IMPORTANT INFORMATION FOR PARENTS AND CAREGIVERS IN THE STATE OF CALIFORNIA

  • As of 2014, as part of the Medi-Cal expansion, Medi-Cal insurance companies are required to cover ABA benefits with a doctor referral for ABA services. A diagnosis of autism is NOT required in the state of CA, if you have Medi-Cal, in order to receive ABA services.
    • Medi-Cal covers Applied Behavior Analysis (ABA) therapy for eligible members under 21 years old as part of its Behavioral Health Treatment (BHT) services, even if they don’t have a diagnosed autism spectrum disorder (ASD) but instead have a condition for which ABA is medically necessary. To get coverage, you need a referral from a healthcare provider, a diagnostic assessment by a physician or psychologist, and the plan to obtain services through a Medi-Cal managed care plan or a regional center. 
  • Stated clearly, in order to obtain ABA services you need a referral for ABA from an M.D. or PhD
  • The Regional Center of CA provides diagnostic evaluation for children on or around or after their 3rd birthday. If your child is receiving UNDER 3 services in the form of ABA, SLP, or OT please contact your services coordinator to schedule the diagnostic evaluation at LEAST 6 months prior to your child’s 3rd birthday. There may be a 6 – 12 months waitlist for regional centers so continue to contact your service coordinator until your appointment is scheduled. 
  • If your child has UNDER 3 ABA services, it is IMPERATIVE that by the time your child is at LEAST 28 months you call and get your child on any and all waitlist (including Regional Center) to have a diagnostic evaluation before your child turns 3 years of age. There can be up to 6-12 month wait list for these services so it is very important to get on all waitlists in order to get the evaluation done as close to your child turning 3 as possible.
    • Why does the age of 3 matter?
      • The ages of 12 months to 36 months are the most impactful times for treatment
      • At the age of 3 Regional Center services for ABA are typically transferred to Insurance as Regional Center is a funder of last resort.
        • If you have Medi-Cal: get a referal for ABA from your pediatrician BEFORE your child turns 3 so that your ABA provider can transition from Regional Center to Insurance funding BEFORE 3 and avoid any gap in service
        • If you have PRIVATE insurance: you will HAVE TO have a diagnosis of autism in order to continue ABA as they are ONLY required to fund ABA with a diagnosis of autism (this is different than if you have Medi-Cal). That is why it is so important if you have private insurance, to get a diagnostic evaluation BEFORE your child turns 3 – so that you can avoid any gap in services.