Yes, Medicaid covers ABA therapy in Georgia. For a child to be eligible for ABA therapy coverage under Georgia Medicaid, they must have a formal diagnosis of ASD, adhering to DSM-5 standards. This diagnosis includes both a medical code and a level of severity for autism. It's important to note that Medicaid covers ABA therapy only for certain diagnoses, and services won't be approved if the child does not meet these specific diagnostic criteria.
Applied Behavior Analysis (ABA) therapy, a crucial intervention for children with Autism Spectrum Disorder (ASD), has been covered by Georgia Medicaid since January 2018. This inclusion marks a significant step forward, expanding access to ABA therapy for families across Georgia and providing assistance with therapy costs, depending on specific plan benefits.
Along with the diagnosis, Georgia Medicaid may request additional documents like the Individualized Family Service Plan (IFSP) or the Individualized Education Plan (IEP). These documents, though not mandatory, are helpful in obtaining authorization for ABA services. Once all necessary information is compiled, it can be submitted by a Medicaid provider to authorize ABA services, typically for 3-6 months and covering 10-30 hours per week based on the BCBA supervisor's recommendation.
Georgia Medicaid's coverage of ABA therapy provides essential support for families with children diagnosed with ASD, helping them access critical treatment. Understanding the eligibility criteria, diagnosis process, and authorization requirements is key for families to navigate the system effectively and ensure their children receive the necessary care.
A: A diagnosis of ASD can be made by developmental pediatricians, psychologists, psychiatrists, or through certain early intervention programs.
A: Diagnostic tools such as the Autism Diagnosis Interview – Revised (ADI-R) are typically used for evaluation. These are required for Medicaid authorization.
Contact us today to discuss your insurance coverage options together.
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