Autism Insurance Coverage USA — 2026 Guide
State Autism Insurance Mandates
All 50 states have autism insurance mandates as of 2025. Coverage varies significantly. Most states cover ABA therapy up to age 21, some to age 18, some no age cap.
Federal Coverage
- Medicaid covers ABA in all 50 states via EPSDT
- Medicare limited BH coverage (not typically ABA)
- TRICARE covers ABA for military dependents
- ACA marketplace plans must cover ABA in autism-mandate states
Commercial Insurance Coverage
- Fully-insured plans MUST comply with state mandate
- Self-funded ERISA plans EXEMPT from state mandate (can deny ABA)
- MHPAEA federal parity applies to self-funded plans
Common Coverage Denials
- Not medically necessary (missing DSM-5-TR criteria documentation)
- Not evidence-based (must document ABA methodology)
- Age cap exceeded (state-specific)
- Prior auth expired
- Insufficient supervision documentation
ABA Billing Services · Revenant Care
– KD, Revenant Care