ABA Therapy Glossaryfor Parents
All termsEPSDT
EPSDT is the Medicaid benefit for enrolled children under 21, covering screenings, follow-up diagnosis and treatment that is medically necessary.
What it means
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is the Medicaid benefit for children under 21. Your child must be enrolled in Medicaid to get it. It covers checkups at set ages and screening tests, such as for development, hearing and vision. It also covers tests to follow up when a risk shows up, and treatment to correct or reduce problems that are found.
Under EPSDT, a state must cover what a child needs to correct or improve a condition. It has to be medically necessary and fit one of the federal Medicaid service types. This holds even if the state's own plan doesn't list it. The state makes that call case by case. States can't put hard caps on these services for children. They can use soft limits that your child can go past with prior authorization, meaning the plan's sign-off before services start.
What it looks like for your child
If your child has Medicaid, EPSDT calls for screenings that look for health and developmental issues, such as autism, as early as possible. Federal guidance says applied behavior analysis (ABA) is one way to treat autism, and it doesn't require ABA by name. Still, many parts of an ABA plan can be covered. If the state and your child's provider disagree about what's needed, the state makes the call. You can then appeal through the state's Medicaid fair hearing process.
What to ask your BCBA
- Weekly hour limits: Ask your Board Certified Behavior Analyst (BCBA) whether your state sets a weekly limit on ABA hours and what it takes to go past it.
- Children's Health Insurance Program (CHIP): Ask whether your child's CHIP plan includes EPSDT, since separate CHIP programs vary by state.
- Who handles approvals: Ask who sends prior authorization requests and how you'll hear about decisions.
Does your child have Medicaid and need ABA therapy?
A BCBA can explain what Medicaid needs to see before ABA hours are approved.
Sources
- Medicaid.gov, EPSDT benefit page.
- Centers for Medicare & Medicaid Services (CMS), autism services bulletin, pp. 1 and 4 to 5 (July 7, 2014).
- CMS, EPSDT guide for states, pp. 23 to 24 (June 2014).
- CMS, Medicaid ABA Toolkit, pp. 7 and 54 to 55 (August 2026).
Related terms
Medical necessity and prior authorization
Medical necessity means care is needed to diagnose or treat a condition, and prior authorization is your plan's approval of a service before it begins.
Definition →
Medicaid waiver
A Medicaid waiver is a state program that pays for extra home and community supports for people who'd otherwise need institutional-level care.
Definition →
Treatment plan (comprehensive vs focused ABA)
An ABA treatment plan is the written, individualized plan your BCBA builds before services start, setting goals, methods, weekly hours and a review schedule.
Definition →
ABA assessment (VB-MAPP, ABLLS-R)
An ABA assessment is how a BCBA measures your child's strengths, missing skills and barriers to learning before writing a treatment plan.
Definition →