Insurance is usually the first worry parents tell us about, and it is a fair one. The good news is that Florida has real coverage pathways for ABA, through Florida Medicaid and through many private plans. This page explains how each one works in plain words, what you will need, and how Paramount Behavior checks it for you at no cost.
The short version
If your child is under 21 and has Florida Medicaid, medically necessary ABA is a covered benefit. If your child has a private plan, Florida law requires many group health plans to cover ABA for autism, with some limits. In both cases, a few things are almost always needed: documentation of your child's needs, a doctor's order or prescription, and an approval from the plan before therapy starts.
Every plan is different, so the only reliable answer comes from checking your actual policy. We do that for free.
Florida Medicaid
The Florida Agency for Health Care Administration (AHCA) says Florida Medicaid covers behavior analysis services for eligible recipients under 21 who need them for medical reasons. The rule that governs this is Rule 59G-4.125 of the Florida Administrative Code, effective February 10, 2025. For people 21 and older, behavior analysis is available through the iBudget Waiver instead.
AHCA lists what a family typically needs to start:
- Active Florida Medicaid coverage for your child, usually through a managed care plan such as Sunshine Health
- A written order for behavior analysis services from a doctor
- A comprehensive diagnostic evaluation led by a licensed practitioner
- Prior authorization. AHCA states that all behavior analysis services must have prior authorization to be paid for by Florida Medicaid, and the request goes to your child's managed care plan
Private insurance and Florida's autism law
Florida's autism coverage law, section 627.6686 of the Florida Statutes, requires covered group health plans to cover the screening and treatment of autism spectrum disorder, including applied behavior analysis. ABA has to be provided by someone certified under section 393.17 or licensed under chapter 490 or 491, which is why a BCBA plays the lead role on your child's team.
Florida's law applies to certain fully insured group plans. Individual plans, small-employer plans and self-funded employer plans can follow different rules, so whether ABA is covered and what limits apply depend on your plan. Where the law applies, the treatment must be prescribed by your child's doctor under a treatment plan.
Paramount Behavior verifies your benefits for free before therapy starts, so you know what your plan covers before anything begins.
Plans we work with
Paramount Behavior works with Florida Medicaid, including Molina Healthcare, Sunshine Health, Children's Medical Services Health Plan and Community Care Plan, and we can check your benefits with private plans such as Aetna, Cigna, Florida Blue and UnitedHealthcare. Your exact benefits depend on the plan your employer chose and on your own policy, so we verify them for you before therapy starts. If your plan is not on this list, call us anyway. Families with the Step Up For Students scholarship (FES-UA) can also use it for ABA with us: see our Step Up scholarship page.
What "prior authorization" means
Prior authorization is simply the plan's approval before therapy begins. The BCBA assesses your child and writes a treatment plan, and then we send it to your insurance with the supporting documents. The plan approves a certain number of hours for a certain time. When the time is up, we send updated information to ask for more.
You do not have to do this yourself. Our team prepares and submits the requests and keeps track of the dates.
How we verify your benefits for free
After your first call, we look up your coverage and tell you what we found: whether ABA is covered, whether approval is required, and what you may owe. The benefits check is free, and we usually have an answer the same day. If something is missing, such as a diagnostic evaluation or a doctor's order, we tell you what it is and where to get it.
Many of our families pay little or nothing out of pocket. We will never promise that before we see your plan, but we will give you a straight answer after we do.
Ready to check your coverage
Use the quick request form on this page, or call (561) 421-0047. A real person will answer, in English or Spanish, and we will start your free benefits check.
Does Florida Medicaid cover ABA therapy?
Yes, for eligible children under 21 when the service is medically necessary and approved ahead of time by the child's managed care plan.
Does private insurance in Florida cover ABA for autism?
Many group health plans must cover it under section 627.6686 of the Florida Statutes. Individual, small-employer and self-funded employer plans may follow different rules, so a free benefits check is the only way to know.
Do you accept Molina Healthcare?
Yes. Molina Healthcare is one of the Florida Medicaid plans we work with, and we verify your benefits for free before therapy starts.
Do you accept Sunshine Health?
Yes. Sunshine Health is one of the Florida Medicaid plans we work with. See our Sunshine Health page for how to get started.
How much will I pay?
It depends on your plan. Medicaid families typically pay nothing for covered services. For private plans, we verify your deductible, copay and limits for free and tell you before you start.
My child does not have a diagnosis yet. What can I do?
Plans need evidence of medical need, usually a comprehensive evaluation. We can point you to local evaluation options during your free call.