ABA therapy cost in Maryland, and what Medicaid pays

For Maryland families with Medicaid, ABA therapy for children and young adults under 21 is covered when it is medically necessary and approved by Carelon Behavioral Health. Without that coverage, the cost of ABA depends mostly on how many hours a week your child needs and how much of that time is with a board certified behavior analyst versus a behavior technician.

What drives the cost of ABA

• Hours per week. ABA plans are built around a set number of hours, which is the biggest driver of cost.
• Who delivers each hour. Sessions are run by behavior technicians, while assessment, planning and supervision are done by a BCBA.
• Assessment and reassessment. Plans start with an assessment and are reviewed before each new approval period.
• Caregiver training. Parent and caregiver training is part of good ABA plans.
• How long treatment lasts. Plans include goals for transition, fading and discharge.

How Maryland Medicaid covers ABA

Maryland Medicaid covers medically necessary ABA for members under 21. Carelon Behavioral Health manages it and must approve ABA before sessions begin. Approvals last up to 180 days, and the child is reassessed before each new approval.

To qualify, your child needs an autism spectrum disorder diagnosis from a comprehensive diagnostic evaluation and a referral for ABA from a qualified health care professional, such as a developmental pediatrician, child psychiatrist, psychologist, pediatrician or nurse practitioner. Some children also need a Clinical Confirmation Form, depending on age and date of diagnosis.

Questions to ask any ABA provider about cost

• Do you request the Medicaid or insurance approval for me?
• How many hours do you expect to recommend, and how is that decided?
• Are sessions at home, in a center, or both?
• Can you staff my child's sessions where we live, and when?
• Will I get a Good Faith Estimate if I pay myself?

ABA with Hearthway

Hearthway provides in-home and community ABA through Maryland Medicaid, led by a BCBA. Our office requests Carelon approval, and we confirm staffing for your area before scheduling.

At Hearthway

In-home ABA therapy

Applied behavior analysis in your home and community, led by a board certified behavior analyst, for Maryland Medicaid children and young adults under 21 with autism.

Questions about your situation?

Talk to our office, Monday to Friday, 9 to 5.