Families exploring Applied Behavior Analysis (ABA) in New York often begin with the same question:

Is ABA therapy covered by insurance—and how does that coverage work in practice?

Insurance rules can feel overwhelming, especially when coverage depends on plan type, authorization requirements, and state regulations. This page explains how ABA therapy insurance coverage generally works in New York, what families can expect from private insurance and Child Health Plus, and how to take next steps if they want help reviewing coverage.

How ABA therapy insurance coverage works in New York

In New York, insurance coverage for ABA therapy is typically based on medical necessity. This means services may be covered when they are:

• Recommended or prescribed by a qualified healthcare professional
• Supported by appropriate clinical documentation
• Delivered by credentialed providers who meet plan requirements

State regulations require many insurance plans to recognize ABA as a medically necessary treatment for autism. However, coverage details still vary by policy. Authorization rules, benefit limits, and provider network participation all play a role in determining how services are covered.

Because of these variables, coverage decisions are usually reviewed on a case-by-case basis.

Private insurance coverage for ABA therapy in New York

Many private health insurance plans in New York include benefits for ABA therapy when medical criteria are met. These plans may be offered through employers, unions, or the individual insurance marketplace.

Private insurers that commonly provide ABA therapy coverage in New York include:

• Aetna
• Cigna
• UnitedHealthcare
• Empire BlueCross BlueShield
• EmblemHealth
• Healthfirst
• MetroPlus Health Plan
• 1199SEIU Benefit Funds
• NYSHIP
• Horizon Blue Cross Blue Shield

Coverage may differ depending on the specific plan, employer group, or region. Even within the same insurance company, benefit structures and authorization requirements can vary. For this reason, families often benefit from reviewing plan details before starting services.

Child Health Plus and ABA therapy in New York

Child Health Plus is New York’s state-sponsored health insurance program for children. Some Child Health Plus plans include coverage for behavioral health services, which may include ABA therapy when eligibility criteria are met.

Compared with private insurance, Child Health Plus plans may involve:

• More limited provider networks
• Additional authorization steps
• Age-specific eligibility considerations

Coverage details depend on the specific Child Health Plus plan and the provider’s participation in that network.

Common questions about ABA therapy insurance coverage

Is ABA therapy covered by insurance in New York?

Many insurance plans in New York include coverage for ABA therapy. Coverage is typically determined by medical necessity, plan benefits, and authorization requirements.

Does every insurance plan include ABA therapy benefits?

Coverage for ABA therapy varies by insurance plan. Many plans offer ABA benefits, with coverage determined by factors such as diagnosis, clinical documentation, provider credentials, and network participation.

What documentation is usually required?

Insurance plans commonly request:

• A formal autism diagnosis documented by a qualified healthcare professional
• A recommendation for ABA therapy from a qualified healthcare professional or the child’s primary care physician

Is prior authorization required?

Most insurance plans require prior authorization before ABA services begin. Reauthorization may also be needed at regular intervals, depending on the policy.

From understanding coverage to next steps

This article is intended to help families understand how ABA therapy insurance coverage generally works in New York. It focuses on education and clarification rather than plan-specific determinations.

When families are ready to move from learning to action, many choose to work with a provider’s office that can help review insurance benefits and guide the authorization process. In most cases, provider offices assist by gathering required information, submitting authorization requests, and helping families understand coverage details before services begin.

For an overview of how insurance questions and authorization steps are typically handled, families can review our insurance support page.

➡ View insurance next steps

(This page focuses on coverage support and next steps. Families can review the information and decide whether or not to request additional assistance.)

Request information about ABA insurance options in New York

If you have questions about how insurance coverage may apply to ABA therapy in New York, you may request additional information. Coverage depends on individual plans, eligibility criteria, and service availability.

➡ Request insurance coverage information