Like any treatment, the cost of ABA therapy can add up without insurance coverage. Parents often feel like they have to choose between financial instability and their child’s well-being and future. This isn’t the case.
If you don’t have insurance, you still have options to cover the cost of ABA therapy for your child. Government programs, school-based offerings, scholarships, grants, and payment plans can all offset the cost of ABA therapy, so your child can get the help they need.
A Long-Term Therapy
Applied behavior analysis (ABA) therapy is the leading evidence-based approach to treating people with autism, particularly children with autism. The therapy helps participants to understand and change negative behaviors, learn new skills, and develop positive behaviors so they can successfully navigate the world around them.
This form of therapy is individualized to each client. Practitioners create measurable goals and collect information as each step of the process is completed. This helps them understand how the child is progressing and whether certain approaches are working.
Children going to ABA therapy often need to remain in a program intensively for months or years. Regular appointments are vital to reinforcing behavioral change.
This can get expensive, sometimes even with the help of insurance coverage. The therapist who works best for your child may not be the therapist in your network. Your insurance plan may not cover enough sessions, or it may not cover the full cost of sessions. Your insurance may change, so you need to switch providers in the middle of treatment, which can be disruptive.
There are options that can work alongside insurance coverage to help you afford the right ABA therapy for your child.
The Cost of Therapy
On average, ABA therapy can cost $17,000 each year for one child with autism, according to research from the Centers for Disease Control and Prevention (CDC). However, some families’ costs are reportedly closer to $45,000 to $100,000 every year.
The lifetime average cost of treatment for someone with autism ranges from $1.4 million to $2.4 million, depending on whether they also have a learning disability.
In 2014, 46 states banded together to require insurance providers to cover the costs of autism treatments, including ABA therapy. Currently, some state mandates offer $36,000 to $50,000 in coverage for these costs. For the estimate of $17,000, this appears to be enough, but it may not help some families who have children with autism.
How to Qualify for ABA Therapy Coverage
To qualify your child for insurance coverage for their autism treatment, you must get a diagnosis from a clinician first. Your pediatrician can refer you to a specialist, such as a child psychologist, pediatric neurologist, or developmental pediatrician.
The Centers for Disease Control and Prevention (CDC) offers guidelines on when clinicians should screen children for autism based on developmental milestones. Typically, screenings start around 18 months, and they may continue over a few years, particularly if there is a history of autism in the child’s family.
Check with your insurance provider to understand how treatment will be covered. You can get assistance through employer-based insurance, private insurance, or state or federally subsidized programs. All Medicaid plans must cover autism treatment, for example, but not all ABA providers accept Medicaid.
Programs to Offset the Cost of ABA Therapy for Children With Autism
There are several government programs available to support people with autism. These programs help people find affordable, reputable sources of treatment for autism, or they can provide aid for families in need.
Here are some the federal programs:
- Medicaid: Federal health insurance and the state-level expansions of this program cover health care for low-income families and those who have children with significant special needs. If your child has moderate or severe autism, they may qualify for Medicaid coverage.
- School-based programs: Some ABA providers partner with local schools to provide full-time or part-time support services for families with autistic children. These typically involve weekly visits, and they are only available in certain public and private schools.
- This may work better as a supplemental program for most kids. For children with mild cases of autism and a good base of skills, it could be the primary form of therapy.
- Community programs: Some programs may be available at clinicians’ offices, churches, or community centers on a weekly or monthly basis to reinforce certain skills, like tolerating crowds, accepting “no,” using a menu, staying quiet in certain situations, and other skills.
- Supplemental Security Income (SSI): This federal income program is open to individuals with disabilities regardless of age or work history, as long as they meet medical and financial criteria. It is a needs-based program. In some cases, the financial cost of treatments like long-term ABA therapy can qualify a child for the program.
- Food and housing subsidies: If your child’s medical needs are so great that you struggle financially — or you must spend significant time away from work or are out of work to take care of your child with autism — you may qualify for food stamps and federal housing benefits.
The Danger in Cutting Treatment Short
You may wonder how you can lower the overall cost of treatment for your child. Too many families spend less time with ABA practitioners per week to try to save money, or they follow short-term treatment plans and hope for the best.
Reducing the amount of therapy your child receives is not the answer. Infrequent ABA sessions will mean that it’s difficult to see significant results. Progress that is made can be lost between sessions if they don’t occur regularly.
ABA therapy is a long-term treatment. The results are real, but it takes time for the improvements to take hold.
Finding Additional Funding & Coverage Sources
There are additional sources of funding you can access if federal and state programs don’t cover the cost of ABA therapy for your child.
Autism Speaks hosts a list of grants for families. These funds can help families pay for various expenses related to autism, including ABA therapy. These are typically small or short-term grants, but they can help to fill in financial gaps.
If you don’t have insurance, Medicaid programs can provide coverage in some cases.
Some providers may offer telehealth services. Increasingly, virtual communication with doctors or nurses is becoming normal. Telehealth helps people to get refill prescriptions, receive talk therapy, or discuss sensitive questions with medical providers without having to leave their homes.
One study on the effectiveness of telehealth therapy for autistic individuals compared home-based telehealth, in-home therapy, and clinical therapy. Researchers found that all three methods were effective. Telehealth is easier to access and typically less expensive than clinic visits or in-person, in-home treatment. While in-person visits are preferred for ABA therapy, telehealth sessions may supplement an overall treatment plan in some cases.
Families have the option of paying out of pocket for sessions, and some families take out private loans to cover the cost. Crowdsourcing funds or borrowing money from family can also be an option for some.
Asking for Help From Providers
If you find an ABA therapist you like, they may offer treatment on a sliding scale. In this situation, rates of therapy sessions are based on a family’s income level. This enables families with limited finances to get the treatment their child needs at a lower price point.
Some providers offer families the option of a payment plan, where they can gradually pay off the total bill over time. The child receives treatment now, but the family has time to gather financial resources to pay later.
Some providers may offer a discount when families commit to a certain number of sessions. This discounts the individual cost of each session.
There are many ABA providers that accept a combination of insurance types, including Medicaid and private insurance. Check providers’ websites for more information about the insurance programs they work with. You can also get a referral from your pediatrician or general practitioner to resources that are in your insurance network.
ABA therapy can greatly help your child build skills to navigate the world. If you don’t have insurance, you don’t have to sacrifice this form of treatment for your child. Whether you use federal programs, private grants and scholarships, or other sources of funding, you have options to finance ABA therapy.
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- What Is Covered? The Insurance Landscape for Autism Services. (April 2019). Forbes.
- Financial Resources. Autism Speaks.
- CDC’s Developmental Milestones. (December 2019). Centers for Disease Control and Prevention (CDC).
- Medicaid EPSDT. (August 2018). Autism Speaks.
- Applying for Social Security Disability Benefits With Autism. (May 2019). Organization for Autism Research.
- Government Benefits and Special Needs Trusts. Autism Society.
- Community-Based ABA Therapy. Applied Behavior Center for Autism.
- How Do I Fund My Child’s Applied Behavior Analysis (ABA)? (2019). Indiana Resource Center for Autism, Indiana Institute on Disability and Community.
- Telehealth and Autism: Treating Challenging Behavior at Lower Cost. (February 2016). Pediatrics.
- Autism Grants for Families. Autism Speaks.
- Grants & Scholarships. (2020). American Autism Association.
- Autism Related Scholarships. (2020). College Scholarships.