Maryland Autism Insurance Law

If your child has autism, Maryland law requires many health insurance plans to cover important autism-related services, including Applied Behavior Analysis (ABA) therapy. Insurance companies cannot deny ABA by saying it is “experimental” or “investigational.”

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.

Summary

Maryland has strong insurance protections for children with autism. If your child has a recommendation for ABA or other autism-related therapies, your insurance company generally cannot deny coverage simply because it considers the treatment experimental or because the recommended number of therapy hours falls within the state’s protected minimums. Every child’s needs are different, so the amount of therapy should be based on medical necessity—not an arbitrary limit.