SENTINEL

    ABA Therapy & Healthcare Plans

    Understanding ABA Therapy Coverage in Washington State

    A clear, family-friendly guide to eligibility, how to access services through Apple Health and commercial plans, and next steps for getting started.

    What is ABA?

    Applied Behavior Analysis (ABA) is an evidence-based therapeutic approach commonly used to support people with Autism Spectrum Disorder (ASD) and certain developmental disabilities. ABA focuses on teaching skills (communication, daily living, social skills) and reducing behaviors that interfere with learning or safety through individualized, data-driven plans.

    Who can get ABA through Washington plans?

    Coverage is available through state Medicaid (Apple Health) for eligible members and through many private commercial plans regulated under Washington state law.

    Typical eligibility steps

    1. A confirmed diagnosis of ASD or another qualifying developmental/intellectual disability.
    2. An evaluation and order for ABA by an approved clinical reviewer (often referred to as a Center of Excellence or specialty evaluator in the Apple Health process).
    3. Enrollment with an ABA provider who accepts Apple Health or is in‑network with the member’s commercial plan.

    What’s covered?

    • Comprehensive assessments and individualized treatment planning
    • Direct, hands-on ABA therapy by credentialed clinicians and supervised assistants
    • Caregiver and family training (to generalize skills)
    • Professional supervision, progress reviews, and periodic reassessments
    • Telehealth sessions when clinically appropriate and authorized

    What is often not covered

    • Educational services solely provided by schools
    • Recreational or non‑medical services (e.g., unproven alternative therapies, purely social/recreational programs)
    • Respite or life-coaching that is not medically necessary

    How the Apple Health (Medicaid) pathway usually works

    1. Obtain a formal diagnosis from a qualified clinician (pediatrician, psychologist, psychiatrist, neurologist, etc.).
    2. Schedule an evaluation with a designated reviewer or Center of Excellence to determine medical necessity and issue an order for ABA services.
    3. Choose an ABA provider enrolled with Apple Health or in-network with your managed care plan.
    4. Provider performs intake, baseline assessment, and creates a written treatment plan (goals, service hours, caregiver training, outcome measures).
    5. Services begin; the plan is periodically reviewed and reauthorized based on progress and documentation.

    Note: Individuals in managed-care plans should contact member services for assistance with referral routes and in-network provider listings.

    Tips for families

    • Contact multiple ABA providers early — many have waitlists. Having the evaluator’s order ready will help get you onto the provider’s intake list faster.
    • Ask about parent training and caregiver coaching — these are often included and crucial for generalization of skills.
    • Keep medical and therapy records organized: the plan, progress notes, and reassessments support reauthorization requests.
    • If denied, use your plan’s appeals process and request help from case managers or local advocacy organizations.

    Quick checklist

    • Diagnosis documented
    • COE / specialist evaluation completed
    • Order for ABA written
    • Provider accepts Apple Health / in-network

    Need help?

    Call your managed‑care member services or the Apple Health provider line. Community advocacy groups and local family resource centers can also help navigate referrals and appeals.

    Frequently asked questions

    How long does authorization take?Processing time varies — having a completed evaluation and documentation speeds the process.Can ABA be provided at home?Yes — many plans allow clinic, home, and community-based services when clinically appropriate and authorized.Are telehealth ABA sessions allowed?Telehealth may be permitted for certain services (e.g., caregiver training); check your plan and provider for availability.

    Resources

    • Apple Health / Medicaid provider information (state health agency)
    • List of Centers of Excellence and specialty evaluators
    • Local family resource centers and autism advocacy organizations
    • Insurance appeals guides and sample letters

    Contact & next steps

    Ready to start? Use this checklist to move forward:

    1. Confirm the diagnosis and gather documentation.
    2. Request an evaluation from an approved reviewer or Center of Excellence.
    3. Sign Up Here: https://parents.finnihealth.com/sentinel-neurobx/signup
    4. Contact us for a FREE 30 Minute Consult: https://book.titan.email/sentinelneurobx
    Disclaimer: This resource summarizes common pathways to coverage for ABA therapy in Washington state. It is for informational purposes only and does not replace legal or medical advice. Coverage rules, provider networks, and administrative processes change — always confirm with your plan or state agency.