Does Alliance Health Cover ABA Therapy?
Yes. Alliance Health covers ABA therapy for autism with no copay when it's medically necessary, and each service needs approval before it starts. Alpaca Health accepts Alliance Health, checks your benefits for free, and handles the approval paperwork with your BCBA.
How Alliance Health covers ABA therapy
Alliance Health pays for ABA under NC Medicaid's autism benefit, known as research-based behavioral health treatment (RB-BHT).
- Where the rules live: NC Medicaid's Clinical Coverage Policy 8F sets the ABA rules, and its latest update took effect on August 1, 2026.
- What a Tailored Plan is: Alliance Health runs a Tailored Plan, an NC Medicaid health plan for people with more complex needs, such as an intellectual or developmental disability (I/DD) or a serious mental illness.
- Which counties: Alliance Health serves families whose Medicaid comes through Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange, or Wake County, per the state directory.
- Medicaid Direct: If your child has NC Medicaid Direct (Medicaid without a health plan) in those counties, Alliance Health still manages ABA, plus mental health and I/DD services.
- Not sure which you have: We check your child's plan during your free benefits review.
What your child needs to qualify
1. NC Medicaid through Alliance Health
Your child needs active NC Medicaid through Alliance Health. Adults can qualify too, since NC Medicaid extended ABA past age 21 in July 2021.
2. An autism diagnosis
A licensed psychologist or doctor diagnoses autism with a standard test such as the ADOS-2 (a play-based autism test). Children under 3 can start on a provisional (working) diagnosis but need a full one within six months.
3. An assessment and treatment plan
Your child's BCBA tests your child's skills and writes a treatment plan with at least two goals for you as a caregiver. The assessment has to show that ABA is medically necessary (needed to treat your child's autism).
4. A signed service order
By the first day of therapy, a doctor or licensed psychologist must order ABA in writing, based on that plan. This service order is good for one year, so it has to be renewed every year that therapy continues.
How prior authorization works with Alliance Health
This step means getting Alliance Health's approval before ABA is paid for. Your BCBA or care manager sends the request online. Alliance Health's nurses, doctors, and behavioral health clinicians review it using rules the state approves.
- What's in the request: The diagnosis, the assessment, and the treatment plan go to Alliance Health together.
- Up to 16 hours a week: Each approval can last up to 180 days, and every ABA service counts toward those hours.
- Over 16 hours a week: Since an August 2026 rule change, each approval lasts up to 90 days.
- Renewals: Each reauthorization (a renewed approval) needs an updated treatment plan before the current approval runs out.
- Children under 21: Alliance Health can't deny a child's request just because of a plan limit, since EPSDT (the federal rule that Medicaid covers the care children need) requires a closer review.
- Step 1DiagnosisA licensed clinician confirms autism with a validated tool such as the ADOS-2.
- Step 2Assessment approvalAlliance Health approves the BCBA's assessment hours (CPT 97151).
- Step 3Treatment planThe BCBA sets measurable goals for your child and for you.
- Step 4Service order and approvalA physician or psychologist signs a service order, and Alliance Health approves the hours.
- Step 5Progress reviewsAn updated plan goes back to Alliance Health every 90 or 180 days.
What Alliance Health covers for ABA therapy
Your child's BCBA asks for hours under the billing codes (CPT codes) below. Alliance Health reviews each one before it pays.
- Assessments (97151, 97152): The BCBA's assessment and treatment planning, with a technician's help when needed.
- One-to-one therapy (97153): A behavior technician works with your child on the goals in the treatment plan.
- Group sessions (97154): A technician leads group therapy when the treatment plan calls for it.
- BCBA direction (97155): The BCBA works with your child and directs the technician, and at least 10% of technician hours must include this direction.
- Caregiver training (97156, 97157): Coaching for parents and caregivers, alone or in a group, with at least six sessions in every 180 days.
NC Medicaid sets no default number of weekly ABA hours. Instead, your child's plan offers a range of hours that fits their needs, and time in school doesn't count toward it. Providers can't require a minimum unless your child needs it to make progress.
What families pay with Alliance Health
Covered ABA has no copay for your family. NC Medicaid's copay rules exempt members under 21, and behavioral health care has no copay at any age.
- Covered care stays covered: You won't owe anything for covered care, even if Alliance Health later denies the provider's claim, per its member handbook.
- When you could owe: You may have to pay for care Alliance Health doesn't approve, or if you agree ahead of time to pay privately.
- If you get a bill: Call Alliance Health's member services right away, and if you don't owe it, Alliance Health will contact the provider to fix it.
- Other insurance first: If your child also has private insurance, providers bill it before Medicaid.
Where Alpaca Health accepts Alliance Health
Pick North Carolina or your city below to see local BCBAs, in-home options, and the state rules that shape your coverage.
How Alpaca Health handles your Alliance Health benefits
You don't have to call Alliance Health yourself. After you fill out our short intake form, our team checks your child's Medicaid coverage and health plan. We follow up within one business day with what's covered and what comes next.
- Coverage check: We confirm your child's Medicaid is active and whether Alliance Health or another plan approves ABA.
- Approval paperwork: Your BCBA writes the assessment and treatment plan Alliance Health reviews, and we handle the submission.
- A BCBA who takes your plan: We look for an independent BCBA near you who accepts Alliance Health.
Does Alliance Health cover autism testing?
Yes, psychological testing is covered, but testing past a set number of visits needs Alliance Health's approval. A screening checklist alone can't start ABA. If your child doesn't have a diagnosis yet, Alpaca Health offers an autism evaluation and checks your coverage first.
Does my child need the Innovations Waiver to get ABA?
No, ABA is a regular NC Medicaid service, so your child doesn't need a Medicaid waiver. The NC Innovations Waiver adds home and community supports for people with I/DD. Only Tailored Plans like Alliance Health offer it, and eligible people go on a waiting list when its slots are full.
What if my child is in a Standard Plan instead?
Then that plan approves ABA under the same state policy. Standard Plans are regular NC Medicaid health plans, such as AmeriHealth Caritas North Carolina and Carolina Complete Health. If your child qualifies for a Tailored Plan, you can ask to switch.
Can my child get ABA at home or at school with Alliance Health?
Yes, in-home ABA sessions are covered, and so is ABA at school, in a clinic, or in the community. ABA can't replace a teacher or aide, or repeat services in your child's IEP (special education plan). Since August 2026, technician sessions have to happen in person, not by video.
What can I do if Alliance Health denies ABA?
You can appeal within 60 days of the date on the denial letter, and Alliance Health has 30 days to decide. Ask your BCBA to send updated records that show medical necessity (why your child needs the hours). If you still disagree, you can ask the NC Office of Administrative Hearings for a State Fair Hearing.
Check your Alliance Health coverage
Tell us about your child and their Medicaid plan. We'll confirm your Alliance Health benefits, handle the approval paperwork, and look for a BCBA near you who takes your plan.