ABA insurance and Medicaid coverage in Ohio

Autism insurance mandate

State mandate for autism coverage

Yes, the research found a state autism coverage law.

Statute

Ohio Revised Code 3923.84 (sickness and accident insurers) and 1751.84 (health insuring corporations); as of 2026-10-21, both show 'Effective: March 20, 2025' on codes.ohio.gov (latest legislation Senate Bill 196, 135th General Assembly)

Age limits

The enumerated minimum benefits apply to enrollees/insureds under age 14 (the statute says 'under the age of fourteen'): 20 speech/language therapy visits per year and, separately, 20 occupational therapy visits per year ('twenty visits per year for each service'); and 20 hours per week of clinical therapeutic intervention (defined to include, but not be limited to, applied behavioral analysis). The original read also listed a minimum of 30 mental/behavioral health outpatient visits per year for this age group; this item was not specifically re-confirmed by the fact-checker. The general coverage clauses contain no express age cutoff; only the enumerated minimums are tied to under 14.

Annual cap

No annual cap was identified for clinical therapeutic intervention. The 20 hours per week (includes ABA) is a weekly minimum benefit ('at minimum') for enrollees under 14, not a cap. The text also provides that dollar limits, deductibles and coinsurance may be no less favorable than for substantially all medical/surgical benefits (except the stated minimum-benefit items).

Excludes self-funded employer plans

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

Notes

As of 2026-10-21, the codes.ohio.gov text applies to individual and group policies delivered, issued or renewed in Ohio, but says nothing in the section applies to 'nongrandfathered plans in the individual and small group markets' or to Medicare supplement, accident-only, specified-disease, hospital-indemnity, disability-income, long-term-care or other limited-benefit policies. Coverage is contingent on prior authorization. Prescribing/ordering requirements should be read from the statute itself: division (C)(2)(b) specifies pediatric-health specialization for clinical nurse specialists and certified nurse practitioners, while autism-trained CNSs/CNPs additionally appear in the broader treatment definition in division (F)(10); these provisions should not be treated as a single unqualified coverage condition. Clinical therapeutic intervention must be provided by or under the supervision of a listed professional, including a certified Ohio behavior analyst (ORC 4783.01). The treatment plan may be reviewed annually; that review excludes inpatient services, more frequent review is permitted by individual agreement, and the insurer pays for the review. Self-funded (ERISA) plans are not addressed in the text; statutory silence does not establish whether the mandate applies to them.

Medicaid ABA coverage

Medicaid covers ABA

Yes, per the sources below.

Program

Ohio Medicaid ABA (as of 2026-10-21, delivered through Medicaid managed care plans; ODM's dedicated ABA rules 5160-34-01 to -03 appear only as proposed drafts and are not final or in the current Ohio Administrative Code index)

Agency

Ohio Department of Medicaid (ODM)

Provider enrollment

https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-enrollment/provider-enrollment-main

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.