For many families in New York, understanding how ABA therapy is covered starts with one key question:

What happens if my child is insured through Child Health Plus (CHPlus)?

Child Health Plus plays an important role in providing health coverage for children across New York—especially for families who do not qualify for Medicaid and do not have access to employer-sponsored insurance. This article explains how ABA therapy and autism-related services are generally handled under CHPlus, what families should know, and how this coverage differs from private insurance.

What is Child Health Plus (CHPlus)?

Child Health Plus is a New York State health insurance program that provides low-cost or no-cost coverage for children under age 19.

CHPlus is designed for families who:

• Do not qualify for Medicaid
• Do not have access to affordable employer-sponsored insurance
• Meet income and residency requirements in New York

Coverage is offered through approved health plans and focuses on preventive care, primary care, and medically necessary services for children.

How ABA therapy is generally covered under CHPlus

Under Child Health Plus, coverage for ABA therapy is tied to medical necessity and state-defined benefits for children’s behavioral health services.

In general, ABA-related services under CHPlus may involve:

• Behavioral health evaluations
• Authorization of medically necessary behavioral therapy
• Services delivered through approved provider networks

Coverage decisions are typically guided by New York State policies and the specific CHPlus plan administering benefits.

Because CHPlus is structured differently from private insurance, coverage rules and authorization pathways may not look the same as employer-sponsored plans.

Eligibility basics families should understand

Eligibility for Child Health Plus depends on several factors, including:

• Child’s age (under 19)
• Family income level
• New York State residency
• Access to other insurance options

Families enrolled in CHPlus do not pay deductibles, and monthly premiums—if any—are based on income. This makes CHPlus an important coverage option for many families navigating autism support and behavioral health needs.

How CHPlus differs from private insurance for ABA therapy

Although CHPlus and private insurance both provide health coverage, they function very differently when it comes to ABA therapy.

Key differences families often notice include:

• Plan structure: CHPlus follows state-defined benefit rules, while private insurance varies by employer and policy
• Authorization process: CHPlus authorizations are handled through state-regulated systems and approved plans
• Provider networks: Access may depend on which providers are enrolled with CHPlus-approved plans
• Coverage scope: Private insurance often involves employer-specific benefits, while CHPlus follows standardized program guidelines

Because of these differences, families transitioning between CHPlus and private insurance may experience changes in coverage requirements, provider access, or authorization timelines.

Why understanding CHPlus matters for New York families

In New York City and surrounding areas, Child Health Plus serves a large and diverse population of families. Many parents begin their autism support journey under CHPlus before later transitioning to private insurance—or vice versa.

Understanding how ABA therapy fits within CHPlus coverage can help families:

• Ask informed questions about services
• Understand authorization expectations
• Plan next steps without unnecessary delays

This article is intended to provide general education, not plan-specific determinations.

Moving from CHPlus questions to next steps

When families are ready to explore services or clarify how coverage works for their specific situation, the next step is often reviewing how insurance questions and authorization processes are typically handled.

For an overview of how coverage verification and authorization support works, families can review our insurance support page.

➡ Learn more about insurance support and next steps

Final note for families

Navigating ABA therapy coverage under Child Health Plus can feel complex—especially when policies, eligibility rules, and provider networks are involved. Understanding the basics of how CHPlus works in New York gives families a clearer starting point and helps reduce uncertainty along the way.

If your child is covered through Child Health Plus, learning how behavioral health services are structured can make the path forward feel more manageable.