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Insurance and Grants for ABA Therapy

While paying for ABA therapy can be expensive, there are a few different payment options available to help cover the cost including insurance coverage, grants or scholarships, and out-of-pocket payments. We’ve provided some information on all three of these below to help parents understand their options.

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Health Insurance Coverage

Getting your child the care they need

Many insurance plans now cover ABA therapy as a medical treatment for autism. To receive insurance coverage for ABA therapy, your child may need to receive a formal diagnosis of autism from a licensed healthcare provider. 

As of right now, we cannot diagnose ASD at Pounce but we currently have staff getting their master’s degrees and licenses to be able to identify Autism and other behavioral disorders to provide legal diagnoses for your insurance. Since we cannot offer this service at the moment, we refer to other doctors in the area or you can research one yourself. 

Additionally:

  • Some insurance plans may have restrictions on the number of therapy hours or length of treatment.
  • Health insurance coverage for ABA varies by insurance plan. Check with your insurance provider to see if they cover ABA therapy and what your benefits are. You will want to ask your insurance company a few questions like:
    1. Does my insurance policy cover ABA therapy for my child’s diagnosis?
    2. Are there age requirements for coverage?
    3. How many hours of ABA therapy sessions are covered by my insurance policy? Per week? Per month?
    4. Are there any restrictions on the type of ABA therapy that is covered by my insurance policy?
    5. Is a referral required for ABA therapy services?
    6. Are there any specific ABA therapy providers or clinics that are in-network for my insurance policy?

The current insurance plans we accept are:

  • Experienced professionals: Our team of compassionate and knowledgeable professionals has years of experience working with families and children with special needs.
  • Personalized care: We believe that every child is unique and their behaviors are unique to them. We take a personalized approach to every consultation and support service we offer.
  • In-home consultations: We know that it can be challenging to bring your child to a new environment. We offer in-home consultations and we'll come to you, so your child can feel comfortable and at ease in their own home.

United Health Care

Aetna

Grants and Scholarships

There are several organizations that offer grants and scholarships to help families pay for ABA therapy.

Ohio Department of Education Autism Scholarship Program

Help Me Grow Early Intervention

The Ohio Department of Education Autism Scholarship Program provides scholarships for students with autism who are registered in a public school special education system. The program is intended to provide students with the opportunity to receive a high-quality education that meets their unique needs.

To be eligible for the program, a student must meet the following requirements:

  1. Be a resident of Ohio
  2. Have been identified as having autism spectrum disorder by a school psychologist.
  3. Be between the ages of 3 and 22
  4. Have a current Individual Education Program (IEP) that is agreed upon and finalized by the district of residence and the parent.
 

The maximum scholarship amount is $31,500 for a full program year and subsequent applications submitted later in the school year will be prorated by ODE. The scholarship can be used to pay for tuition, fees, and other services that are necessary for the student’s education.

Help Me Grow is a program offered by the Ohio Department of Health that provides early intervention services to children with developmental delays or disabilities.

  1. Eligibility:
    Help Me Grow is available to children from birth to age three who are at risk for developmental delays or have a diagnosed developmental disability, including those with autism.
  2. Referral process:
    Families can apply to Help Me Grow by completing an online referral form or by contacting their local Help Me Grow program. Once a referral is received, a service coordinator will contact the family, schedule an evaluation, and determine eligibility
  3. Services offered:
    Help Me Grow provides a range of early intervention services, including ABA therapy, to help children develop communication, social, and behavioral skills.
  4. Individualized family service plan:
    Once a child is eligible for Help Me Grow, they will develop an individualized family service plan (IFSP) which outlines the child’s developmental goals and the services that will be provided during ABA therapy.
  5. Service providers:
    Help Me Grow contracts with a network of service providers who must meet certain qualifications and standards set by Help Me Grow and the state of Ohio.
  6. Family involvement:
    Help Me Grow recognizes the importance of family involvement in the early intervention process. Families are encouraged to participate in their child’s ABA therapy sessions and to work collaboratively with the service provider to ensure therapy is effective and meets the child’s needs.

