Maryland Autism Insurance Law

Applied Behavior Analysis (ABA) is one of the most well-researched treatments for autism. Decades of scientific research have shown that ABA can help many autistic individuals build communication, social, daily living, and other important life skills. Because of this strong evidence, ABA is covered by most health insurance plans, including Medicaid, TRICARE, and many private insurance plans.

If your child has autism, Maryland law requires many health insurance plans to cover important autism-related services, including Applied Behavior Analysis (ABA) therapy.

The law also requires coverage for other medically necessary services, such as:

• Psychological services
• Speech therapy
• Occupational therapy
• Physical therapy

How many hours of ABA are covered?

Maryland’s law provides minimum coverage protections based on a child’s age:

• Children ages 18 months through 5 years: Insurance cannot deny coverage simply because a doctor or qualified provider recommends 25 hours or fewer per week of habilitative services.
• Children ages 6 through 18 years: Insurance cannot deny coverage simply because 10 hours or fewer per week are recommended.

This does not mean these are the maximum number of hours your child can receive. Instead, these numbers are a minimum level of protection. If your child needs more services and they are medically necessary, insurance companies may still approve additional hours.

Who can provide services?

Insurance companies may require that services be provided by appropriately licensed or certified professionals, such as licensed behavior analysts and other qualified healthcare providers.

Understanding Your Benefits

If you have questions about your insurance benefits or whether ABA therapy is covered under your plan, we’re here to help. Our team can verify your benefits, explain your coverage, and guide you through the authorization process so you can focus on getting your child the support they need.