Texas Medicaid

A guide for families navigating autism services in Texas

Texas Medicaid Coverage for ABA Therapy

Texas Medicaid logo

At Behavioral Innovations, we understand that navigating insurance coverage can feel overwhelming – especially when you are focused on getting the right support for your child.

This guide provides essential information on how Medicaid in Texas covers Applied Behavior Analysis (ABA) therapy for children diagnosed with autism. It outlines the eligibility requirements families must meet to qualify for coverage and explains what to expect during the approval process.

In addition, we share practical guidance to help families navigate the complexities of accessing ABA therapy through Texas Medicaid, including understanding documentation requirements, prior authorization, and next steps once coverage is confirmed. Our goal is to help families move forward with clarity and confidence as they pursue autism services for their child.

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What Texas Medicaid Covers

Effective February 1, 2022, the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) added Applied Behavior Analysis (ABA) evaluation and treatment services as a covered benefit for children and youth with an autism spectrum disorder (ASD) diagnosis who are enrolled in Texas Medicaid and meet program criteria.

This benefit means eligible families may access insurance support for medically necessary ABA therapy services designed to help improve communication, behavior, and daily living skills.

Basic Eligibility Requirements For ABA Therapy Through Texas Medicaid

To qualify for ABA coverage under Texas Medicaid:

  • Your child must be enrolled in Texas Medicaid. At Behavioral Innovations, we offer ABA therapy for children aged 18 months to 10 years.
  • There must be a current autism spectrum disorder (ASD) diagnosis documented in the child’s medical record.
  • A valid referral or prescription for ABA therapy must accompany service requests and prior authorization.
  • Prior authorization from the child’s Managed Care Organization (MCO) is typically required before services begin.

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Next Steps

If your child is eligible for Medicaid ABA services:

  1. Verify Medicaid eligibility through your state’s enrollment platform or your plan’s member services.
  2. Obtain a current ASD diagnosis from a qualified clinician.
  3. Request a referral for ABA therapy from your child’s physician.
  4. Contact your Medicaid MCO to begin the prior authorization process.

Our team can help you navigate this process and answer questions about coverage and next steps.

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Start the Process for ABA through Texas Medicaid

Our autism services in Texas are tailored for particular age groups and needs. This approach guarantees that each family receives the appropriate assistance.

We could be the right choice for you if:

  • Your child is aged 18 months to 10 years
  • Your child has received an autism diagnosis or is in the process of getting tested for autism
  • You are looking for organized, center-based therapy for autism

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Receive a Diagnosis

Receiving a formal diagnosis of autism is a requirement of Texas Medicaid.  In need of diagnosis? We can help connect you with leading diagnosing providers in your area. Contact our team for more information.

Schedule an Evaluation

ABA Medicaid FAQs

Yes. As of February 1, 2022, Texas Medicaid includes coverage for medically necessary ABA evaluation and treatment services under the Autism Services benefit for eligible children and youth with ASD.

Yes. A current autism spectrum disorder (ASD) diagnosis is required to access ABA therapy coverage through Medicaid in Texas.

Coverage generally requires:

  • A documented ASD diagnosis
  • A referral or prescription for ABA therapy
  • Prior authorization from the child’s Medicaid MCO before services begin.

When you enroll in Texas Medicaid, you will be given a choice of health plans depending on where you live and the program you’re enrolled in. Each plan has different doctors, hospitals, clinics, benefits, and ratings from members. Texas Medicaid has tools to help you choose the best plan for you and your family.

Our team can assist you with understanding your plan, eligibility, and how to get ABA therapy started. Contact us to learn more about navigating Medicaid and next steps.

You can learn more by calling the Texas STAR Program Helpline at 1-800-964-2777 or your current health plan at the number on the back of your ID card.

Start Process for Texas Medicaid ABA Therapy

If you are exploring autism services for your child, the first step is a brief eligibility review.

After submitting the form, our team will:

  • Review your child’s age and needs
  • Confirm available services at nearby Texas locations
  • Contact you to discuss next steps and answer questions

Note: Services are available for children ages 18 months to 10 years and are designed exclusively for autism.

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    We absolutely LOVEEEEEE BI! Since starting at BI, we’ve seen so much improvement in her! She loves going to see her techs and she always gets so excited to go to “school” 🙂 They’re very easy to communicate with – very sweet and caring!
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    High praise for compassionate and knowledgeable BCBAs and RBTs. My son has shown so much improvement since he started and it’s all because of their hard work and dedication. Behavioral Innovations, thank you for being AMAZING.
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    Behavioral Innovations by far has helped my son tremendously with his autism and navigating this journey and what it will look like for him. We have seen an AMAZING shift with our son since starting ABA therapy here and I highly recommend them!
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    Highly recommend Behavioral Innovations! The staff is kind, attentive, and truly cares about the kids and families they serve. We’ve seen great progress and feel very supported.
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    The staff is amazing and truly shows how much they care. They communicate very well and offer excellent group parenting trainings. They also provide many engaging activities for the kids and actively involve parents.
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