ABA Therapy Coverage in Texas: Private Insurance, Texas Medicaid and How to Check Your Benefits

Texas has had an autism insurance law for years, and Texas Medicaid added ABA therapy as a benefit in 2022. But the details matter a great deal: which kind of plan you have, how old your child was when they were diagnosed, and whether your employer's plan is regulated by the state at all.

This guide walks through what Texas law requires of private insurance, how ABA works under Texas Medicaid, what to look for on your card, and how BH Field verifies your benefits before your child's assessment is requested.

Key takeaway: Texas law requires state-regulated group health plans to cover autism treatment, including ABA, for children diagnosed before age 10, and Texas Medicaid covers ABA for members 20 and younger. Whether your plan covers ABA, and on what terms, is confirmed during benefits verification, which we handle for you.

What Texas law requires of private insurance

Texas's autism coverage rule is Texas Insurance Code § 1355.015. In plain language:

• Screening at 18 and 24 months. Plans must cover autism screening for children at 18 and 24 months of age.
• Treatment if diagnosed before age 10. Plans must cover treatment of autism spectrum disorder from the date of diagnosis, as long as the diagnosis was made before the child's 10th birthday.
• ABA is named. The "generally recognized services" a plan must cover, when prescribed by the child's primary care physician in a treatment plan, include evaluation and assessment, applied behavior analysis, behavior training and management, speech, occupational and physical therapy, and medications.
• A possible dollar limit at 10 and older. Plans are not required to cover more than $36,000 per year of ABA for enrollees age 10 or older. Younger children are not subject to that limit under the statute.
• Normal cost sharing applies. Deductibles, copays and coinsurance can apply in the same way as for other benefits in your plan.

Bills filed in 2025 to remove the age-10 rule and the $36,000 limit (HB 813 and SB 562) did not pass, so those rules remain in the statute.

Which plans the law reaches

This part of the Insurance Code applies to group health benefit plans, such as fully insured employer plans and HMOs, and it also reaches the basic coverage plans for Texas public school employees (§ 1355.002). If you buy coverage on your own, check your plan documents or let us check your benefits.

The biggest exception is self-funded employer plans. Many large employers pay claims themselves and use an insurance company only to administer the plan. Those plans are regulated under federal law (ERISA), so state mandates like this one generally do not apply. Many self-funded plans still cover ABA, but their rules can differ. Your HR department can tell you whether your plan is fully insured or self-funded.

ABA under Texas Medicaid

Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC). Autism services, including ABA evaluation and treatment, became a benefit of the Texas Health Steps–Comprehensive Care Program for dates of service on or after February 1, 2022, for members 20 years of age and younger who meet the program's criteria (TMHP notice).

According to HHSC's guide for families:

• Your child needs an evaluation to find out whether they qualify for Medicaid ABA.
• ABA is provided by Licensed Behavior Analysts (LBAs) and can be delivered in the home, the community or a clinic.
• To learn more, you can call your child's primary care provider, call your health plan using the number on the back of the card, or call the Texas Medicaid & Healthcare Partnership (TMHP) at 800-925-9126.

Most children with Texas Medicaid get their benefits through a managed care health plan. Programs include STAR, and STAR Kids for children and young adults 20 and younger with disabilities. HHSC requires these health plans to follow the Medicaid ABA policy, but each plan handles its own authorizations, so the plan named on your child's card is the one that matters.

Whether BH Field can serve your child under your specific Medicaid health plan is something we confirm during benefits verification. We will tell you plainly what we find.

What to check on your insurance card

Have your child's insurance card in hand (front and back) and look for:

• The plan name and logo. For Medicaid members, this shows which health plan and program your child is in.
• The member ID and group number. We need both.
• The policyholder. If your child is on a parent's employer plan, we need that parent's name and date of birth.
• Phone numbers on the back. Look for member services and, if listed, behavioral health. ABA is often managed by a plan's behavioral health team.
• Words like "administered by." On an employer plan, this can be a sign that the plan is self-funded. It is not proof, so check with HR if you are unsure.
• A second card. If your child has two plans, send both. Which one pays first matters.

Also note when your child was diagnosed. Under Texas law, the age at diagnosis can affect what a state-regulated group plan must cover.

How BH Field verifies your benefits

Benefits verification is built into our intake, before the assessment is requested. Our intake has nine stages:

1. You complete the questionnaire on our site.
2. We contact you within 24 hours and tell you exactly which documents to send.
3. You send your documents, including both sides of your insurance card and your child's diagnosis report. This stage sets the pace of everything after it.
4. We build your intake package in 1 to 3 business days. We verify your insurance benefits and coverage, confirm your diagnosis paperwork will be accepted, and prepare the authorization request.
5. Insurance approves the assessment, in 1 day to 4 weeks depending on your plan.
6. Your BCBA assesses your child and writes the report, usually in 1 to 2 weeks.
7. Clinical review of the report, in 2 to 4 business days.
8. Insurance approves treatment and sets your child's hours, in 1 day to 4 weeks.
9. We match your team, in 1 business day to 4 weeks.

From first contact to first session usually takes 2 to 16 weeks. Where you land depends mostly on your insurer, which can approve an authorization in a day or take up to a month, and on your schedule flexibility, any language or therapist-gender preference, and your location.

After the benefits check, we explain what we found: whether ABA is covered, whether authorization is needed, and what cost sharing may apply. We never tell a family a plan covers something before we have confirmed it.

How BH Field serves families in Texas

BH Field is now open in Texas, with an office at 2631 Gattis School Rd, Suite 220, Round Rock, TX 78664, and we serve families across the state. We do not have a clinic in Texas yet, so direct ABA therapy is delivered in person by a Registered Behavior Technician (RBT) at home or at school. Telehealth is used for assessments, BCBA supervision and parent training. Our team is bilingual in English and Spanish.

Behavior analysts in Texas are licensed by the Texas Department of Licensing and Regulation (TDLR).

Questions? Call (877) 438-1265 or email info@bhfield.com.

Next steps

• Learn how we serve families statewide on our Texas page.
• Ready to begin? Start ABA therapy and we will contact you within 24 hours.
• Gather your documents with the ABA intake checklist.
• See how we check your plan on our insurance verification page.