Key Points:

Virginia Medicaid does cover ABA therapy, but eligibility is tied to specific requirements and diagnoses.
Families must navigate Medicaid Virginia eligibility rules, applications, and documentation to access services.
Knowing which providers offer ABA therapy that takes Medicaid is essential to receiving consistent, quality care.

If you’re a parent or caregiver of a child with autism in Virginia, you may have already heard about Applied Behavior Analysis (ABA) therapy as a recommended treatment. The next big question becomes: Does Medicaid cover therapy in VA, and how do you access it?

Families often begin this search for Medicaid Virginia eligibility during moments of stress, perhaps after receiving a diagnosis or facing waitlists and rising therapy costs. ABA therapy can be life-changing, but for many, the cost without insurance or Medicaid support can be overwhelming.

This guide breaks down everything you need to know about Medicaid for ABA therapy in Virginia. We’ll go over eligibility rules, how to apply, what coverage looks like, and where to find ABA therapy covered by Medicaid.

Let’s start with what Medicaid actually offers in this context.

Does Medicaid Cover ABA Therapy in VA?

Yes, Virginia Medicaid does cover ABA therapy for children diagnosed with Autism Spectrum Disorder (ASD). Coverage falls under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which mandates medically necessary services for individuals under 21.

The inclusion of ABA under Medicaid coverage in Virginia is in alignment with federal requirements. According to the Virginia Medicaid manual, ABA therapy is considered a medically necessary service when specific criteria are met, particularly a documented diagnosis of ASD by a qualified professional.

That said, coverage alone doesn’t mean immediate access. Understanding Virginia Medicaid rules and how they apply to ABA is critical.

Medicaid Virginia Eligibility: Who Qualifies for ABA Therapy?

To access ABA therapy that takes Medicaid, your child must meet certain Virginia Medicaid eligibility requirements. These include:

Age Requirement: Must be under the age of 21.
Diagnosis Requirement: A documented autism diagnosis (using standardized diagnostic tools such as ADOS-2 or CARS).
Medical Necessity: ABA must be deemed medically necessary, confirmed by a licensed physician or psychologist.
Functional Limitations: Documentation showing significant deficits in communication, behavior, or social skills.

Children already enrolled in Medicaid in Virginia do not need to reapply for Medicaid, but must go through an additional step of obtaining service authorization for ABA therapy.

How to Apply for Medicaid in Virginia

If your child is not already enrolled in Medicaid, the first step is the Medicaid application in Virginia.

How to apply for Medicaid in Virginia:

Online: Use the CommonHelp portal to complete the Virginia Medicaid application form.
By Phone: Call Cover Virginia at 1-855-242-8282.
In Person: Visit your local Department of Social Services (DSS) office.
Mail: Download and submit the Virginia Medicaid application form via mail.

When applying, be prepared with the following:

Proof of income
Child’s Social Security number
Citizenship verification
Documentation of disability (if applicable)

To qualify for Medicaid, income limits vary based on household size. A 2025 guideline (subject to annual changes) places the income cap at approximately $43,056/year for a family of 3 (FAMIS Plus and Medicaid combined).

Check with Cover Virginia or DSS for current Medicaid eligibility in Virginia thresholds.

Steps After Approval: Accessing ABA Therapy Covered by Medicaid

Once your child is approved and enrolled in Medicaid, the next phase is securing authorization for ABA services. This involves:

Getting a formal ASD diagnosis from a licensed psychologist or physician.
Obtaining a referral for ABA therapy.
Assessment by a Board Certified Behavior Analyst (BCBA), who will develop a treatment plan.
Submitting the plan to Medicaid for pre-authorization.

Only once all of these steps are complete will services begin.

It’s important to work with ABA therapy providers who accept Medicaid, as not all clinics or BCBAs do. Look for programs explicitly stating they are credentialed with Virginia Medicaid or MCOs (Managed Care Organizations) such as Aetna Better Health, Anthem HealthKeepers, or Optima.

Finding ABA Therapy That Takes Medicaid

Many families face another roadblock after approval: locating ABA therapy that takes Medicaid.

Here’s how to narrow your search:

Use the DMAS Provider Search Tool to find Medicaid-enrolled ABA providers.
Ask your child’s physician or psychologist for referrals to Medicaid-friendly providers.
Call providers directly and ask: “Do you offer ABA therapy covered by Medicaid?”
Ask about waitlists, as Medicaid-covered services can fill up quickly.

Be sure to verify that both the clinic and the individual behavior analyst are approved by Virginia Medicaid.

Understanding the Virginia Medicaid Manual and Rules

The Virginia Medicaid manual outlines the specific processes and requirements for all Medicaid-funded services, including ABA therapy. Key highlights for ABA include:

Only children under 21 are eligible under EPSDT.
Services must be rendered by or under the supervision of a licensed and certified behavior analyst.
ABA must be individualized, not delivered in a group format.
Regular progress reviews and re-authorizations are required.

Familiarizing yourself with these Virginia Medicaid rules ensures that you stay compliant and prepared for re-evaluation periods, which typically happen every 6 to 12 months.

Tips for Navigating the Medicaid Process

Keep records: Document every communication with providers and Medicaid representatives.
Know your deadlines: Reauthorization is time-sensitive; mark dates on your calendar.
Ask questions: Medicaid language can be confusing; don’t hesitate to ask your BCBA or caseworker for clarification.
Stay proactive: If a provider has a long waitlist, get on several at once.

Being proactive and organized can drastically reduce delays in care.

The Autism Benefits in Virginia You Should Know

In addition to ABA therapy Medicaid coverage, Virginia Medicaid also offers:

Speech and Occupational Therapy
Psychiatric and behavioral counseling
Assistive technologies
Respite care (in some waiver programs)

Each of these can support your child’s overall development and long-term success, especially when coordinated with ABA services.

How ABA Therapy and Medicaid Work Together

Virginia offers meaningful support for families through its Medicaid program, especially for children with autism. But the process can feel overwhelming.

From navigating Medicaid Virginia eligibility to choosing a provider, each step requires persistence and planning. Still, the payoff, access to evidence-based, individualized ABA therapy covered by Medicaid, is significant.

Don’t get discouraged by paperwork or waitlists. With the right guidance and resources, Medicaid can provide not just coverage, but a real opportunity for your child to grow, develop, and thrive.

If you’re ready to explore ABA therapy in Virginia or ABA therapy in Maryland, Storybook ABA is here to help. Our team specializes in compassionate, individualized care for children with autism, and yes, we offer ABA therapy that takes Medicaid.

Whether you’re just starting the Medicaid application or already approved and searching for a provider, Storybook ABA can guide you each step of the way. We work with most major Managed Care Organizations and help families navigate coverage and documentation, so your child gets the care they deserve without unnecessary delays.

Reach out to us today to begin your child’s ABA journey in Virginia or Maryland.

Virginia Medicaid Eligibility for ABA Therapy: A Complete Guide