Does Med-QUEST Cover ABA Therapy?
Yes. Med-QUEST, Hawaii's Medicaid program, covers ABA therapy for members under 21 with autism when it's medically necessary, and Med-QUEST says this care comes at no cost to you. Alpaca Health accepts Med-QUEST, checks your benefits for free, and handles the approval paperwork with your BCBA.
How Med-QUEST covers ABA therapy
Since 2015, Med-QUEST has required its health plans to pay for ABA for members under 21. Your child has to need it for their health, which Medicaid calls medically necessary.
- Where the rules live: Med-QUEST's ABA guidelines (memo QI-2431) spell out each step, from screening to treatment.
- Part of EPSDT: ABA is an EPSDT benefit (the federal rule that Medicaid pays for the treatment children need until age 21).
- Your child's health plan: Med-QUEST pays QUEST Integration plans to handle most of its members' care, and your child's plan approves and pays for ABA.
- Help finding care: You can ask your child's plan for Health Coordination (help with each step toward ABA) at any time, and the plan must help your child's doctor find a specialist or BCBA.
- Toddlers in Early Intervention: Children under 3 in Hawaii's Early Intervention Program can also get medically necessary ABA from their health plan.
- Not sure which plan you have: We check your child's plan during your free benefits review.
What your child needs to qualify
1. Med-QUEST coverage under age 21
Your child needs active Med-QUEST coverage and must be under 21.
2. An autism diagnosis, or signs of autism
A pediatrician can make the diagnosis, and so can specialists like a psychologist, psychiatrist, or neurologist. If a clinician suspects autism but needs more testing, your child may qualify for up to 26 weeks of ABA first.
3. An assessment and treatment plan
A BCBA licensed in Hawaii, or one of the clinicians who can diagnose autism, tests your child's skills and writes a treatment plan. It lists each goal, how progress will be measured, and the hours needed to reach it.
4. A licensed ABA team enrolled in Medicaid
Your child's BCBA needs a Hawaii license and must be enrolled in Hawaii Medicaid. Trained technicians (RBTs) can run sessions while that BCBA oversees them.
How prior authorization works with Med-QUEST
This step means getting your child's health plan to approve ABA before it's paid for. Screening and the autism diagnosis skip this step, but therapy always needs it. Your child's plan can require it for the BCBA's assessment too.
- What your BCBA sends: The assessment and treatment plan go to your child's QUEST Integration plan before therapy starts.
- Approvals last up to 26 weeks: The BCBA asks for a set number of hours a week for up to 26 weeks, about six months, at a time.
- Renewals without gaps: Each reauthorization (a renewed approval) request goes in at least two weeks before the current one ends, with a progress report on every goal.
- Holding steady counts: Plans keep approving ABA while your child improves or holds steady in social, communication, language, behavior, or daily living skills.
- If the plan says no: You have 60 days from the denial notice to file an appeal, and your BCBA can appeal for you with your written consent.
- Step 1Screening and diagnosisMed-QUEST needs no prior approval for autism screening or the diagnostic evaluation.
- Step 2AssessmentA BCBA assesses your child, with approval first if your QUEST Integration plan requires it (CPT 97151).
- Step 3Treatment planThe BCBA sets measurable goals and the weekly hours each goal needs.
- Step 4Plan approvalYour QUEST Integration plan approves weekly hours for up to 26 weeks.
- Step 5Progress reviewsProgress reports go back to your Med-QUEST plan at least every 26 weeks.
What Med-QUEST covers for ABA therapy
Your child's BCBA asks for hours under the billing codes (CPT codes) below, which come from Med-QUEST's ABA rules.
- Assessments (97151, 97152): The BCBA's assessment, treatment plan, and progress reports, with help from an assistant behavior analyst when needed.
- One-to-one therapy (97153, 97155): An RBT works with your child, and the BCBA joins sessions to change the plan or guide the RBT.
- Group sessions (97154, 97158): Groups of 2 to 8 children, led by an RBT or by the BCBA.
- Caregiver training (97156, 97157): Coaching for parents and caregivers, for your family alone or with other families.
