ABA insurance and Medicaid coverage in California

Autism insurance mandate

State mandate for autism coverage

Yes, the research found a state autism coverage law.

Statute

Cal. Health & Safety Code 1374.73 (health care service plans); QAS provider/professional/paraprofessional defined by reference to Cal. Bus. & Prof. Code 4999.200-4999.202; parallel Cal. Insurance Code 10144.51 for CDI-regulated policies

Age limits

We could not verify this yet - check with your state insurance department.

Annual cap

We could not verify this yet - check with your state insurance department.

Excludes self-funded employer plans

We could not verify this yet - check with your state insurance department.

Notes

As of 2026-10-21, a mirror of the statute states plans with hospital/medical/surgical coverage must cover behavioral health treatment for pervasive developmental disorder or autism, subject to the same requirements as H&S 1374.72, and must maintain an adequate network that includes qualified autism service providers who supervise or employ qualified autism service professionals or paraprofessionals. The mirrored text states the section does not apply to Medi-Cal program contracts; that exclusion concerns this statute only and does not address whether Medi-Cal separately covers ABA. The section also excludes specialized plans that do not deliver mental or behavioral health services. The statute restricts use of the treatment plan for respite, daycare or educational services; this is a restriction on the treatment plan, not a blanket exclusion of otherwise medically necessary treatment delivered in those settings. Under §1374.73(c), for contracts issued, amended, or renewed on or after Jan. 1, 2026, plans may not require rediagnosis to maintain behavioral health treatment coverage. Treatment reevaluation, physician/psychologist-directed rediagnosis, and utilization review remain permitted, and existing treatment cannot be discontinued or delayed pending rediagnosis. The cited pages do not expressly establish the presence or absence of an age limit or dollar cap, or whether self-funded plans are excluded, so those fields are left null/unknown. NCSL (page updated 2021-08-24) also notes the law does not require benefits exceeding ACA essential health benefits. This section covers DMHC-regulated plans; the checker reports that Insurance Code 10144.51 is the parallel provision for CDI-regulated policies, but its terms are not summarized here.

Medicaid ABA coverage

Medicaid covers ABA

Yes, per the sources below.

Program

Medi-Cal Behavioral Health Treatment (BHT), including ABA, for eligible members under 21 through EPSDT

Agency

California Department of Health Care Services (DHCS)

Provider enrollment

https://www.dhcs.ca.gov/providers-partners/provider-application-and-validation-for-enrollment/

Payers named in our research

Names come from the research behind this page. Appearing here does not mean a payer is accepting new providers or that networks are open. Always confirm directly with the payer.