February 12, 2023

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ABA Therapy: Payment Options for Parents in New York

Applied behavior analysis, or ABA, is the most widespread accepted therapy for children with autism.

In New York, there are several options when paying for ABA therapy no matter your income level. Below, we will discuss each in detail and provide some links to resources that can help you make the best decision for your child.

Paying for ABA with insurance

The most common way people pay for ABA therapy is through insurance. Many commercial and government-sponsored health plans cover ABA therapy, though the coverage can vary greatly.

If you have insurance, the first step is to contact your insurer and ask about coverage for ABA therapy. You will likely need to provide them with information about your child’s diagnosis and treatment plan. Once you know what your insurer will cover, you can start looking for providers who accept your insurance.

One way to find in-network providers is to use the Autism Speaks Provider Directory. This directory includes over 3,400 ABA providers across the United States who have agreed to accept insurance. 

When vetting these services, make sure to ask about their experience working with children on the autism spectrum and whether they accept your specific plan.

If you’re having trouble finding an in-network provider, you can also contact your insurer directly and ask for a list of recommended providers. 

Out-of-network providers may also be an option, but you will likely have to pay more out of pocket. If you have exhausted your in-network options without a solution, try message boards or online support groups for parents of children with autism. You may be able to find someone in a similar situation who can recommend a provider.

If neither of those options applies to you, co-payment is also an option. 

Co-payment assistance

For those with less-than-ideal insurance coverage or high deductibles, some organizations can help with the cost of ABA therapy. These organizations typically have a list of in-network providers and will work with you to assist your co-pays or deductibles.

Let’s take a look at some of the best options among these organizations.

Autism Care Today

One of these is Autism Care Today, which offers grants of up to $5,000. It has helped more than 1,500 families nationwide with autism-related expenses and has given out more than $1.85 million since 2005. 

They also offer separate programs for military families and those in need of immediate treatment. The application process is simple and can be completed online.

C.A.R.E Foundation

The California Autism Resource & Evaluation Foundation may not sound like an organization that can help New Yorkers, but they offer grants to anyone in the U.S. that makes less than $75,000 per year. The best part about this assistance is there is no yearly deadline – C.A.R.E. will accept applications at any time.

Cerner Charitable Foundation

Not only will Cerner help pay for ABA treatment in New York but they also offer grants for travel, lodging, and vehicle modification if necessary. A good thing to remember is that not all of these organizations will be able to offer ongoing or yearly grants. Cerner, for instance, only offers a maximum of three in a child’s lifetime.

United Healthcare Children’s Foundation

This nationwide charity offers support to families with a wide variety of medical expenses and therapies based on improving the life of a child. This application is online-only and requires proof of non-coverage from an insurance company or some other form of documentation.

If you have exhausted some of these grants or require another source of assistance, there is a third option available to some people. 

Is ABA therapy covered by Medicaid in New York?

Yes! In 2019, New York formed the Children’s Waiver, which covers children with autism and can help provide wrap-around coverage. 

The waiver essentially means that Medicaid eligibility is based on the child’s income instead of the parents, allowing them to be covered by the program. That helps to cover the gap between what private insurance will cover and what parents can afford to pay out of pocket.

Since the prices of ABA therapy can be extremely expensive – as much as $250,000 per year, depending on a child’s specific needs – even those families that don’t normally qualify for Medicaid will need substantial assistance. 

This waiver allows Medicaid to pay for ABA therapy for children with autism regardless of the family’s income. 

If you think your child might be eligible for this waiver, contact your local Medicaid office or regional Front Door office, which offers services provided by the Office for People With Developmental Disabilities. 

For those parents who are 65 and above, there are also Medicare options that are available.

Insurance providers that GoldenCare works with

One of the country’s oldest insurance brokers for long-term care, GoldenCare is now working with ABA insurance providers in New York including:

• Aetna Better Health of New York
• Cigna Health Insurance
• UnitedHealth Group/Optum
• Horizon Blue Cross Blue Shield
• WellCare of New York
• Beacon Health Options
• EmblemHealth

Any of these companies can be a great resource for you and your family as you seek out coverage and providers for ABA therapy. For more information about GoldenCare’s services, contact them toll-free at (888) 825-0231 or get a free online quote.

Final thoughts

For those families that are dealing with an autism diagnosis, ABA therapy is often the best option available. It can be expensive, but there are ways to offset the cost. New York offers several programs that can help families pay for ABA therapy, whether it’s through insurance, grants, or Medicaid.

If you’re not sure where to start, the best thing to do is contact your insurer and ask about coverage. You can also speak with your child’s doctor or a local autism support group for recommendations on providers in your area. 

No matter what level of income you have, there is an answer out there to provide your child with the best possible care.

 

If you are ready to work with the best ABA therapy provider in New York, give us a call at (732) 402-0297. Our dedicated team is ready to help and we will treat you like family