What is the Medicaid Buy-in Program?

In the past, Applied Behavioral Analysis (ABA) was not covered by most health insurance plans. However, with the ongoing proven success of ABA-based treatment for autism, the autism insurance mandate was established and passed. Although the autism mandate varies from state to state, specifically, the State of Texas mandate for autism requires health benefit plans to provide coverage to an enrollee who diagnosed with autism spectrum disorder (ASD) from the date of diagnosis until the enrollee completes nine years of age, for all generally recognized services including ABA, speech therapy, occupational therapy, and/or physical therapy prescribed in relation to ASD by the child’s primary care physician in a treatment plan recognized by that physician.

Just because the State of Texas has an autism mandate, it does not mean all health insurance plans are required to include the coverage and benefits for the autism diagnosis. Please note that the autism mandate is applicable to the fully-funded, state-regulated plans only. If your health insurance plan is through your employer and is a self-funded plan, it does not legally have to offer the autism benefits. Self-funded plans are generally paid for by the employers and are governed by the federal government. The employers can decide which health benefits they want to provide. Although some self-funded health insurance plans cover the Applied Behavioral Analysis (ABA) therapy, there is no requirement by the federal government that requires them to do so.

Insurance Services

Tangible Difference Learning Center is proud to support its clients with a dedicated, professional insurance & medical billing group within our company. This includes a team of directors and staff members who have years of experience in managed care health insurance contracting, billing, authorizations/pre-certifications and denial rebuttals. New insurance laws and mandates in Texas can be difficult to understand in regards to the benefits and eligibility for Applied Behavioral Analysis (ABA), speech therapy and occupational therapy. However, TDLC’s insurance experts are well versed in different plans of most major health insurance carriers. We are your advocate and are qualified to assist you because:

If you would like to know if you have coverage, we can help. Please contact us at 713.

Qualifications:

Family of up to 3

Up to $4,633

Family of up to 6

Up to $7,498

The most a family will pay is $230 each month.

Where to get more information: