ABA insurance and Medicaid coverage in Texas

Last researched October 21, 2026

Who pays for ABA in Texas, 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

Medium confidence: reputable secondary source

State mandate for autism coverage: Yes, the research found a state autism coverage law.
Statute: Tex. Ins. Code § 1355.015 (with applicability in § 1355.002)
Age limits: As of 2026-10-21, per the text read (the mirror displays an original-source access date of May 10, 2025): plans must cover treatment of ASD for an enrollee diagnosed with ASD from the date of diagnosis, only if the diagnosis was in place before the child's 10th birthday (§ 1355.015(a-1)). Screening coverage at 18 and 24 months.
Annual cap: A plan is not required to cover ABA above $36,000 per year for an enrollee 10 years of age or older (§ 1355.015(c-1)). Section 1355.015 states no corresponding dollar cap for children under 10; that does not by itself establish that coverage is unlimited.
Excludes self-funded employer plans: We could not verify this yet - check with your state insurance department.
Notes: Subchapter applies only to group health benefit plans (insurance companies, HMOs, group hospital service corporations, etc.), including the plans specified in § 1355.002(b), Chapters 1575 and 1579, and, 'to the extent permitted by ERISA', multiple employer welfare arrangements. Not applicable to standard health benefit plans under Ch. 1507 (§ 1355.015). Qualified health plan (QHP) exceptions: subsection (f) conditionally excludes screening coverage under subsection (a), and subsection (g) concerns benefits exceeding essential health benefits that would require state payments. Covered services must be prescribed by the enrollee's primary care physician in a treatment plan; ABA is listed among 'generally recognized services'. Providers may be state-licensed/certified/registered practitioners, practitioners holding qualifying federal credentials, or practitioners with TRICARE certification under subsection (b)(1), and subsection (b)(2) permits supervision by any practitioner meeting those alternatives. The statute text was read via a public mirror of the official site; 2025 session amendments after the mirror's access date were not checked. Whether self-funded (ERISA) plans are excluded was not established by the sources reviewed.

Sources (3)

Medicaid ABA coverage

Medium confidence: reputable secondary source

Medicaid covers ABA: Yes, per the sources below.
Program: Texas Medicaid ABA benefit (Texas Health Steps-Comprehensive Care Program; Autism Services in the TMPPM Children's Services Handbook), effective Feb. 1, 2022
Agency: Texas Health and Human Services Commission (HHSC); claims/enrollment via TMHP
Provider enrollment: https://www.tmhp.com/topics/provider-enrollment

Sources (7)

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.

Medicaid managed care plans

Superior HealthPlan - Requires prior authorization for all Medicaid ABA services (STAR, STAR Health, STAR Kids and STAR+PLUS MBCC per its notice).
Community Health Choice - Medicaid STAR program ABA quick-reference guide (July 2022).
Blue Cross and Blue Shield of Texas (Medicaid) - Contracts with a network of ABA providers for Texas Medicaid per its provider FAQ.

How to enroll

Start at the state Medicaid provider enrollment page: https://www.tmhp.com/topics/provider-enrollment.
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 Texas.

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