BCBA®

Applies to all health insurance plans in the state
Coverage is limited to $36,000 annually
No visitation limits
Applies to individuals age 21 and younger
Practitioner must be a board-certified behavior analyst or working under the supervision of a BCBA®

Applies to specified group health insurance policies and individual plans
Coverage limit is the same as for other treatments/therapies
No visitation limits
No age limits
Practitioner must be nationally certified as a board-certified behavior analyst (BCBA®)

Applies to all health insurance plans and health maintenance contracts, and includes coverage for autism spectrum disorders as well as Down Syndrome
Coverage is limited to $36,000 annually and $200,000 in total lifetime benefits
No visitation limits
No age restriction
Practitioner must be nationally certified as a board-certified behavior analyst (BCBA®)

Applies to state-regulated private insurance companies’ group policies
Coverage is limited to $30,000 annually
No visitation limits
Applies to individuals age six and under
Practitioner must be nationally certified as a board-certified behavior analyst (BCBA®) or working under the supervision of a BCBA®

Applies to all state-regulated health insurance plans
Coverage is limited to $25,000 annually
No visitation limits
Applies to individuals 13 years of age and younger
Practitioner must be a board-certified behavior analyst (BCBA®) and licensed through Hawaii’s Department of Commerce and Consumer Affairs’ Professional and Vocational Licensing Division

Idaho’s insurance laws do not require insurers to cover ABA therapy.

Applies to all individual and group accident and health insurance or managed care plans in the state
Coverage limit is $44,877 per year (figure from 2016; figure to be adjusted annually for inflation)
No visitation limits
Applies to individuals 21 years of age and younger
Practitioner must be a licensed physician or a certified health care professional. Legislation expected to pass in 2017 will require practitioner to hold national certification as a board-certified behavior analyst.

Applies to all group accident and sickness insurance policies in the state
No coverage limit
No visitation limits
No age restriction
Practitioner must be a board-certified behavior analyst (BCBA®)

Applies to all state employee health care plans in the state
Coverage is limited to $36,000 per year
No visitation limits
Applies to individuals age 21 and younger
Practitioner must be a board-certified behavior analyst (BCBA®) or performed by a board-certified assistant behavior analyst under the supervision of a BCBA®

Applies to all health insurance plans that cover medical, surgical or hospital expense coverage in the state
Coverage is limited to 1300 hours for children under 4 and 520 hours for children from 4-12
No visitation limits
Applies to individuals age 12 and under
Practitioner must be a board-certified behavior analyst (BCBA®)

Applies to all state employee health benefit plans and large group health benefit plans in the state
Coverage is limited to $50,000 for children ages 1-7, and $1,000 per month per individual for children ages 7-21.
No visitation limits
Applies to individuals ages 1-21
Practitioner must be a board-certified behavior analyst licensed by the Kentucky Applied Behavior Analysis Licensing Board or a supervisee working under the supervision of a BCBA® or BCaBA®.

Applies to all health insurance policies and health maintenance organizations except those employers with 10 or fewer employees
Coverage is limited to $36,000 per year
No visitation limits
Applies to individuals 21 years of age and under
Practitioner must be licensed or certified by the Louisiana Behavior Analyst Board

Applies to all individual health insurance policies, group health insurance policies, and individual and group health maintenance organization contracts
Coverage is limited to $36,000 per year
No visitation limits
Applies to individuals age 21 and under
Practitioner must be a licensed clinical psychologist, or certified through the Behavior Analyst Certification Board or the Association of Professional Behavior Analysts

Applies to all insurers, health benefit plans, nonprofit health service plans, and health maintenance organizations in the state
No coverage limits
No visitation limits
Applies to individuals age 19 and under
Practitioner must be a board-certified behavior analyst (BCBA®)

Applies to specified individual, group and state employee health plans in the state
No coverage limit
No visitation limits
No age restriction
Practitioner must be a board-certified behavior analyst or supervised by a board-certified behavior analyst

Applies to all individual health policies and health maintenance organization plans in the state
Coverage is limited to $50,000 for children up to age six, $40,000 for children ages 7-12, and $30,000 for children ages 13-18.
No visitation limits
Applies to individuals 18 years of age and younger.
Practitioner must be a psychologist licensed to practice in the state of Michigan