United Healthcare Children’s Foundation

United Healthcare’s grant eligibility is for all children with varying conditions, not just children with Autism. Here are some of the general eligibility requirements:
  1. Age and Citizenship:
    For applying to the grant, a child needs to be 16 years old or younger when the application is submitted. Specific use of the grant for ABA therapy, the child must be aged 3-6. They must also have a U.S social security number to prove they are a US citizen.
  2. Income:
    Reported income on IRS tax forms need to be under a certain amount, depending on the size of the family.
    • 2 Family Members – $55,000
    • 3 Family Members – $85,000
    • 4 Family Members – $115,000
    • 5 Family Members – $145,000
  3. Insurance:
    A child must be insured by an individual or employer plan for the entire duration of the grant. Insurance can be supplemented through CHIP or Medicaid.
  4. Duration:
    The grant can cover past expenses 60 days prior to eligibility and last for one year.
  5. Amount:
    A child can receive a maximum of $5,000 in one year and $10,000 lifetime from the grant, but the use of the grant for ABA therapy can only occur once per child. You will need to re-apply to gain additional support passed the one-year mark.
  6. Diagnosis:
    All therapies provided must be from a licensed medical professional in the US. To be used for ABA therapy, this means a diagnosis of autism spectrum disorder or another developmental disability is necessary.
  7. Exclusions:
    There are many listed on the UHCCF website, most notably relating to ABA is the one grant per child, limiting electronic device purchases, and all medications must be FDA approved. 

You can read the rest of the exclusions and all eligibility requirements here: https://www.uhccf.org/apply-for-a-grant/eligibility-requirements/

Franklin County Board of Developmental Disabilities

Parents and caregivers can reach out to Franklin County Board of Developmental Disabilities if their child or children have or are suspected of having a disability. FCBDD provides services including Early Childhood Education, Home-based and School-based services.

To qualify, one must live in Franklin County and meet the standards of the Ohio Department of Developmental Disabilities. If a child’s condition is likely indefinite and their impairments are solely caused my mental illness like Autism Spectrum Disorder, then they can qualify if they meet certain criteria depending on their age: 

  • Below age three – 1 developmental delay
  • Ages three to six – 2 developmental delays
  • Over the age of six – 3 developmental delays in major life functions such as self care, learning, mobility or others.

Children ages 3 and below will fall into the Help Me Grow program of Franklin County. 

Children ages 3 and above can apply on the FCBDD website here: https://fcbdd.org/prescreen-intake-form/ 

While we provide services mostly to children, we do want to point out that FCBDD provides a wide variety of services including adult programs so the Franklin County Board of Developmental Disabilities can be a life-long resource for local families. 

Partnered Programs with Autism speaks

Autism Speaks partners with nearly 20 different grant and scholarship programs around the country that have funding for children with ASD. Many of them are nationwide programs which means there are more people applying for the grants so it can be competitive. 

Each program may have specific eligibility requirements such as a formal diagnosis of autism, income restrictions with required proof of financial need, or location. We recommend reading each program’s details to see if you qualify.

smiling child psychologist and kid with autism playing with building blocks
speech therapy activities

If grants or health insurance don't cover

Out of Pocket Payment

Paying for ABA therapy out of pocket is an option but we recommend doing everything you can to apply for grants or even switching insurances as this will reduce the cost of care for your child. 

If you do have to pay out of pocket, we recommend creating a budget for ongoing expenses, including ABA therapy for your child. That way you can get an idea of hour many days/hours you can afford each month. 

When cost is an issue, we recommend parents and families get more involved. In-home ABA therapy is the best option so parents can be more integrated into our sessions and we’ll help teach you some of the ABA techniques. This way you can continue working with your child and help them develop while not paying for additional hours of therapy.

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