ABA insurance and Medicaid coverage in Connecticut

Autism insurance mandate

State mandate for autism coverage

Yes, the research found a state autism coverage law.

Statute

Conn. Gen. Stat. §§ 38a-488b (individual) and 38a-514b (group). Age change: Nov. Sp. Sess. P.A. 25-3, §§ 5 (group) and 6 (individual). Dollar-cap repeal: June Sp. Sess. P.A. 15-5, §§ 347 (group) and 348 (individual).

Age limits

As of 2026-10-21, behavioral therapy is defined as therapy provided to children less than 21 years of age (Conn. Gen. Stat. §§ 38a-488b(a)(4) and 38a-514b(a)(4)). On and after January 1, 2027, Nov. Sp. Sess. P.A. 25-3 changes that definition to individuals under 26 years of age. Diagnosis, prescription drugs, psychiatric services, psychological services, physical therapy, speech and language pathology, and occupational therapy have no age limit in these sections.

Annual cap

None. Sections 38a-488b and 38a-514b set no annual or lifetime dollar cap. Subsections (d) prohibit limits on the number of visits except for lack of medical necessity. June Sp. Sess. P.A. 15-5, § 347, repealed the group-policy yearly behavioral-therapy maximums of $50,000 (under age 9), $35,000 (at least 9 and under 13), and $25,000 (at least 13 and under 15), effective January 1, 2016.

Excludes self-funded employer plans

Yes, self-funded employer plans are generally outside state mandates.

Notes

The mandate applies to individual and group policies of the types in Conn. Gen. Stat. § 38a-469(1), (2), (4), (11), and (12) — basic hospital expense, basic medical-surgical expense, major medical expense, a hospital or medical service plan contract, and hospital and medical coverage issued to subscribers of a health care center — that are delivered, issued for delivery, renewed, amended, or continued in Connecticut. Autism spectrum disorder, as defined in the most recent DSM, is an illness. Covered treatment must be medically necessary and ordered by a licensed physician, licensed psychologist, or licensed clinical social worker under a treatment plan developed by a licensed behavior analyst, physician, psychologist, or clinical social worker. Behavioral therapy includes applied behavior analysis, cognitive behavioral therapy, and other empirically supported therapies consistent with designations of the Commissioner of Social Services under § 17a-215c(e), and must be provided or supervised by a licensed behavior analyst, physician, or psychologist, with at least one hour of face-to-face supervision for each ten hours. Prescription drugs are covered only to the extent drugs are covered for other conditions. An outpatient treatment plan may be reviewed no more than once every six months unless the treating clinician agrees to more frequent review, and a diagnosis is valid for at least 12 months unless the clinician sets a shorter period. Cost sharing cannot be greater than for other medical, surgical, or physical conditions. General policy exclusions may still apply, including coordination of benefits, participating-provider requirements, restrictions on services by family or household members, and case management. The sections do not require payment for special education and related services under an individualized education program pursuant to § 10-76d unless another state or federal law requires it. CID Bulletin HC-99 (August 20, 2014) directed carriers to remove applied-behavior-analysis dollar limits because ACA section 2711 preempts dollar limits; the bulletin cites Conn. Gen. Stat. § 38a-514(b). OLR Report 2026-R-0129 (October 8, 2026) states that ERISA generally keeps Connecticut benefit mandates from applying to self-insured health plans, and that the state employee plan, although self-insured, incorporates state mandated benefits in practice. OLR Report 2020-R-0214 states that ERISA does not apply to governmental or church plans (29 U.S.C. § 1003) and that the Connecticut Insurance Department does not have jurisdiction over self-insured plans.

Medicaid ABA coverage

Medicaid covers ABA

Yes, per the sources below.

Program

HUSKY Health ASD services: Medicaid HUSKY A, C and D, plus HUSKY B (CHIP). CT BHP's treatment guideline covers medically necessary ASD treatment, including ABA, for members under 21. Provider Alert PA-2026-01, issued February 6, 2026, confirms HUSKY B expansion effective October 1, 2025.

Agency

Connecticut Department of Social Services (DSS). Carelon Behavioral Health of Connecticut administers CT BHP and qualifies ASD providers; DSS and Gainwell handle Medicaid enrollment and claims.

Provider enrollment

https://www.ctdssmap.com/CTPortal/portals/0/StaticContent/incProviderServicesLinkEDSProvEnrollment.htm

Payers named in our research

We could not verify named payers for Connecticut yet - check with the state Medicaid agency.