If your son or daughter was diagnosed with autism spectrum disorder (ASD), you probably know that professional attention and care are crucial. Yet, they are also expensive.
In light of that, we put together this article to help you understand what your options are for paying for your autistic child's ABA therapy treatments in Houston.
Click here if you want to learn more about our ABA therapy program in Houston.
What is ABA therapy?
Applied behavior analysis (ABA) therapy enables autistic patients to manage and improve their symptoms.
Children with autism who undergo ABA therapy sessions typically perform better in the following areas:
- Academic performance
- Communication capabilities
- Reading
- Social skills
- Adaptive learning (for example, doing chores, employment, motor skills, and personal hygiene)
Because ABA therapy is the most prevalent treatment for autism, many people place a high value on it.
How much does ABA therapy cost on average?
The average cost of hiring a licensed and certified ABA therapist is $120 per hour. To clarify, this is equal to $4,800 if your child or loved one saw a practitioner for 40 hours per week.
On an annual basis, the expenses could add up to almost $250,000 for those who don't have insurance.
Does Medicaid cover ABA therapy in Houston?
Three states' Medicaid programs don't include ABA therapy coverage, and Texas is among them.
Texas's Law on Autism Insurance Coverage
In Texas, any health insurance plan is required, by law, to cover generally-recognized autism therapies and forms of care. However, for a health insurance plan to pay for ABA therapy, you need to obtain a recommendation from your or your loved one's doctor.
Generally-Recognized Services
You want to keep in mind that Texas's laws specifically use the term "generally-recognized services" when referring to prescribed ASD treatments that insurance plans must cover.
ABA therapy is among them, alongside the following "generally-recognized services":
- Medications
- Nutritional supplements
- Occupational therapy
- Physical therapy
- Speech therapy
- Other treatment plans
Although this requirement used to only apply to private insurance policies, it was recently extended to encompass state-funded coverage plans.
Does private insurance in Texas cover ABA?
This depends on the policy that you have. In short, there are two types of insurance plans in the Lone Star State:
Self-Funded Plans
With a self-funded policy, your employer (who provides the insurance) will directly cover the bill for ABA therapy sessions. After that, they contact the insurance company to receive reimbursement.
Employers that offer self-funded plans have contracts with insurance firms, and they work together on administering the treatments, maintaining claims records, and making payment/reimbursement arrangements.
In the past, only self-funded plans in Texas covered ABA therapy.
Fully-Funded Plans
On January 1st, 2010, a new law kicked in and mandated that state-funded plans pay for the care of any autistic child who is under the age of 10.
The Following Plans Cover ABA Therapy in Texas
Your insurance will cover your loved one's ABA therapy costs in Houston (and in the state of Texas, in general) if you have a private health policy with one of those companies:
- Aetna
- Beacon/Value Options
- Blue Cross Blue Shield Texas
- Blue Cross Blue Shield Magellan
- Cigna Behavioral Health
- ComPsych
- Humana (LifeSynch)
- Magellan
- TRICARE
- United Health Care/United Behavioral Health/UMR
Texans and Houston residents who don't have Medicaid or one of the above plans can still get ABA therapy coverage through alternative options.
Other Ways to Pay For ABA Therapy in Texas
The following governmental programs may help you pay for your child's ABA therapy:
Supplemental Security Income
The Social Security Administration has a supplemental security income (SSI) for children program, and kids that are considered disabled could be eligible for it.
SSI is specifically designed to assist families and individuals that have a limited amount of income or resources.
Firstly, to qualify for SSI benefits, your kid must be under the age of 18. However, those who are attending college are entitled to these benefits until they become 22 years old.
Secondly, to obtain financial support through SSI's disability program, your son or daughter must meet Social Security's definition of "disabled". To do so, you need to demonstrate two things (which shouldn't be difficult for those with an autism diagnosis):
- The child's disability causes "marked and severe functional limitations".
- Their condition "has lasted or can be expected to last for a continuous period of not less than 12 months".
Apart from the federal government, kids with ASD can get help from the state in Texas.
The Health and Human Services Children's Autism Program
The Texas Health and Human Services Autism Program extends to any child who is a Texas resident, between 3 and 15 years of age, and officially diagnosed with autism.
The state's Department of Health and Human Services (HHS) will cover the costs of up to 180 hours of ABA therapy sessions per year. To clarify, this is the equivalent of 3 and a half hours per week.
Having said that, many autistic kids need 40 hours of ABA therapy (or at least when they initially start seeing a provider). If you're in this situation, you should consider additional forms of support alongside the Texas HHS program.
Other Resources That Can Help Pay For ABA Therapy in Texas
There are several Texas-based and national nonprofit organizations that assist families with the expenses of ABA therapy.
- ACT Today: Autism Care Today/ACT Today has programs that pay for ABA therapy. Moreover, they can help you access funds through one of their many partner organizations.
- The People Project: Formerly known as the Huckleberry Foundation, the People Project "provides financial assistance to families with children in need of therapy stemming from special needs [and] mental health issues". They are also launching a Mental Health Aid Fund that pays for evaluations, parental training, equine/horse therapy, prescriptions, and more.
- Autism Speaks: Autism Speaks, a nationally-renowned nonprofit, can refer you to a variety of programs and organizations based on your specific situation. Additionally, they have valuable financial planning tools and apps that are designed for parents.
- Giving Angels Foundation: The Giving Angels Foundation particularly caters to low-income households that have kids with physical or mental disabilities. Their one-time allowance/grant could be as high as $500, and families may obtain up to $50,000 per year in aid from this organization.
To summarize, the cost of ABA therapy is certainly expensive. While Medicaid in Texas doesn't pay for it, the state's laws require private insurance companies to do so.
The fact that there are multiple federal, state, and nonprofit programs that financially support the families of autistic children should give you even more options for ways to cover your son or daughter's ABA therapy bill.
