Cecily Ruttenberg

The Best & Worst States to Live in to get ABA If You Have a Child With Autism

If you have a child on the autism spectrum, where you live has never mattered more. See how your state fares. 


States with Autism benefits 1

Where you live has never mattered more if you have a child with autism! Certain states have passed strong laws requiring insurers to cover autism treatments, while other states have not. A smaller number of states have gone a step further and required that intensive autism treatments be a required benefit in Affordable Care Act plans sold on the state exchange. And finally, while the federal government has told states that their Medicaid programs must offer ABA therapy for children under 21, so far only a handful of states have put this directive into action. Read on to see how your state fares.


Forty two states have now mandated some degree of insurance coverage of autism treatments., however five states in the nation have no such laws and no current plans to introduce laws which allow people with autism to access medically necessary treatments.  Presently, the worst states to live in if you have a child with autism are: Alabama, Idaho, North Dakota, Oklahoma and Wyoming.

Ohio, Tennessee and North Carolina each have either introduced autism health insurance legislation or are in the process of doing so (from Autism Speaks). If you live in a state without a benefit, the only way to receive ABA is to work for an employer that voluntarily offers the benefit, or to obtain it through the school district, which frequently involves a protracted legal fight. 

Utah, Hawaii, Mississippi, and Georgia have all passed legislation which becomes active in January, 2016, though all have opted out of offering the benefit through their their exchanges.


*Laws are constantly changing. Email us if something has changed and we missed it!  

ABA in ACA plans


ABA for Medicaid
AK X X  in 2016
AZ X X  
AR X X  
CO X X  X (in 2016 and currently through waiver)
CT X (financial limits by age groups) X X
DE X X  
DC X  (through waiver with age limits)
FL X   X
GA X (with age limits, 2016)    
HI X    
IL X X  
IN X X  
IA X    X (in 2016)
KS X    
KY X X  
LA X (financial limits) X X
ME X (age limits) X  X
MD X X  
MI X  X  (with waiver to age 6)
MN X X (in 2016) X (multiple waivers)
MS  (In progress)    
MO X X  X (in 2016)
MT X X  
NE X    
NV X X X (begin 2016)
NH X X  
NJ X X  
NM X (financial limits) X X
NY X X  
OH   X  
PA X   X
RI X   X
SC X   X
SD X (only MA level)    
TX X X  
UT In effect 2016   X (2016)
VT X (age limits) X X
VA  X   X
WV X  X  X
WI X X  X (2016)

Very low-income families on Medicaid, despite their low socioeconomic status, may fare better in some states than their higher wage earning peers. In July 2014, the Centers for Medicaid and Medicare released guidance that ABA therapy must be offered to children under 21 across the nation, as part of the federal statute Early Periodic Screening Diagnosis and Treatment. This is a huge boon to low-income families impacted by autism as well as children who may qualify for Medicaid based on the degree of their disability. CMS has stressed that care must not be denied or delayed, and has suggested that all states must be in compliance by 2019.  

To date, California, Connecticut, Florida, Louisiana, Massachusetts, New Mexico, Oregon, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia and Washington are offering or in final stages of establishing EPSDT services for autism treatments through their Medicaid programs.  Washington D.C. offers some ABA through Medicaid with age limits, as does Michigan to age 6. Some of this coverage has been the result of litigation. Some states offer behavior intervention through Medicaid waivers, which waive traditional income requirements, rather than due to the recent Federal directive. Connecticut's implementations is questionable, as autism advocates argue that the state’s strict requirements—such as requiring a licensed caregiver to be present at all times during treatment-create too high a barrier to access. Tennessee’s Tenncare offers ABA, but require BCBA’s (board certified behavior analysts) only, not line therapist, which makes it nearly impossible to implement. South Carolina has begun offering the benefit but there are problems with implementation. West Virgnia is technically offering the benefit but obstacles exist to getting providers on board. Some states have only been able to offer it in limited geographic locales. 

California Alabama
Massachussetts Idaho
Oregon North Dakota
Washington Oklahoma

(This article compares states by their autism insurance coverage laws. It does not take into account school district and other autism services.)

