ABA insurance and Medicaid coverage in North Dakota
Last researched October 21, 2026
Who pays for ABA in North Dakota, and what a practice has to do to bill them. Coverage details here come from statutes and agency pages we read, not from payer marketing.
Autism insurance mandate
- State mandate for autism coverage
Yes, the research found a state autism coverage law.
- Statute
ND Insurance Department Bulletin 2018-1, issued July 10, 2018, applies federal Mental Health Parity and Addiction Equity Act (MHPAEA) requirements to autism treatment coverage. This is a parity-based regulatory requirement; no autism-specific coverage statute was identified in the current NDCC chapter 26.1-36.
- Age limits
Autism Speaks' North Dakota coverage summary, last updated December 2019, reports no ABA coverage caps and identifies age caps as quantitative limitations subject to MHPAEA. Current member-specific age restrictions were not verified.
- Annual cap
Autism Speaks reports no ABA coverage caps. The ND Insurance Department's Sanford examination report dated October 20, 2023 found the examined plan's age-tiered annual ABA maximums inconsistent with Bulletin 2018-1. This does not establish unlimited coverage regardless of medical necessity or other lawful plan conditions.
- Excludes self-funded employer plans
We could not verify this yet - check with your state insurance department.
- Notes
As reviewed on 2026-10-21, exists=true denotes the Department's parity-based coverage requirement, not an unconditional autism mandate covering every plan. Its July 11, 2018 announcement states that carriers covering autism may not exclude ABA for children as experimental or investigational, and autism treatment limitations must satisfy parity with medical/surgical benefits. Compliance deadlines were October 1, 2018 for Department-regulated grandfathered and transitional policies, and January 1, 2019 for non-grandfathered policies and Department-regulated self-funded Multiple Employer Welfare Arrangement plans. The announcement does not extend that statement to all self-funded employer plans. The Department continues to list Bulletin 2018-1. Its Sanford examination found that the examined plan's $36,000/$25,000/$12,500 age-tiered ABA limits violated the bulletin; those amounts must not be presented as current statutory caps. The section's medium confidence reflects reliance on the dated advocacy summary for the categorical no-cap statement.
Sources (5)
- ND Insurance Department — Commissioner issues bulletin supporting treatments for autism spectrum disorder (July 11, 2018)
- ND Insurance Department — Bulletins; lists Bulletin 2018-1, issued July 10, 2018
- NDCC chapter 26.1-36 — Accident and health insurance
- ND Insurance Department — Sanford Health Plan market conduct examination, dated October 20, 2023; contract review of ABA limits
- Autism Speaks — North Dakota state-regulated insurance coverage (last updated December 2019)
Medicaid ABA coverage
- Medicaid covers ABA
We could not verify this yet - check with North Dakota Health and Human Services, Medical Services Division (the February 2025 policy header still reads North Dakota Department of Human Services, Medical Services Division).
- Program
Medicaid Autism Applied Behavior Analysis Service (Autism ABA service), a Medicaid State Plan EPSDT/preventive service
- Agency
North Dakota Health and Human Services, Medical Services Division (the February 2025 policy header still reads North Dakota Department of Human Services, Medical Services Division)
- Provider enrollment
- https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information
Sources (7)
- North Dakota Medicaid Policy and Procedures for the Autism Applied Behavior Analysis Service (revision February 2025; effective February 2025; supersedes July 2023)
- Children's Waiver Services, North Dakota Health and Human Services (ABA service section; policy link labeled July 2025)
- Medicaid Provider Enrollment, North Dakota Health and Human Services
- Applied Behavior Analysis (ABA) Group Application Requirements (revision 11-2025)
- NDAC Article 112-05, Behavior Analyst Licensure, Chapter 112-05-01 (effective January 1, 2021)
- NDCC Chapter 43-64, Behavior Analysts
- N.D. Admin. Code 112-05-01-14, Exemptions from licensure (Cornell LII; effective January 1, 2021)
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.
Commercial insurers
- Blue Cross Blue Shield of North Dakota - Reported in 2018 as covering ABA from Jan 1, 2018 (secondary source; verify current policy).
- Sanford Health Plan - Reported in 2018 as covering ABA from Jan 1, 2018 with tiered age-based annual maximums (secondary source; verify current policy).
Other payers
- North Dakota Medicaid (fee-for-service, Medical Services Division) - Payer for the Autism ABA Service; service authorization submitted via web-based request twice per year.
How to enroll
- Start at the state Medicaid provider enrollment page: https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information.
- Ask each commercial payer you want to bill for its credentialing application and timeline. We have not verified payer timelines.
- Confirm which staff types the payer reimburses, including whether technicians must hold the RBT credential. See BT vs RBT in North Dakota.
Related guides for North Dakota
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