Navigating Insurance, Managed Care and Medicaid

Updated: Aug 8, 2019

As an autism parent or educator, it is integral to understand the healthcare benefits being offered. With the laws constantly changing, Yellow Bus ABA is always ready to advise or educate families about their best course of action. ABA therapy for example, can be provided through the DOH (Department Of Health), Early Intervention (NYSEIP) program under special instruction. The Early Intervention program is available only until a child reaches the age of three. Another option, is private insurance or specific medicaid programs. Our insurance and reimbursement specialist made a list of basic information for New York and New Jersey residents .

New Jersey State Reimbursement

Private insurance pays for ABA therapy in New Jersey. Medicaid in New Jersey for behavioral health is provided through CSOC (Children System of Care). PerfomCare is the single access point for providing services through the DCF (Department of Children and Families). Currently medicaid only covers children who are in desperate need of ABA and only through a waiver program. Governor Murphy in his FY19 plan included ABA to be covered completely for all children diagnosed with ASD. In the fall of 2018 Yellow Bus ABA attended the medicaid forum discussing how services will be provided. In March 2019 an SPA (State Plan Amendment) was submitted to the federal government to include ABA therapy in the federal budget. Once the SPA is approved medicaid eligible families will have access to ABA coverage. For more information how to access ABA coverage please email David@yellowbusaba.com

New York State Reimbursement Most private insurance covers ABA therapy in New York. In his 2019 state budget, Governor Andrew Cuomo added ABA as a medically necessary treatment for children diagnosed with ASD. It is still under debate if the service will be covered under the OMH (Office of Mental Health) or OPWDD (Office of Persons With Developmental Disabilities). Currently medicaid does not cover ABA in NY but it looks like in the near future it will be covered. Many managed care medicaid plans although they did not cover ABA in the past have started covering ABA under the 2019 budget addendum. Another great option is the NYCHIP plan. The New York CHIP (Child Health Plus) generally covers ABA with almost no copay or patient responsibilities. Lastly the Family Supports Service may provide grants to pay for this service. For more information how to access ABA coverage please email David@yellowbusaba.com

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