Does Vaya Partners Cover ABA Therapy?
Yes. Vaya Partners, formerly Vaya Health, covers ABA therapy for autism through NC Medicaid when it's medically necessary, and there's no copay for covered ABA. Alpaca Health accepts Vaya Partners, checks your benefits for free, and handles the approval paperwork with your BCBA.
How Vaya Partners covers ABA therapy
NC Medicaid pays for ABA through its autism benefit, and Vaya Partners manages that benefit for members in its counties.
- Where the rules live: NC Medicaid calls the benefit Research-Based Behavioral Health Treatment (RB-BHT), and its Clinical Coverage Policy 8F sets the rules, last updated on August 1, 2026.
- A new name: NC Medicaid says Vaya Health and Partners Health Management merged into Vaya Partners on October 1, 2026.
- Tailored Plan members: The Vaya Partners Tailored Plan is a Medicaid health plan for people who need care for a serious mental health condition, severe substance use, intellectual or developmental disabilities (I/DD), or a brain injury.
- NC Medicaid Direct members: If your child has Medicaid without a health plan, called NC Medicaid Direct, Vaya Partners still manages ABA for families in its counties.
- Not sure which you have: We check which plan your child has during your free benefits review.
What your child needs to qualify
1. NC Medicaid through Vaya Partners
Your child needs NC Medicaid in one of the counties Vaya Partners serves, through its Tailored Plan or NC Medicaid Direct. Each county has only one Tailored Plan.
2. An autism diagnosis made with an approved test
A licensed psychologist, psychological associate, or doctor confirms autism with an approved test like the ADOS-2 (a play-based autism assessment). Children under 3 can start with a provisional (temporary) diagnosis if a full diagnosis follows within six months.
3. A signed service order
Before therapy starts, a doctor or licensed psychologist signs an order for ABA. It's based on the assessment and plan, and it lasts one year.
4. An assessment and treatment plan
The BCBA tests your child's skills and writes a treatment plan with measurable goals, two or more of them for you as a caregiver. The results must show ABA is medically necessary (needed to treat your child's autism).
5. A licensed ABA team
In North Carolina, a licensed behavior analyst (a BCBA with a state license), doctor, or licensed psychologist writes the plan. Technicians who work with your child need a technician certification (RBT or ABAT) within 120 days of being hired.
How prior authorization works with Vaya Partners
This step means getting Vaya Partners' approval before ABA is paid for. Your child's BCBA sends each request through the plan's provider portal, and Vaya Partners decides standard requests within 7 days.
- What the BCBA sends: The assessment, the treatment plan, the signed service order, and records of how your child's autism was diagnosed.
- How long approval lasts: Up to 180 days for plans of 16 hours a week or less, and up to 90 days for plans over 16 hours a week.
- Renewals: Each reauthorization (a renewed approval) needs an updated treatment plan before the current approval ends.
- Children under 21: Vaya Partners can't turn down a child's request just because of plan limits, since EPSDT (Medicaid's promise of needed care for children) requires a second review, per its member handbook.
- If the answer is no: You can appeal, and the denial notice explains how.
- Step 1DiagnosisA psychologist or physician confirms autism with an approved test such as the ADOS-2.
- Step 2Assessment approvalVaya Partners approves the BCBA's first assessment (CPT 97151).
- Step 3Plan and orderThe BCBA writes the treatment plan, and a doctor or psychologist signs the service order.
- Step 4Therapy approvalVaya Partners approves up to 180 days of therapy, or 90 days for plans over 16 hours a week.
- Step 5RenewalsAn updated plan goes to Vaya Partners before each approval ends.
What Vaya Partners covers for ABA therapy
Each billing code (CPT code) below needs approval before the service starts. The same rules apply in the Tailored Plan and in NC Medicaid Direct.
- Assessments (97151, 97152): The BCBA's testing and treatment planning, plus follow-up observation by a technician.
- One-to-one therapy (97153): A certified technician works with your child in person, since technician sessions can't be held by video.
- Group sessions (97154): Small-group therapy with a technician when the treatment plan calls for it.
- BCBA supervision (97155): The BCBA joins sessions to adjust the plan for at least 1 of every 10 hours a technician spends with your child.
- Caregiver training (97156, 97157): Coaching for parents and caregivers, one family at a time or in groups, with at least six sessions scheduled for every 180 days.
NC Medicaid doesn't allow default hours, so the plan offers a range of weekly ABA hours that fits your child. School hours don't count toward that total. A provider also can't require a minimum number of hours unless your child needs them to make progress.
What families pay with Vaya Partners
There's no copay for covered ABA. NC Medicaid's copay rules don't apply to kids under 21 or to behavioral health and I/DD care.
- No monthly premium: NC Medicaid doesn't charge one for your child's coverage.
- Stay in network: A provider who takes Medicaid generally can't bill you, but you may owe for care that wasn't approved or came from a provider outside the network.
- Other insurance pays first: If your child also has private insurance, the provider bills that plan before Medicaid.
- If a bill arrives: Call Vaya Partners instead of ignoring it, and the plan will contact the provider if you don't owe the amount.
Where Alpaca Health accepts Vaya Partners
Vaya Partners serves 47 counties in western and central North Carolina, including Gaston, Iredell, Lincoln, and Union near Charlotte.
We check whether a BCBA near you accepts Vaya Partners before care starts.
See North Carolina options →How Alpaca Health handles your Vaya Partners benefits
You don't have to call Vaya Partners yourself. After you fill out our short intake form, our team checks your child's Medicaid and which plan manages it. 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 Vaya Partners is the plan that approves ABA.
- Approval paperwork: Your BCBA writes the assessment and treatment plan Vaya Partners reviews, and we handle the submission.
- A BCBA who takes your plan: We look for an independent BCBA near you who accepts Vaya Partners.
Is Vaya Health the same as Vaya Partners?
Yes, Vaya Health, which ran the Vaya Total Care plan, joined with Partners Health Management to form Vaya Partners. Members didn't need to do anything to switch, and their benefits stayed the same. They can keep seeing their current providers and should use the new Vaya Partners ID card.
Does my child need the NC Innovations Waiver to get ABA?
No, ABA is a regular NC Medicaid benefit, so your child doesn't need a Medicaid waiver for it. The Innovations Waiver adds home and community supports for people with I/DD. When its limited slots fill up, names go on a waitlist called the Registry of Unmet Needs. While your child waits, Vaya Partners can help you find other supports, such as respite for caregivers.
Does my child need a new autism evaluation under the 2026 rules?
It depends on the test used. Since August 2026, NC Medicaid accepts a diagnosis made with one of four tests: the BOSA, TAP, ADOS-2, or CARS2. For children already in ABA who were diagnosed another way, Vaya Health asked providers to refer them for an updated assessment. Alpaca Health offers an autism evaluation and checks your coverage first.
Does Vaya Partners cover ABA therapy for teens and adults?
Yes, NC Medicaid's August 2026 update removed the under-21 age limit from its ABA policy. Vaya Partners also lists ABA for all ages. Teens and adults still need a qualifying diagnosis and a plan that shows ABA is medically necessary. A teen's plan can focus on a few skills, like social skills.
Can my child get ABA at home or by telehealth with Vaya Partners?
In-home ABA sessions are covered, and sessions can also happen in a clinic, at school, or in the community. Technician sessions must be in person wherever they happen. Parent training can happen by video, and so can up to half of the BCBA's supervision time.
Check your Vaya Partners coverage
Tell us about your child and their Medicaid plan. We'll confirm your Vaya Partners benefits, handle the approval paperwork, and look for a BCBA near you who takes your plan.