Does Molina Healthcare Cover ABA Therapy?
Yes, through its STAR Medicaid plan in Texas. Molina Healthcare covers ABA therapy for children and youth 20 and younger with autism when it's medically necessary, but its CHIP plan doesn't include ABA. Alpaca Health accepts Molina Healthcare, checks your benefits for free, handles the approval paperwork with your BCBA, and doesn't have a waitlist.
How Molina Healthcare covers ABA therapy
Molina Healthcare of Texas pays for ABA as a Medicaid benefit for members 20 and younger.
- The plan for children: Molina's STAR plan serves children, families, and pregnant women in the Dallas, El Paso, Harris (Houston area), Hidalgo, and Jefferson service areas.
- Same rules as Texas Medicaid: Molina's ABA guidance says the state's Medicaid autism policy is its only test of medical need, and every Texas Medicaid health plan has to follow that policy.
- Part of Texas Health Steps: ABA is part of Texas Health Steps, the state's name for EPSDT (the federal rule that Medicaid pays for the care children need through age 20).
- CHIP doesn't include ABA: The state's Medicaid and CHIP guide says Texas Health Steps isn't a CHIP benefit, so Molina's CHIP plan doesn't pay for ABA.
- No STAR Kids plan: Molina doesn't offer STAR Kids, which children with SSI or certain waivers must join, so those children get ABA through a STAR Kids plan instead.
- Not sure which plan you have: We check your child's plan during your free benefits review.
What your child needs to qualify
1. Molina Medicaid at age 20 or younger
Your child needs active coverage in Molina's STAR plan. The ABA benefit ends on the 21st birthday.
2. An autism diagnosis
A specialist, such as a licensed psychologist or a developmental pediatrician, has to make the diagnosis. They use a standard test like the ADOS-2 (a play-based autism test), and the diagnosis must be from the past 3 years.
3. A referral from your child's doctor
Molina doesn't require referrals for most care, but Texas Medicaid's ABA rules do. Your child's regular doctor can sign it, once for the first assessment and again before therapy starts.
4. An assessment that shows medical necessity
A licensed behavior analyst (LBA) tests your child's skills and writes a treatment plan. A diagnosis alone isn't enough, so the assessment must show medical necessity, which means ABA is needed to treat your child's condition.
5. A behavior analyst enrolled in Medicaid
Only LBAs enrolled in Texas Medicaid can bill for ABA, so a BCBA also needs a Texas license. Licensed assistants and certified technicians can run some sessions under the LBA.
How prior authorization works with Molina Healthcare
This step means Molina has to approve ABA before it pays. Molina's approval rules say it won't pay for care given before approval. Your child's LBA sends each request.
- Every ABA service: Molina's ABA guidance says all ABA services need approval, from the first assessment to weekly therapy.
- What the LBA sends: The assessment, the treatment plan, and the signed referral from your child's doctor go to Molina.
- First approval: Under the state's ABA rules, treatment is approved for 90 days, and one more 90 days can follow if attendance logs and a progress summary support it.
- Renewals every 180 days: After that, each reauthorization (a renewed approval) can cover up to 180 days and needs a new assessment.
- Attendance counts: You and your child are expected to attend at least 85% of planned sessions to keep the same hours.
- Step 1DiagnosisA specialist confirms autism with a standard test, within the past 3 years.
- Step 2Referral and assessmentYour child's doctor signs a referral, and Molina approves the LBA's assessment (CPT 97151).
- Step 3Treatment planThe LBA sets measurable goals for your child and for parent training.
- Step 4Therapy approvalMolina approves the first 90 days of therapy.
- Step 5Progress reviewsAttendance logs and progress summaries go to Molina before each renewal.
What Molina Healthcare covers for ABA therapy
Molina's ABA guidance lists the billing codes (CPT codes) providers can use. Your child's LBA asks Molina for hours under each code.
- Assessments (97151): The LBA gets up to 6 hours to test your child's skills and write the plan, and repeats the assessment every 180 days.
- One-to-one therapy (97153, 97155): A behavior technician works with your child, and the LBA joins some sessions to supervise and adjust the plan.
- Group sessions (97154, 97158): Your child can join a group of 2 to 8 children when the treatment plan calls for it.
- Caregiver training (97156): The LBA leads parent training, with or without your child in the room.
- Team meetings (99366): You can meet with the LBA and at least 2 other licensed professionals up to 2 times a year.
Your child's LBA recommends the weekly ABA hours, and Molina's guidance says the hours should match your child's medical need. Texas Medicaid's guidelines put maintenance programs at 2 to 4 hours a week or less, and intensive programs at more than 20 hours a week.
What families pay with Molina Healthcare
Covered ABA costs nothing with Molina Medicaid. Molina's provider manual says Medicaid members have no copays, deductibles, or coinsurance. Those are the shares of a bill that other plans pass to families.
- No bills for covered care: Providers in Molina's network can't bill you for covered services, and you can't be charged for a missed appointment.
