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Does EmblemHealth Cover ABA Therapy?

Does EmblemHealth Cover ABA Therapy?

The answer is a resounding yes.

EmblemHealth, recognizing the critical importance of effective autism care, has expanded its insurance coverage to include Applied Behavior Analysis (ABA) services for eligible Medicaid members. This significant development, effective from Jan. 1, 2023, marks a substantial step forward in providing essential support to those impacted by ASD.

This expansion in coverage is a game-changer for many. EmblemHealth now covers ABA services when provided by Licensed Behavior Analysts (LBAs), Certified Behavior Analyst Assistants (CBAAs), or other professionals specified under Article 167 of New York State education law. This broadening of provider options underlines EmblemHealth's commitment to making ABA therapy more accessible to those in need.

EmblemHealth's Coverage Expansion for ABA Services

Who is Eligible?

Eligibility for ABA therapy under EmblemHealth's Medicaid plan is clearly defined:

- The member must be under the age of 21.

- They need to have received a diagnosis of autism spectrum disorder and/or Rett syndrome, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

- A referral is required from a New York State-licensed and Medicaid-enrolled physician, psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant.


This approach ensures that ABA services are provided to those who can benefit most from this specialized care.


The Role of ABA Therapy in Autism Treatment

ABA therapy is a cornerstone in the treatment of autism spectrum disorders. It is tailored to meet the unique needs of each individual, focusing on improving communication, social skills, and learning strategies. EmblemHealth's coverage of ABA therapy acknowledges its vital role in enhancing the quality of life for individuals with ASD.

Conclusion: A Step Forward in Autism Care

EmblemHealth's expanded coverage for ABA therapy is a significant stride towards better healthcare for individuals with ASD. By making these services more accessible, EmblemHealth is not only supporting the developmental needs of children and young adults with ASD but also providing families with the necessary resources and support.


For more detailed information on EmblemHealth’s ABA therapy coverage, eligibility criteria, or to discuss specific needs, individuals and families are encouraged to contact EmblemHealth directly.

FAQ

Q: What types of professionals are authorized to provide ABA therapy under EmblemHealth's coverage?

A: Under EmblemHealth's coverage plan, ABA therapy can be provided by Licensed Behavior Analysts (LBAs), Certified Behavior Analyst Assistants (CBAAs) working under the supervision of LBAs, or other qualified individuals. This ensures that members receive care from professionals who meet specific licensure and certification standards, guaranteeing a high level of expertise in ABA therapy.

Q: How can EmblemHealth Medicaid members begin the process of receiving ABA therapy?

A: EmblemHealth Medicaid members interested in receiving ABA therapy should start by obtaining a referral from a Medicaid-enrolled physician or mental health professional. The referring provider should follow the criteria for diagnosing autism spectrum disorder found in the DSM-5. Once the referral is made, members can contact EmblemHealth to understand the specifics of their coverage and to find qualified ABA therapy providers in their area.

Contact us today to discuss your insurance coverage options together.


Let Level Ahead ABA be your partner on this journey.


Insurances We Accept

At Level Ahead ABA, we simplify the insurance process, ensuring you can access our exceptional ABA therapy with peace of mind.

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