Does Texas Medicaid Cover ABA Therapy?
Yes. Texas Medicaid covers ABA therapy for children and youth 20 and younger with autism when it's medically necessary, and families don't pay for covered services. Alpaca Health accepts Texas Medicaid, checks your benefits for free, handles the approval paperwork with your BCBA, and doesn't have a waitlist.
How Texas Medicaid covers ABA therapy
Texas Medicaid has paid for ABA since February 1, 2022, whether or not your child has a health plan.
- Where the rules live: Texas Medicaid's provider manual holds the ABA rules, and a 2022 notice requires every Medicaid health plan to follow them.
- Part of Texas Health Steps: ABA falls under Texas Health Steps, the state's name for EPSDT (the federal rule that Medicaid pays for the treatment children need, through age 20).
- Health plans: Children in STAR, STAR Kids (for children with disabilities), or STAR Health (for children in state care) get ABA through their Medicaid health plan.
- Traditional Medicaid: For children without a health plan, TMHP, the state's Medicaid claims administrator, reviews ABA requests.
- Not sure which you have: We check your child's plan during your free benefits review.
What your child needs to qualify
1. Medicaid coverage at age 20 or younger
Your child needs active Texas Medicaid and must be 20 or younger. Coverage under this benefit stops on the 21st birthday.
2. An autism diagnosis
Only a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or diagnostic team can diagnose autism for this benefit. They use a standard test such as the ADOS-2 (a play-based autism assessment), and the diagnosis must be from the past 3 years.
3. A referral from your child's doctor
Your child's doctor signs a referral for the ABA evaluation and again for treatment. It can come from your child's primary care provider.
4. An evaluation and treatment plan
A Licensed Behavior Analyst (LBA) tests your child's skills and writes a treatment plan. A diagnosis alone isn't enough, so the evaluation must show ABA is medically necessary (needed to treat your child's condition).
5. A licensed ABA team
Only licensed behavior analysts can bill Texas Medicaid for ABA, so a BCBA also needs a Texas license. The LBA can have licensed assistants and certified technicians run some sessions.
How prior authorization works with Texas Medicaid
This step means getting Medicaid's approval before ABA is paid for. Your child's health plan reviews the request, or TMHP does if your child has traditional Medicaid.
- Who sends it: Your child's LBA submits the evaluation and treatment plan, along with a request form your child's doctor signs.
- First approval: Treatment is approved for 90 days, and one 90-day extension can follow if attendance logs and a progress summary support it.
- Renewals every 180 days: After the first 180 days, each reauthorization (a renewed approval) can cover up to 180 days and needs a new evaluation plus a diagnosis from the past 3 years.
- Attendance counts: You and your child are expected to attend at least 85% of planned sessions, or the LBA must explain why the same hours are still needed.
- Breaks restart the process: If ABA stops for 180 days or more, the next request starts over as a new one.
- Step 1DiagnosisA specialist confirms autism with a standard test, within the past 3 years.
- Step 2Referral and evaluationYour child's doctor refers you, and Texas Medicaid approves the LBA's evaluation (CPT 97151).
- Step 3Treatment planThe LBA sets measurable goals for your child and for parent training.
- Step 4Therapy approvalTexas Medicaid approves the first 90 days of therapy.
- Step 5Progress reviewsAttendance and progress go back to Texas Medicaid before each renewal.
What Texas Medicaid covers for ABA therapy
Your child's LBA asks for a set number of hours under the billing codes (CPT codes) below.
- Evaluations (97151): The LBA's assessment and treatment plan, up to 6 hours, repeated every 180 days.
- One-to-one therapy (97153, 97155): A behavior technician works with your child, and the LBA joins sessions to adjust the plan and supervise.
- Group sessions (97154, 97158): Groups of 2 to 8 children when the treatment plan calls for it.
- Caregiver training (97156): Coaching for parents and caregivers, with or without your child in the room.
- Team meetings (99366): Up to 2 meetings a year where the LBA and at least 2 other licensed professionals meet with you.
Your child's LBA recommends the weekly ABA hours in the treatment plan. Medicaid's guidelines run from 2 to 4 hours a week to maintain skills, up to more than 20 for intensive programs. Direct therapy is limited to 8 hours a day.