- Check the network first: A provider who isn't in Molina's network can bill you once they've told you they don't take Molina, so check before care starts.
- Other insurance pays first: If your child also has private insurance, providers bill it before Molina, since Medicaid pays last.
- Care Medicaid doesn't cover: A provider can bill you for services outside the benefit, such as ABA aimed at academic goals, after telling you they aren't covered.
Where Alpaca Health accepts Molina Healthcare
Pick Texas below to see local BCBAs, in-home options, and the Texas rules that shape your coverage.
Independent BCBAs around Dallas and Houston, two of Molina's STAR areas, accept Molina Healthcare.
See Texas options →How Alpaca Health handles your Molina Healthcare benefits
You don't have to call Molina yourself. After you fill out our short intake form, our team checks your child's Medicaid coverage and Molina plan. We follow up within one business day with what's covered and what comes next.
- Coverage check: We confirm your child's coverage is active and whether they're in Molina's STAR plan or its CHIP plan.
- Approval paperwork: Your BCBA writes the assessment and treatment plan Molina reviews, and we handle the submission.
- A BCBA who takes your plan: We match you with an independent BCBA who accepts Molina Healthcare and has openings now.
Molina Healthcare BCBAs near you
Each clinician below accepts Molina Healthcare and works with Alpaca Health. Browse the full provider directory, or fill out the intake form and we'll match you.
Heather Miller is a Board Certified Behavior Analyst (BCBA) and the Owner of BrightMinds Texas ABA. Her commitment to compassionate and effective therapy is deeply personal: she is also a parent of a child with Autism Spectrum Disorder (ASD).
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Dr. Tranika Jefferson, Ph.D., BCBA-D, LBA, is a Licensed and Board Certified Behavior Analyst-Doctoral and the Founder and CEO of The Behavioral Wellness Academy, PLLC, serving schools and Home and Community-based Services (HCS) organizations across the Houston, TX metropolitan area.
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Bayli Krasovic, M.A., BCBA, LBA, is a Board Certified Behavior Analyst and co-founder of Unscripted ABA, a practice dedicated to delivering compassionate, evidence-based ABA services to children and their families.
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Christina Nicholas-James, BCBA, is a Board Certified Behavior Analyst and the owner of Infinite Hope ABA. Christina specializes in working with individuals with high-intensity behaviors and in caregiver training, with experience across in-home, clinical, and residential settings.
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Julia Conn, MA, BCBA, LBA, is the owner and founder of Little Bridge Behavioral Health. She has more than 17 years of experience working with individuals on the autism spectrum and is passionate about neuro-affirming practices and self-advocacy skills.
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Kailey Brown is a Board Certified Behavior Analyst and co-founder of Unscripted ABA, a BCBA-owned practice in the DFW area that provides individualized, relationship-focused services in home, school, and community settings.
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Lindsey Lambert, M.S., BCBA, LBA, is a cofounder of Unscripted ABA and a behavior analyst with over a decade of experience across home, school, community, private clinic, and nonprofit settings.
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Sarah Liberty is a Board Certified Behavior Analyst who has worked in the field of behavior analysis for more than ten years, supporting children, teens, and adults across clinic, home, and community settings. She earned her Master's in Applied Behavior Analysis and spent eight years as an RBT before becoming a BCBA, giving her a strong foundation in both direct care and clinical decision making.
Book a consultationView profileDoes Molina CHIP cover ABA therapy?
No, Molina offers ABA only to Medicaid members, so its CHIP plan doesn't pay for it. Texas CHIP does cover speech, physical, and occupational therapy. We can check whether your child has CHIP or Medicaid during your free benefits review.
How long does Molina take to approve ABA therapy?
Molina decides a standard request within 3 business days and an urgent one within 72 hours. Missing records can slow things down, so Molina asks for all of them with the request. The ABA assessment is approved first, and treatment needs its own approval.
What can I do if Molina denies ABA therapy?
You can appeal within 60 days of the denial letter's date, and Molina decides within 30 days. To keep current ABA going during the appeal, file within 10 days, but you may owe for it if you lose. Next, you have 120 days to ask for an outside medical review or a state fair hearing. For a medical necessity denial, your child's BCBA can send records that show the need.
Does Molina cover autism testing?
Yes, for Molina Medicaid members. Texas Health Steps checkups include autism screening at 18 and 24 months. Medicaid also pays for the testing that confirms a diagnosis. If your child doesn't have a diagnosis yet, Alpaca Health offers an autism evaluation and checks your coverage first.
Can my child get ABA at home with Molina?
Yes, Molina covers in-home ABA sessions, and its ABA guidance also lists clinic and community settings. A behavior technician working as a shadow or aide at school isn't covered. The LBA can hold the assessment, parent training, and team meetings by live video, while technician sessions stay in person.
Check your Molina Healthcare coverage
Tell us about your child and their Molina plan. We'll confirm your Molina Healthcare benefits, handle the approval paperwork, and match you with a BCBA who takes your plan.