- Severe behavior (0362T, 0373T): Assessment and therapy for children with destructive behavior, with two or more staff in a setting adapted to the child.
Med-QUEST's rules set no weekly hour limit, so your child's weekly ABA hours come from the treatment plan. BCBAs can also ask for extra hours for school-age children when school is out.
What families pay with Med-QUEST
You don't pay for covered ABA. Med-QUEST says its EPSDT care, which includes ABA, comes at no cost to you.
- Other insurance pays first: If your child also has private insurance, that plan pays before Med-QUEST, so tell Med-QUEST about it and ask your health plan how the two work together.
- What Med-QUEST won't pay for: ABA from a family or household member, custodial care (supervision rather than treatment), and ABA given outside Hawaii aren't covered.
How Alpaca Health handles your Med-QUEST benefits
You don't have to call Med-QUEST or your health plan yourself. After you fill out our short intake form, our team checks your child's Med-QUEST 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 Med-QUEST coverage is active and which QUEST Integration plan approves ABA.
- Approval paperwork: Your BCBA writes the assessment and treatment plan your health plan reviews, and we handle the submission.
- A BCBA who takes your plan: We look for an independent BCBA near you who accepts Med-QUEST.
Med-QUEST BCBAs near you
Each clinician below accepts Med-QUEST and works with Alpaca Health. Browse the full provider directory, or fill out the intake form and we'll help you find care.
Eric Geimer, M.Ed., BCBA, LBA, is a licensed behavior analyst with nearly a decade of experience supporting families across Hawaii. Based in Honolulu, Eric holds a master’s in Educational Psychology from the University of Hawaii at Manoa, along with dual undergraduate degrees in History and Interdisciplinary Social Science.
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Jessica Cheeks, BCBA, LBA, is the founder of Behavior Analytics Hawaii, with more than 12 years of experience in homes, schools, and clinics. A parent of children with special needs and a former military spouse, she is especially dedicated to military families.
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Khent Calaguas, MA SpEd., BCBA, LBA, is the founder and clinical director of Kaleido Behavioral Health, with over 12 years of experience in applied behavior analysis and a commitment to neuro-affirming, person-centered care.
Book a consultationView profileDo all QUEST Integration plans cover ABA therapy?
Yes, every QUEST Integration plan follows the same ABA rules. That includes AlohaCare, HMSA, UnitedHealthcare Community Plan, and Kaiser Permanente on Oahu and Maui. ʻOhana Health Plan follows them too, but it leaves QUEST at the end of 2026. Its members move to a new plan on January 1, 2027.
Does Med-QUEST cover autism testing?
Yes. Autism screening and developmental screening are part of your child's EPSDT checkups. Testing to diagnose autism is covered too. Your plan can ask for a referral from your child's doctor first, and extra psychological tests can need approval. If your child doesn't have a diagnosis yet, Alpaca Health offers an autism evaluation and checks your coverage first.
Can my child start ABA before an autism diagnosis with Med-QUEST?
Yes, through a trial of ABA while testing goes on. The clinician who suspects autism asks your child's health plan to approve up to 26 weeks of ABA. The plan can extend the trial after that. The request lists your child's current diagnoses, such as a language disorder or a developmental delay, and how the delays affect your child.
Does my child need a Medicaid waiver to get ABA in Hawaii?
No, ABA is a regular Med-QUEST benefit for members under 21, and it isn't a waiver service. Children in the I/DD waiver (for intellectual and developmental disabilities) still get ABA from their health plan. The waiver adds home and community services that help them live at home.
Can my child get ABA at home or at school with Med-QUEST?
In-home ABA sessions are covered, and so are sessions in a clinic or out in the community. At school, Hawaii's public schools provide the ABA your child needs to learn. Outside school hours, your health plan works with your child's IEP team to set up any other care your child needs.
Check your Med-QUEST coverage
Tell us about your child and their QUEST Integration plan. We'll confirm your Med-QUEST benefits, handle the approval paperwork, and look for a BCBA near you who takes your plan.