Does Medicaid Cover ABA Therapy in Maryland? Here’s What You Need to Know

Meta Description: Discover which ABA therapy services are covered by Medicaid in Maryland, including eligibility, approved providers, and how to access care for your child.

Key Points:

• Maryland Medicaid covers ABA therapy services for children with autism under specific conditions and provider requirements.
  
• Coverage is available through the Autism Waiver and Maryland’s EPSDT benefit, but eligibility criteria and provider networks matter.
  
• Parents need to ensure services are delivered by a Maryland Medicaid provider to receive full coverage and avoid unexpected out-of-pocket costs.

Understanding ABA Therapy and Medicaid Coverage in Maryland

When your child is diagnosed with autism, one of the first recommendations you may hear from healthcare providers is Applied Behavior Analysis (ABA) therapy. It’s widely used to help children with autism build communication, behavioral, and daily living skills.

But ABA therapy is also expensive. Naturally, many families in Maryland turn to Medicaid for help. You may be asking: Does Medicaid cover ABA therapy in Maryland? Where can I find ABA therapy that accepts Medicaid near me?

This article will break down exactly what ABA therapy services are covered by Medicaid in Maryland, who qualifies, and what steps you can take to access care without financial strain.

What Is Covered: ABA Therapy Medicaid Services in Maryland

Maryland Medicaid does cover ABA therapy services for children diagnosed with Autism Spectrum Disorder (ASD). Coverage typically falls under two main pathways:

1. Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
   
2. Maryland Autism Waiver (administered by the Maryland State Department of Education)

EPSDT Coverage

The EPSDT benefit is a federal Medicaid mandate that requires states to cover any medically necessary treatment for children under 21, including ABA therapy.

Under EPSDT, ABA therapy is covered as long as:

• The child is under 21 years old.
  
• The service is deemed medically necessary by a licensed provider.
  
• The provider is enrolled as a Maryland Medicaid provider.

ABA services under EPSDT typically include:

• Functional Behavior Assessments (FBA)
  
• Behavior Intervention Plans (BIP)
  
• Direct 1:1 ABA therapy sessions
  
• Parent training
  
• Supervision by a Board Certified Behavior Analyst (BCBA)

Parents must ensure they are working with an ABA therapy provider in Maryland who accepts Medicaid. Otherwise, they risk partial coverage or full out-of-pocket responsibility.

Autism Waiver Program

The Maryland Autism Waiver is another path through which children with autism may receive ABA therapy Medicaid coverage. It provides intensive services to children in their homes and communities, including:

• Respite care
  
• Intensive individual support services (IISS)
  
• Family consultation
  
• Therapeutic integration

While the Autism Waiver offers broader support than just ABA therapy, it is not automatically available. The waiver has a limited number of slots, and families must go through an application process, which includes a waitlist.

Tip: If your child is diagnosed, get on the Autism Waiver Registry as soon as possible, even if you’re currently accessing services through other Medicaid pathways.

Eligibility: Can a Child With Autism Get Medicaid in Maryland?

Many parents ask, Can a child with autism get Medicaid even if we have private insurance? The answer is yes, in some cases.

There are two main eligibility routes:

1. Income-Based Medicaid – For families meeting the income criteria based on household size.
   
2. Medicaid for Disabled Child (SSI-related Medicaid)

• If a child meets the Social Security Administration’s criteria for disability, they may qualify for Medicaid regardless of parental income.
• Autism is often recognized as a qualifying disability if it results in functional limitations.

Families should contact their local Maryland Department of Social Services or visit the Maryland Health Connection website to explore options.

Finding ABA Therapy That Accepts Medicaid in Maryland

Even if Medicaid covers ABA therapy, not all providers accept Medicaid. Searching for “ABA therapy near me that accepts Medicaid” often leads to confusing or incomplete results.

Here are the steps to make the process smoother:

1. Search Medicaid Provider Directories
   

   • Use the Maryland Medicaid provider directory to find licensed providers.
     
   • Contact providers directly and ask if they accept Medicaid for ABA services.
     

2. Ask Your Pediatrician or Developmental Specialist
   

   • Many professionals are familiar with ABA Medicaid providers and can offer referrals.
     

3. Verify the Medicaid Billing Credentials
   

   • Ensure the clinic or BCBA is an approved Maryland Medicaid provider.
     
   • ABA services must be delivered by a provider authorized to bill Medicaid or they won’t be reimbursed.
     

4. Confirm Services in the Maryland Medicaid Fee Schedule
   

   • Review the Maryland Medicaid fee schedule to understand what services are reimbursable under ABA.
     
   • This can help ensure your child is receiving covered services and help avoid denials.

What to Expect From ABA Therapy Covered by Medicaid

ABA therapy covered by Medicaid in Maryland will include structured programs that may occur in the home, clinic, school, or community settings.

Key components often include:

• Assessment and goal setting by a BCBA
  
• Ongoing data collection and progress tracking
  
• Behavior interventions customized to your child
  
• Family and caregiver training

The intensity of services varies, but many Medicaid-covered plans offer up to 10–40 hours of ABA therapy per week, depending on the child’s needs.

Providers must regularly justify the medical necessity of ongoing services through updated treatment plans and documented progress.

Common Challenges and How to Navigate Them

While it’s encouraging that ABA therapy Medicaid coverage is available, families can still face some hurdles:

• Waitlists for Autism Waiver Services
  
  • Solution: Enroll early and seek EPSDT services in the meantime.

• Difficulty Finding ABA Therapy That Accepts Medicaid
  
  • Solution: Start your search with known Maryland Medicaid providers and verify their credentials.

• Limited Provider Availability in Rural Areas
  
  • Solution: Ask about telehealth ABA therapy or hybrid services. Some Medicaid plans now cover remote options.

• Gaps in Coordination Between Medicaid and Schools
  
  • Solution: Work with your child’s IEP team to ensure Medicaid-based ABA therapy aligns with educational goals.
    

Wrapping Up: ABA Therapy Coverage Through Maryland Medicaid

Accessing ABA therapy in Maryland through Medicaid can be life-changing — but it does require careful navigation. Medicaid does cover ABA therapy through EPSDT and the Autism Waiver, but only if you work with the right providers and follow the necessary documentation and eligibility steps.

Whether you’re wondering whether Medicaid covers ABA therapy? Or looking for ABA therapy near me that accepts Medicaid, know that help is available. You’ll need to be persistent and well-informed, but your child can get the services they need with the right guidance.

If you’re searching for ABA therapy that accepts Medicaid in Maryland or Virginia, Storybook ABA offers compassionate, customized care that meets your child’s needs. Our team of credentialed professionals is Medicaid-approved and experienced in helping families navigate the process from start to finish.

From behavior assessments to parent training and ongoing ABA sessions, our services at Storybook ABA are eligible under Medicaid, and we’ll help you every step of the way. Whether you’re already enrolled in Maryland Medicaid or just beginning the journey, we’re here to support your family.

Contact us today to learn more about our ABA therapy services in Maryland and Virginia and schedule a consultation.