Applied Behavior Analysis

Autism Spectrum Disorder and other developmental and intellectual disabilities

There are many types of treatments available for Autism Spectrum Disorder and other developmental and intellectual disabilities. Treatments usually fall under:

• Behavior and communication approaches
• Dietary approaches
• Medication
• Complementary and alternative medicine

Applied Behavior Analysis (ABA) is a behavior treatment approach covered by Apple Health (Medicaid) for clients who qualify.

You may qualify for other services, including:

• Speech and language services
• Physical therapy
• Occupational therapy
• Sensory integration

Additional information about these therapies can be found under habilitative and rehabilitative services. 

Applied Behavior Analysis

Applied Behavior Analysis (ABA) helps people with autism and other developmental disabilities improve important skills. It teaches social, communication and self-care skills while reducing harmful behaviors. ABA uses proven methods, like rewards, to encourage learning.

Providers track progress using science-based tools. They adjust treatment plans if needed. ABA services slowly decrease as people improve. 

ABA therapy is personalized and focuses on what matters most in daily life. Goals, settings, and hours depend on each person's needs.

Eligibility

To be eligible for ABA, clients must:

• Be evaluated by an Apple Health approved COE provider.
• Receive a prescription for Applied Behavior Analysis therapy.

Accessing services

Step 1: Choose a Center of Excellence (COE) provider

Clients enrolled in managed care can contact their plan for assistance finding a Center of Excellence (COE) provider in network, get connected with an ABA case manager, and learn about program benefits.

Clients not enrolled in managed care can choose a provider from our Centers of Excellence provider list.

• Clients 20 years of age and younger must see an ABA COE provider.
• Clients 21 years of age and older must see a neurologist, psychiatrist or psychologist.

Step 2: Diagnostic evaluation and ABA order

The COE provider will:

• Complete a comprehensive diagnostic evaluation.
• Recommend a multidisciplinary treatment plan.
• Order ABA therapy if appropriate.

If a COE provider determines a client may benefit from ABA therapy, they will provide the client, caregiver, or family with a copy of their evaluation and order. Clients should bring the evaluation and order to their ABA provider.

Step 3: Find an ABA provider

Clients enrolled in managed care can contact their plan for help finding an ABA provider in network.

Clients not enrolled in a managed care plan can choose a provider from the Apple Health fee-for-service ABA provider directory. (Directorio de proveedores de tarifa por servicios de Apple Health en español.)

It is common for providers to have wait lists for services. Contact all area ABA providers who accept Apple Health and get on multiple wait lists to schedule the first available appointment.

Step 4: Access ABA services

Your ABA provider will:

• Complete intake assessments,
• Develop an individualized treatment plan, and
• Request prior authorization for ABA services.

ABA services can start when authorization is complete.