How NC Medicaid Covers ABA Therapy: A Complete Guide

NC Medicaid and ABA Therapy

If your child is enrolled in North Carolina Medicaid or NC Health Choice, ABA therapy services are likely covered at no out-of-pocket cost to you. Here’s everything you need to know.

Eligibility Requirements

To access Medicaid-funded ABA therapy in North Carolina, your child generally needs:

• Active enrollment in NC Medicaid or NC Health Choice
• A diagnosis of Autism Spectrum Disorder from a qualified provider
• A medical necessity determination

What’s Covered

NC Medicaid covers a comprehensive range of ABA services:

• Comprehensive assessments and functional behavior assessments
• Individual ABA therapy with a Registered Behavior Technician
• BCBA supervision and treatment planning
• Parent/caregiver training sessions
• Telehealth services for remote parent coaching

The Authorization Process

Most Medicaid-funded ABA therapy requires prior authorization. Here’s how the process works:

1. Referral — Your pediatrician or our intake team initiates the process
2. Assessment — A BCBA conducts a comprehensive evaluation
3. Authorization request — We submit the clinical documentation to Medicaid
4. Approval — Services are authorized (typically 10-40 hours per week)
5. Ongoing reviews — We submit for re-authorization as needed

How We Help

Navigating Medicaid can be overwhelming. Our intake team handles the entire authorization process, communicates directly with your Medicaid plan, and ensures there are no gaps in your child’s care.