How does your zip code impact your child’s access to autism support? While Applied Behavior Analysis (ABA) therapy has shown promising results for many children on the autism spectrum, its availability can differ dramatically from one state to another. Nevada and California, despite their proximity, do have differences in ABA coverage policies.
ABA Coverage in Nevada
Nevada has recently made progress in supporting families who need Applied Behavior Analysis (ABA) therapy. In 2009, Nevada passed legislation requiring health insurance plans to cover ABA therapy for children diagnosed with autism. Here are some key aspects of Nevada’s ABA coverage today:
- Insurance mandates: Nevada requires most health insurance plans to cover ABA therapy for children diagnosed with autism. This includes both private insurance and Medicaid. The mandate ensures that families may get ABA services from various healthcare practitioners, including diagnosis and therapy.
- Age limit amendment: Nevada’s insurance coverage for ABA therapy was historically limited to individuals under 18 or up to 22 if the individual was still in high school. However, in 2023, new legislation (SB191) expanded Medicaid coverage to include individuals up to 27. The age extension for ABA therapy in Nevada makes sure that people with autism can keep getting the support they need, even as adults. Continuing therapy into adulthood will help them live more independently.
- Medicaid expansion: Nevada’s Medicaid program includes ABA coverage for children and, with the recent legislative update, adults up to age 27.
ABA Coverage in California
California’s expansive healthcare policies, especially in Sacramento, mandate that most families can access ABA services through insurance. This includes:
- California’s Autism Insurance Law (SB 946). Like Nevada, the law applies to private insurance, though services may differ depending on the carrier. Because ABA therapy is considered an essential health benefit for those with autism, coverage here is usually somewhat extensive compared to other states. There are no limits on the number of therapy hours a person can receive, and insurance companies can’t deny coverage based on a lack of parent participation.
- Regional centers: California provides a system of regional centers that offer support services for individuals with developmental disabilities, including autism. These centers help families coordinate care and access ABA therapy. Families without private health insurance can turn to these state-funded regional centers to help guide them through medical red tape and confusing assessment procedures, often providing interim services. Residents interested in receiving services as adults must show proof of a disability diagnosed before their 18th birthday.
- Medi-Cal coverage: Medi-Cal, California’s Medicaid program, also covers ABA therapy for children under 21 diagnosed with or suspected of having autism.
- Age restrictions: Receiving ABA services after age 21 is not mandated. Private insurance plans may cover ABA services after your child turns 21, but this is not guaranteed.
Nevada vs. California
The approval of SB191 in Nevada was an important milestone since it allowed Medicaid to pay ABA therapy up to age 27, a benefit that California does not yet offer.
California leads with its well-established infrastructure, as SB 946 mandates that insurance providers cover ABA therapy without caps on therapy hours. California’s regional centers provide additional state-funded services, filling gaps that private insurance may not cover. While Nevada’s Medicaid expansion benefits adults, California’s broader support system and fewer therapy restrictions often make services more accessible.
ABA therapy can be a lifesaver for families who have children with autism. With the recent changes Nevada made to extend the age limit for ABA services, we are excited to see what states will be encouraged to make positive changes of their own.