Implementation for Medicaid through EPSDT in other states is a moving target. A number of states including Texas, New York, Utah, Montana and Georgia are in implementation discussions with their state Medicaid departments. Still other states are handling claims on a case by case basis or providing some coverage through Managed Care Organizations. Improved and more formalized coverage will likely occur in the coming year but will require sustained and consistent efforts. Autism Speaks has taken an active role in advocating for full and prompt compliance with EPSDT coverage requirements. “Kids on Medicaid are entitled to medically necessary treatments under the law regardless of what state they happen to live in” said Dan Unumb, Executive Director of the Autism Speaks Legal Resource Center.


Twenty-nine states have not only passed autism insurance mandates requiring private insurers to offer ABA therapy in state regulated plans, but they have also opted to mandate the benefit in Affordable Care Act plans sold on the exchange. These states are Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Texas, Vermont, West Virginia, Washington and Wisconsin (from Autism Speaks). Minnesota will require ABA in its Affordable Care Act plans, but not until 2016 .

Among the states, some laws mandate treatment without limitation, while others set age caps, limits on hours per week, and annual financial limits. Maine, for example, only requires insurers to provide the behavioral therapy Applied Behavior Analysis (ABA) until a child is 10-years-old, -- this represents improvement over their initial law, which mandated services until age 6. Nebraska has capped the hours of ABA at 25 per week. The status of these limits is somewhat in flux, however, as the ACA prohibits financial limitations on essential health benefits and other limits are increasingly being challenged and in many cases withdrawn in light of state and federal mental health parity requirements. Also, thanks to advocacy efforts of Autism Speaks, several state legislatures have recently or are in the process of expanding their mandates to treat children up to an older age, to provide more hours, or cover the individual market. (Kansas, Maine, South Carolina, Virginia). Many states only mandate ABA for employers with more than 50 employees. Autism Speaks is advocating that these mandates be re-examined and re-applied to include all with state regulated plans. The specifics of the mandates differ in each state.


Of the 29 states listed above, California, Massachusetts, Oregon, and Washington hold the distinction of the best states to live in if you have a child with autism. Each of these states:
1. Mandates ABA with no age cap, visit or financial limits.
2. Offer the ABA benefit on their ACA plans
3. Has or are in the final stages (MA) of implementing an ABA benefit for Medicaid through EPSDT.

(Disclaimer: Unfortunately, there are often bureaucratic and administrative obstacles to accessing benefits; however these states have the best laws in place with regards to insurance.)


The remaining states have passed autism health insurance mandates requiring private insurers to offer ABA therapy, however these states opted not to offer ABA in their Affordable Care Act plans. The states are Kansas, Minnesota, Iowa, Pennsylvania, Florida, South Carolina, Mississippi, Georgia, Hawaii and Virginia. In some of these states (Florida, Pennsylvania, South Carolina), the mandate only applies to state-regulated plans with 50 or more employees. This is often a small piece of the pie.

April is Autism Awareness month and a good time to assess where the nation stands. The latest numbers from the Centers for Disease Control and Prevention report that 1 in 68 children have an autism spectrum disorder (ASD). This number is up from 1 in 88 children in 2012. Applied Behavior Analysis is still the strongest, evidence-based treatment proven to make a difference in children with autism. “Without these therapies, states will pay more and pay later, by missing the early intervention window to maximize potential,” said Dr. Karen Fessel, Executive Director of the Autism Health Insurance Project. “We applaud the states that have passed autism health insurance mandates and chosen to offer ABA in their health exchanges and through Medicaid.”

The Autism Health Insurance Project is a nonprofit organization that helps families and providers secure insurance coverage for interventions related to autism and mental health disorders. On a sliding scale fee, we act on behalf of families, filing appeals and grievances with health plans and state regulators in order to secure coverage of all needed treatments entitled by law.

*If you have specific questions leave them in the comments field and we will be sure to respond. 




Read 112720 times Last modified on Wednesday, 09 September 2015 12:31


  • Amy
    Amy Friday, 25 December 2015 20:52 Comment Link

    How can Washington State be one of the best? We lived there for 11 years. Could not get Medicaid for our son because we made too much, however, our regular insurance would not cover his pull ups nor ABA once I retired. The school system was not great either-suspending him for things that were in his IEP. The Dept of Developmental Disabilities was a joke. The waiting list was decades long-not exactly an over exaggeration when you consider he would get bumped down the list constantly, plus they actually told us that it would not be until he is an adult before he would likely get services. We moved to PA. Had Medicaid for him within 30 days (it is based on diagnosis), got a prescription for pull ups from his pediatrician, we get in home support staff for about 20 hours per week, he attends an approved private school for autistic children that is no cost to families, I could go on and on. He has things set in motion for when he is an adult as he is already in the system and receiving waiver services. We have had a significant amount of help since moving to PA. We had nothing besides a few hours of ABA in Washington. I don't get how the article figures this out.

  • sarah
    sarah Tuesday, 08 December 2015 15:40 Comment Link

    I'm trying to get some questions answered about this new law... How many hours of ABA therapy can my kids get Iin Utah per week? Does it depend on a doctor's evaluation? (considering they already have a diagnosis)? Can one insurance provider offer more hours than another? I just want to make sure I'm getting the best plan possible. Thanks!

  • Stephanie
    Stephanie Tuesday, 27 October 2015 11:38 Comment Link

    I would greatly appreciate more info on autism therapies, wait lists etc in Texas if that's at all possible.

  • T. Page
    T. Page Tuesday, 20 October 2015 11:43 Comment Link

    This information is inacurate. ND does cover forms of ABA in the autism waiver (they must be evidence-based) and they are working on puting this into the state plan (Medicaid) to go into effect early next year (pending CMS' federal approval.) FL had a lawsuit, so it is covered there (not sure if their approval is still pending), VA has always had it in their state Medicaid services... I'm not saying there isn't always MORE that can be done, but Alaska only has limited diagnosticians in the entire state, so no matter how many BCBA's and insurance coverage you can get, determining medical necessity would be a bugger. MN and OR both have their Medicaid coverage draft into CMS and are awaiting approval. HI also had a lawsuit and is now covering services (or ammending and waiting on CMS to provide those services) and OH just got slapped with a class-action suit b/c their coverage wasn't actually covering everyone. I agree that where you live IS critical... but I wouldn't go off an article that could be out-of-date the day after it is published. Things are just changing too fast right now

  • Emily
    Emily Tuesday, 13 October 2015 23:23 Comment Link

    I live in Arlington TX, my 2 almost 3 year old son needs ABA therapy. The school system is saying they do not offer it. My company health plan does not cover it. What are my options for treatment?

  • Sayantan Sen
    Sayantan Sen Thursday, 08 October 2015 13:58 Comment Link

    I have medical insurance from my employer. I base location is California, but my employer headquartered at New York State. It seems that due to that reason insurance provider is not covering any of the behavioral therapy. How can I proceed?

  • maria
    maria Wednesday, 30 September 2015 08:34 Comment Link

    My 3 yr old son was diagnosed with autism 5 months ago, he is currently enrolled in an early intervention program in a public school here in florida where he receives ot, pt and st therapy which are all covered by Florida kidcare however they do not want to cover aba therapy because im on the highest plan. What should i do?

  • Raquel
    Raquel Saturday, 12 September 2015 14:40 Comment Link

    I was told that every school district has at least one BCBA and can offer Aba therapy but it might take some fighting. I can get Aba through Medicaid however there's a wait list and I'm trying to get him something in the meantime. I have considered getting a secondary insurance thru the ACA but I wanted to see my other options before signing up. Any info would help we live in Houston Texas in the HISD district. Thanks!

  • Autism Health Insurance Project
    Autism Health Insurance Project Thursday, 03 September 2015 13:29 Comment Link

    ORG, Your best bet if you live in New York is to buy a plan on the exchange, AND make an appointment with your HR department to encourage them to offer the ABA benefit voluntarily. There is info on our website including a sample letter and a PPT to present to your HR dept under self-insured plans. Meanwhile you are lucky that NY offers ABA in its exchange plans. Open enrollment is coming up Nov. 2015. Good luck. Feel free to email us directly if you have other questions.

  • Mary
    Mary Monday, 31 August 2015 21:59 Comment Link

    We are considering moving to Austin from Utah because we heard they had better resources and unlimited ABA for kids under 10. Can anyone verify if this is true?


Leave a comment

Make sure you enter all the required information, indicated by an asterisk (*). HTML code is not allowed.