Insurance coverage
Great News for Medicaid Members!
Blue Jay ABA proudly accepts Medicaid for ABA therapy services. Contact us to verify your coverage and begin services.
Verify Your CoverageDoes Medicaid Cover ABA Therapy?
Yes — North Carolina Medicaid covers Applied Behavior Analysis (ABA) therapy for children and adolescents diagnosed with Autism Spectrum Disorder (ASD). ABA therapy is a highly effective, evidence-based treatment that helps children with autism develop communication, social, and daily living skills. Coverage is provided through Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which guarantees medically necessary services for individuals under 21 — including ABA therapy. At Blue Jay ABA, we’re proud to support North Carolina families by providing accessible, Medicaid-covered care.
Coverage details
Key Points About Medicaid's ABA Therapy Coverage
Medicaid Coverage Through EPSDT
EPSDT is a federal Medicaid mandate that requires states to cover all medically necessary care for Medicaid-enrolled children under the age of 21. If your child qualifies for ABA therapy based on medical necessity, NC Medicaid is required to cover the service, even if it’s not explicitly listed in the state plan.
Medical Necessity and Diagnosis
To access ABA therapy through Medicaid
Your child must be under 21 years old
Be enrolled in NC Medicaid
Have a formal ASD diagnosis from a licensed provider (e.g., pediatrician, psychologist)
Have a treatment plan that demonstrates medical necessity
Prior Authorization Required
NC Medicaid requires pre-authorization before ABA therapy can begin. The treatment plan must include:
Diagnostic documentation
Functional assessments
Clearly defined goals and objectives
Recommended service hours and frequency
We handle all of this for you to minimize stress and speed up approval.
ABA therapy may be delivered in
The home
Clinic-based settings
Community or school environments, when appropriate
We’ll help you select the most appropriate and effective setting for your child’s needs.
How it works
How to Get Started With ABA Therapy
- 1
Get a diagnosis
Your insurance provider typically requires a diagnosis from a healthcare provider before starting ABA services.
- 2
Verify Insurance
We simplify everything from insurance verification to enrollment, minimizing paperwork.
- 3
We Assess
Our care begins with a thorough assessment. Our clinical team evaluates your child’s strengths and weaknesses to develop a personalized treatment plan.
- 4
Get Personalized Treatment
Our team of BCBAs and RBTs collaborate to deliver high-quality, convenient care tailored to your child’s needs.
FAQ
FAQs About Medicaid & ABA Therapy
Does Blue Jay ABA Accept North Carolina Medicaid?
ABA therapy for autism is a treatment approach that uses principles of Applied Behavior Analysis to improve social, communication, and learning skills through positive reinforcement and structured techniques. It's tailored to your child’s individual needs, aiming to reduce challenging behaviors and promote positive behaviors in daily life.
What Is Needed to Get ABA Therapy Approved?
To access Medicaid-covered ABA therapy, you’ll need: • A formal ASD diagnosis • Proof of Medicaid enrollment • A pre-approved treatment plan submitted to Medicaid We take care of the documentation and help you through the entire process.
Are There Limits on ABA Services?
Under the EPSDT benefit, there are no hard limits on the number of hours or visits — as long as the services are medically necessary and progress is documented.
What If My Request Is Denied?
If your child’s ABA request is denied, we will: • Review the denial reason • Help collect additional documentation • File an appeal and advocate for your child’s needs We’re committed to helping you access the services your child deserves.
Insurance accepted
Other carriers
More insurance we accept
Start ABA Therapy With Medicaid Today
If your child is enrolled and diagnosed, Blue Jay ABA is here to help them thrive. From verification to daily therapy, we support your family every step of the way.