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

Other services available instead of or in addition to ABA include:

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

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

Applied Behavior Analysis

Applied Behavior Analysis (ABA) is an approach to improve behavior and skills related to core impairments associated with autism and a number of other developmental disabilities, such as social communication and restrictive behaviors. It uses principles of human behavior, such as reinforcement, to teach social, communication, adaptive, and self-management skills while reducing harmful behaviors.

Providers measure progress using scientific methods to determine if the interventions are effective or if changes to the treatment plan are needed. ABA services are phased out over time as clients make progress. 

ABA therapy is highly individualized and focuses on social significance, which promotes a family-centered, whole life approach. The treatment goals, settings, and hours are recommended based on each person's unique needs.

Eligibility

To be eligible for ABA, the client must first:

• Be evaluated by an Apple Health approved COE provider, and
• 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 COE provider in network, get connected with an ABA case manager, and learn about program benefits.

Client 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 over 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, and
• 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 to take to an ABA provider. 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-services ABA provider directory.

It is common for providers to have waiting lists for services. Contact all ABA providers who accept Apple Health in their area and get on multiple waiting lists to get 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.