Does Maryland Medicaid Cover ABA Therapy?

If your child has Maryland Medicaid and has just been diagnosed with autism, or you think they might be, one of your first questions is probably whether Medicaid will pay for ABA therapy. In most cases it will. Maryland Medicaid covers medically necessary Applied Behavior Analysis (ABA) for members under 21, and the benefit has been in place since 2017.

What trips families up is the process: who runs the benefit, what paperwork comes first, and why the health plan on your child’s card may not be the one you call. This guide walks through each of those in plain language. If you’re still at the very beginning, our guide to getting started with ABA therapy in Maryland covers the bigger picture.

The short answer: yes, for members under 21

The Maryland Department of Health (MDH) began covering medically necessary ABA for Medicaid participants under 21 on January 1, 2017. Under the state’s ABA regulations, a child qualifies for the benefit when they:

• Are younger than 21
• Live at home or in the community (not in a hospital or institution)
• Have an autism spectrum disorder (ASD) diagnosis from a qualified health care professional, based on a comprehensive diagnostic evaluation
• Have behaviors or skill gaps that significantly interfere with home, school or community activities
• Are referred for ABA by a licensed health care professional
• Have an ABA treatment plan written by a licensed behavior analyst or licensed psychologist

As with any medical benefit, coverage depends on medical necessity: ABA has to be an appropriate, recommended treatment for your child in particular.

Why Medicaid covers it: EPSDT

In Maryland, ABA is offered only through Medicaid’s EPSDT program (Early and Periodic Screening, Diagnosis, and Treatment). EPSDT is the part of Medicaid that provides comprehensive and preventive health care for enrolled children and young adults under 21. For a child with autism, it’s the reason a treatment like ABA can be covered when it’s medically necessary.

You don’t need to remember the acronym. What matters is that coverage exists, so if someone tells you Medicaid doesn’t pay for ABA, keep asking.

Who runs the benefit: Carelon Behavioral Health Maryland

This is the part that confuses many families, and it’s specific to Maryland.

Most children on Maryland Medicaid are enrolled in HealthChoice, the state’s managed care program. Their card names a managed care organization (MCO), and the MCO handles most of their medical care. ABA works differently.

Maryland covers ABA through the Medicaid fee-for-service program and its behavioral health administrative services organization (ASO), Carelon Behavioral Health Maryland. MDH describes Carelon as the administrator of the Maryland ABA program. The arrangement covers HealthChoice members too. MDH says all Medicaid members, including HealthChoice managed care members, go through Carelon for covered specialty behavioral health services.

In practice:

	Your HealthChoice MCO	Carelon Behavioral Health Maryland
What it handles	Most medical care, plus primary behavioral health care given by primary care providers	Specialty behavioral health services paid by Medicaid fee-for-service, including the ABA program
ABA authorizations	Not the usual route	Yes: Carelon issues the prior authorization
Who to call	The member services number on your MCO card	Carelon at 1-800-888-1965 (TTY 711)

Your child’s pediatrician visits still go through their MCO. The ABA authorization goes through Carelon.

What you’ll need before ABA starts

Every Maryland Medicaid ABA service needs prior authorization from Carelon, and Carelon authorizes ABA only after certain steps are done. Here’s the usual order.

1. A comprehensive diagnostic evaluation (CDE)

A qualified health care professional has to diagnose autism through a comprehensive diagnostic evaluation. Maryland’s ABA provider manual lists these qualified professionals:

• Developmental pediatricians
• Pediatricians
• Pediatric neurologists
• Child psychiatrists
• Clinical psychologists
• Neuropsychologists
• Nurse practitioners

The professional needs training and experience diagnosing autism. The evaluation has to include a direct observation of your child, an interview with you, your child’s developmental and psychosocial history, a description of how your child is functioning across the major areas of development, and a confirmed ASD diagnosis. It should end with a referral for ABA.

If your child was diagnosed some time ago, you may be asked for an updated confirmation. The manual describes a Clinical Confirmation Form that a qualified professional completes to confirm a child still meets the criteria for autism. Whether you need one depends on how old your child was when diagnosed and how long ago that was.

2. An ABA assessment and treatment plan

Next, a behavior analyst (or a psychologist) assesses your child and writes a detailed treatment plan. Maryland’s regulations say the plan must be centered on your child and family and take into account your child’s age, school schedule and daily routine. It also needs measurable goals, the planned weekly hours, a plan for coordinating care with you, training and support for parents or caregivers, and clear criteria for when services would end.

