Autism and Insurance Coverage in Maryland

Does Autism and ABA therapy cost covered by Insurance in Maryland ? Under the Maryland Insurance Code, insurance policies that cover medical or surgical treatment must also cover the diagnosis and treatment of autism spectrum disorder (ASD) for individuals under the age of 21. This includes coverage for autism therapy services such as applied behavior analysis (ABA) therapy, occupational therapy, speech therapy, and other evidence-based treatments for ASD.

Maryland lawmakers approved a Bill in 2012 requiring that coverage for autism treatment be clarified by regulators under Maryland’s existing Habilitative Services Mandate.  The Maryland Habilitative Services Mandate is a state law that requires insurance policies in Maryland to cover certain habilitative services for individuals under the age of 21. Habilitative services are treatments or therapies that help individuals with disabilities acquire, retain, or improve skills related to communication, mobility, self-care, and other activities of daily living.

The Maryland Habilitative Services Mandate applies to both private insurance policies and plans offered through the Maryland Health Benefit Exchange. It requires insurance policies to cover habilitative services that are medically necessary and provided by a licensed or certified provider.

Following type plans are covered:

  • Individual Plans 
  • Fully Insured Large Group Plans 
  • Fully Insured Small Group Plans – 

What services are covered by law?

  • Behavioral health treatment, including applied behavior analysis (ABA). 
  • Psychological care, including direct or consultative services and psychotherapy.
  • Speech, occupational and physical therapy

How do you qualify for the coverage ?

  • Formal Diagnosis in Writing form a licensed professional
  • Prescription for ABA outlining Medical Necessity
  • Treatment Plan Outlining Goals

*Disclaimer Note: The information in this website is provided to assist physicians and families navigate funding for services. It is based on our internal research, and is not a guarantee of funding. Please check with your state law agency page by clicking this link