IEP Services vs. ABA Therapy in Maryland: What Each Covers and How to Use Both

If your child has autism, or you suspect they might, you’ll probably hear about two kinds of help that sound alike: services through an IEP at school, and ABA therapy through your health insurance or Medicaid. Both can involve trained professionals, measurable goals and behavior support. But they come from different systems, answer to different rules and aim at different things.

They aren’t competing options. Many Maryland families use both. This guide explains how they differ, how each is paid for, and how to make them work together. For the full path from first concerns to first session, see our guide to getting started with ABA therapy in Maryland.

The short version

	IEP services (school system)	ABA therapy (insurance or Medicaid)
Funded by	Your local school system, at no cost to families	Private health insurance or Maryland Medicaid
Gatekeeper	IEP team, including you, through Child Find and special education evaluations	Your health plan or, for Medicaid, Carelon Behavioral Health Maryland, through prior authorization
Eligibility	A qualifying disability that affects learning, under one of Maryland’s special education categories	Usually a formal autism diagnosis and a finding of medical necessity
Goals	Helping your child learn and take part in school	Medically necessary skill-building and behavior support in daily life
Setting	School or childcare setting, during the school day	Typically home or community; school only in limited cases
Schedule	Follows the school year; some children qualify for extended school year services	Not tied to the school calendar

What an IEP provides

An Individualized Education Program (IEP) is a written plan for providing special education and related services to a student with a disability. In Maryland, a free appropriate public education is guaranteed for eligible students with disabilities from birth through the end of the school year in which they turn 21. Preschool special education covers ages 3 through 5.

Eligibility. A child qualifies if they have a disability under one of Maryland’s categories and it affects their learning. The categories include autism and developmental delay (ages 3 to 7). The process starts with a referral to your local school system’s Child Find office. MSDE also suggests contacting your neighborhood school. You give consent before any assessments, and you’re a member of the team that decides eligibility. Under Maryland’s rules (COMAR 13A.05.01.06), the school system must complete the initial evaluation within 60 days of your consent for assessments, and within 90 days of receiving a written referral. If your child is found eligible, the IEP meeting is held within 30 days of that decision.

What’s in it. The IEP sets measurable annual goals and lists special education, related services (such as speech-language, occupational and physical therapy, psychological services, and parent counseling and training), and supports and accommodations. MSDE notes that IEP goals must be related to helping the child in school.

Where and when. Services take place in a school or childcare setting during the school day, in the least restrictive environment, with children without disabilities whenever appropriate. Progress is usually reported quarterly during the school year, and the IEP is reviewed at least once a year.

Cost. IEP services are free to families. With your consent, Medicaid may help pay for certain health-related services.

What medically necessary ABA provides

Applied Behavior Analysis (ABA) is a treatment for autism designed and supervised by a behavior analyst, often delivered one-on-one, with goals written around your child’s needs across daily life. That can include communication, play and social skills, self-care, safety, and reducing behaviors that get in the way of learning.

Who pays.

• Private insurance. Maryland’s habilitative services law (Insurance §15-835) requires plans issued or delivered in Maryland to cover habilitative services for children, including ABA for autism, until at least the end of the month in which the child turns 19. Self-funded employer plans aren’t bound by that law. Our guide to Maryland’s autism insurance mandate explains the details.
• Medicaid. Maryland Medicaid covers medically necessary ABA for members under 21, administered by Carelon Behavioral Health Maryland with prior authorization. See Does Maryland Medicaid cover ABA therapy?

Eligibility. Coverage generally requires a formal autism diagnosis, a referral or prescription, a behavior analyst’s assessment and treatment plan, and prior authorization based on medical necessity.

Where. Maryland Medicaid’s rules say ABA is delivered in a home or community setting, including a clinic, when medically necessary, and MDH describes the home as the standard setting. Parent and caregiver training is part of the treatment.

When. ABA isn’t tied to the school calendar, so sessions can continue after school, on weekends and during school breaks, depending on your child’s plan and authorization.

Where the two meet: rules that keep them separate

Maryland has rules on both sides that keep the two systems from overlapping:

On the insurance side:

• §15-835 says a health plan doesn’t have to pay for habilitative services delivered through early intervention or school services. The school pays for what’s in the IEP.
• COMAR 31.10.39 says a plan may not deny payment just because a treatment goal names the child’s educational setting as where the service happens. A plan also isn’t required to provide the services or meet the obligations a public school has under an IEP and federal special education law.
• The Maryland Insurance Administration notes that some children need help with things that don’t affect their education, such as social interaction, and that families can pursue those services through their health plan.

On the Medicaid side, the MDH ABA provider manual says:

• ABA during school hours isn’t the standard model of Maryland Medicaid’s ABA benefit. When it’s approved, it’s short-term and must be clinically justified.
• A behavior technician may not serve as a one-on-one educational aide or provide academic instruction. School placements that require families to supply support staff as a condition of enrollment don’t meet medical necessity criteria.
• Schools remain responsible for appropriate placements, accommodations and supports through the IEP or 504 process.
• School-based ABA may be appropriate in limited cases, such as helping a child use skills they’ve already mastered in a new setting, or helping school staff reduce challenging behaviors that happen only at school. The plan must show there’s no duplication with school services and must include a plan for fading out.

The idea behind all of these rules is simple: the school is responsible for education, and health coverage is responsible for medically necessary treatment.

Using both well: coordination tips

When the two teams talk to each other, your child gets more consistent support. Some practical steps:

• Share the IEP with your ABA provider. Maryland Medicaid asks for a copy of the IEP when school-based ABA is requested, and even when it isn’t, the behavior analyst can use it to avoid repeating goals.
• Share relevant ABA updates with the IEP team. If your child has learned a new way to ask for a break at home, the teacher may want to reinforce it at school.
• Line up strategies. Using the same words, visual supports and reinforcement at home and school helps your child carry skills from one place to the other.
• Use your parent training. Maryland Medicaid requires parents or caregivers to be trained to reinforce ABA, and that training can make you the link between the two teams.
• Keep the roles clear. If a need is about learning in the classroom, raise it with the IEP team. If it’s about daily living, behavior at home, or community skills, raise it with your ABA team and health plan.

Common questions from families

“The school offered services. Do we still need ABA?” It depends on your child. School services focus on education, while ABA addresses medically necessary needs across daily life. A diagnosing clinician or behavior analyst can help you decide whether ABA is recommended.

“Can the school just provide ABA?” Schools decide what goes in an IEP based on your child’s educational needs, and some may use behavior-analytic strategies. That’s still separate from an insurance- or Medicaid-funded ABA program.

“My child is under 3.” Start with the Maryland Infants and Toddlers Program. Our guide to the age-3 transition in Maryland explains what comes next, including the Extended IFSP Option.

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 insurance or Medicaid 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 10.09.28.05 (ABA limitations)
• Md. Code, Insurance §15-835
• COMAR 31.10.39.03 (UR criteria for autism)
• MIA, Parents’ Guide to Habilitative Services 2024
• MSDE, Understanding Service Delivery for Children Ages 0-5 Years
• COMAR 13A.05.01.06 (special education evaluation timelines)

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.