3. Prior authorization, then reauthorization every 180 days

The provider sends the plan to Carelon for prior authorization. Under the provider manual, an authorization lasts no more than 180 days. Before it ends, the behavior analyst reassesses your child, and services can continue only if they’re still medically necessary and newly authorized. That 180-day cycle repeats for as long as your child is in treatment.

Where Medicaid ABA happens, and your part in it

Maryland’s rules say ABA is delivered in a home or community setting, including a clinic, when medically necessary. MDH’s provider manual describes the home as the standard setting because it helps children use their skills in everyday life and makes parent training possible. Clinic-based services need a specific clinical reason.

Parents and caregivers are part of treatment, too. Maryland’s regulations require that the parent or caregiver be trained to reinforce ABA in a clinically effective way, so expect to learn strategies you can use between sessions.

Maryland Medicaid treats ABA during school hours as a short-term exception, not the standard model. A behavior technician can’t act as a one-on-one school aide, and schools stay responsible for educational supports through the IEP or 504 process. For more on how the two systems fit together, see our guide to IEP services vs. ABA therapy in Maryland.

How to check your child’s coverage

You can do some of this yourself before you talk to a provider:

1. Confirm your child has active Medicaid. If you’re not sure, or have questions about HealthChoice, the HealthChoice Help Line is 800-284-4510.
2. Gather the diagnosis paperwork. Find the evaluation report that diagnosed autism, plus any written referral for ABA. Check that it was done by one of the professionals listed above.
3. Ask about ABA through Carelon. Carelon’s Maryland line, 1-800-888-1965 (TTY 711), is listed for Medicaid participants who need help.
4. Write everything down. Note the date, the representative’s name and any reference number from each call.
5. Let a provider verify it. An ABA agency that works with Maryland Medicaid can confirm the details and send the authorization request for you.

You don’t have to finish this list before reaching out. Many families start with a consultation and let the provider check coverage.

A note on the Autism Waiver

You may also hear about Maryland’s Autism Waiver, a separate Medicaid program with its own rules. MDH says it serves eligible children and young adults with autism from age 1 until the end of the school year in which they turn 21. To qualify, a child needs an IFSP or IEP with at least 15 hours a week of special education and related services and must meet financial limits based on their own income and assets. The waiver has a waitlist, and families can join it by calling the Autism Waiver registry at 866-417-3480. The waiver has its own eligibility rules and services. Maryland’s eligibility rules for the ABA benefit described above don’t require waiver enrollment.

Common worries

“Our MCO said they don’t cover ABA.” That may simply mean the MCO doesn’t handle it. In Maryland, ABA goes through the fee-for-service program and Carelon, even for HealthChoice members.

“We’re still waiting for an evaluation.” The diagnosis and referral have to come before authorization. It’s still worth talking with a provider now so you know what the evaluation needs to include.

“What if services are reduced or denied?” Read any letter you get carefully and note any deadlines in it. Then ask Carelon what your options are, and ask your provider what extra documentation might help.

Getting started with Climbing Star in Maryland

Climbing Star’s Maryland practice, Climbing Star MD, is based in Elkridge and provides in-home ABA across Howard County, Baltimore County, Baltimore City and Anne Arundel County. We verify your child’s Medicaid or insurance benefits before services start and help with the prior-authorization paperwork. Treatment plans are designed and supervised by licensed behavior analysts, and trained behavior technicians deliver sessions under their supervision. The first step is a free consultation: call our Maryland line at (410) 670-5250 or start online.

Official sources

The rules in this article come from these official Maryland and federal sources (checked October 2026):

• MDH, Applied Behavior Analysis program page
• MDH, Maryland Medical Assistance Program ABA Provider Manual, effective Feb 1, 2026
• COMAR 10.09.28.03 (ABA participant eligibility)
• COMAR 10.09.28.05 (ABA limitations)
• MDH, HealthChoice and Behavioral Health Coverage
• Carelon Behavioral Health Maryland home page
• MDH, Autism Waiver page

This article is for general informational purposes and is not medical or legal advice. Coverage rules change; please verify your specific plan and consult qualified professionals about your child’s needs.