What families pay with Texas Medicaid
Covered ABA costs your family nothing. Under Medicaid's member rights, providers can't charge copays or any other amount for covered care.
- No deposits or no-show fees: Under Texas Medicaid's billing rules, providers can't ask for a down payment for covered care or charge you for a missed appointment.
- Private insurance pays first: If your child also has private insurance, it's billed before Medicaid, and under Medicaid's other-insurance rules, a provider who takes Medicaid can't bill you for the balance or copays on covered services.
- Services Medicaid doesn't cover: You can be billed for these, such as ABA aimed at academic goals, and providers should tell you before care starts.
Where Alpaca Health accepts Texas Medicaid
Pick Texas or your city below to see local BCBAs, in-home options, and the Texas rules that shape your coverage.
How Alpaca Health handles your Texas Medicaid benefits
You don't have to call Texas Medicaid 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 which health plan, if any, approves ABA.
- Approval paperwork: Your BCBA writes the evaluation and treatment plan Texas Medicaid reviews, and we handle the submission.
- A BCBA who takes your plan: We match you with an independent BCBA who accepts Texas Medicaid and has openings now.
Texas Medicaid BCBAs near you
Each clinician below accepts Texas Medicaid and works with Alpaca Health. Browse the full provider directory, or fill out the intake form and we'll match you.
Alicia Smith is a Board Certified Behavior Analyst and the founder of Sensory Support Solutions PLLC, where care is rooted in cultural competence, family, and the lived experiences that shape each treatment plan.
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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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Bridget Peyton is a Board Certified Behavior Analyst and the founder of Wildflower Wellness and Behavior. She helps families work through daily routine struggles, put self-care strategies in place, and learn evidence-based behavior change practices that restore a balanced lifestyle filled with meaningful relationships.
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Cheryl Durgin is a Board Certified Behavior Analyst and educator with over 25 years of experience supporting children, families, and schools in building meaningful, lasting skills for life.
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Connie L. Green, M.Ed., BCBA, LBA, is the founder of Thrive and Shine ABA Services in Coppell, Texas, where she supports children, teens, and adults in home, community, and transitional settings. She focuses on young adults building independence.
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DeTrevion B. James is a Board Certified Behavior Analyst (BCBA) and Licensed Behavior Analyst in Texas with over seven years of experience providing ABA services to children, adolescents, and adults with autism.
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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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K'Tyrra Sanderfer is a Board Certified Behavior Analyst with over 15 years of experience in childcare and early childhood education, and she has dedicated her career to helping children grow, learn, and thrive.
Book a consultationView profileDoes my child need a Medicaid waiver to get ABA in Texas?
No, ABA is a regular Texas Medicaid benefit through age 20, so your child doesn't need a waiver. Waiver programs for children with disabilities add long-term services and supports (ongoing help with daily living). Children in them get their basic Medicaid, ABA included, through STAR Kids.
Do STAR Kids and STAR Health cover ABA therapy?
Yes, both programs cover ABA. Members get the same benefits as regular Texas Medicaid. STAR Kids serves children with disabilities through plans like Blue Cross STAR Kids, and Superior HealthPlan runs STAR Health.
Does Texas Medicaid cover autism testing?
Yes. Texas Health Steps checkups include autism screening at 18 and 24 months, and Medicaid also pays for testing to diagnose autism. A screening checklist like the M-CHAT-R can't replace the standard diagnostic test. If your child doesn't have a diagnosis yet, Alpaca Health offers an autism evaluation and checks your coverage first.
Does Texas Medicaid cover ABA therapy for adults?
No, Texas Medicaid's ABA benefit ends on the 21st birthday. That age limit comes from EPSDT. This federal rule makes every state's Medicaid cover the care children need until age 21. Ask your child's LBA to plan for that birthday early, since every treatment plan must include a transition plan.
Can my child get ABA at home or at school with Texas Medicaid?
In-home ABA sessions are covered, but a behavior technician working as a school aide isn't. Texas Medicaid also pays for ABA in a clinic, an office, or the community. It won't pay for ABA aimed at academic goals.
Check your Texas Medicaid coverage
Tell us about your child and their Medicaid plan. We'll confirm your Texas Medicaid benefits, handle the approval paperwork, and match you with a BCBA who takes your plan.