ABA Therapy Payment Options in New Jersey

December 19, 2021

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If your child has been diagnosed with autism spectrum disorder, you want to ensure that you have access to the best treatments available.

However, your child may require up to 40 weekly hours of ABA therapy and the cost can quickly add up.

Fortunately, several resources are available to help you cover the cost of the treatment.

In this article we will break down the different payment options for ABA therapy in NJ.

What Is ABA Therapy?

Applied behavior analysis (ABA) therapy is currently the most effective form of autism treatment. ABA is a targeted intervention based on the child’s strengths and weaknesses. It uses positive reinforcement strategies to teach and reinforce skills such as:

Language and communication skills
Non-verbal communication skills
Social skills
Following instructions
Initiating conversations
Improving attention and focus
Fine motor skills and dexterity
Reducing problematic behaviors such as anger and meltdowns
Pre-academic and academic skills.

Over 90% of children with autism who go through ABA therapy make substantial improvements, while close to 50% reach a development stage where they are indistinguishable from neurotypical children.

How Much Does ABA THerapy Cost?

The cost of ABA therapy depends on several factors, including:

Your child’s needs
The severity of your child’s condition
The type of program you choose
The location where therapy takes place
The provider and the qualifications of the therapist.

On average, one hour of ABA therapy provided by a board-certified ABA therapist costs $120. Therapists who are not board certified may provide treatment at lower rates, however, for best results it is highly recommended to work only with certified therapists.

It is important to keep in mind that ABA is a long-term treatment. Although most ABA therapists work with children with autism between 10 and 20 hours per week, some children require up to 40 weekly hours of therapy for several years to see improvement.

If your child receives 40 hours of therapy per week, intensive treatment can cost $4,800 per week or $250,000 per year without insurance

Does Medicaid Cover ABA Therapy in New Jersey?

Yes. As of April 2020, NJ FamilyCare Medicaid reimburses Medicaid-enrolled ABA therapy providers for autism treatment services, including:

Behavior identification assessments
Supporting assessments
Adaptive behavior treatment
Individual and group treatment
Family adaptive behavior treatment.

New Jersey’s Mandate of Autism Coverage

The New Jersey Mandate of Autism Coverage signed in 2009 requires specified health insurance policies to provide benefits for the treatment of autism spectrum disorde r and other developmental disabilities. Coverage includes medically necessary occupational therapy, physical therapy, and speech therapy prescribed through a treatment plan.

Autism diagnosis

In New Jersey, the Mandate requires that a diagnosis of autism spectrum disorder be made by a physician. What’s more, services must be provided only if autism is your child’s primary diagnosis and if the physician indicates that the services are medically necessary to treat the condition.

Treatment plan prescription

The Mandate specifies that therapy must be prescribed through a treatment plan created by the child’s physician. However, many New Jersey insurers allow and some even require Board Certified Behavior Analysts (BCBAs) and other therapy providers to create the treatment plan. Check your insurer’s guidelines to determine whether the plan must be prepared by a physician or it can be created by a provider. Insurers may only request an updated treatment plan once every six months.

How To Get Coverage for ABA Therapy?

Certain insurance plans are exempt from state mandates. The New Jersey Mandate of Autism Coverage only applies to state-regulated insurance plans and plans that cover state workers, including most teachers.

State-regulated insurance plans

If you have a state-regulated insurance plan, the Mandate:

Requires screening and diagnosis of autism and other developmental disabilities
Requires coverage for expenses for any occupational, physical, and speech therapy that is medically necessary
Requires coverage for medically necessary ABA therapy as prescribed through a treatment plan to treat autism
Prohibits denial of coverage based on the fact that therapy is not restorative.

The Mandate will usually apply to your insurance plan if your employer is based in New Jersey and has less than 50 employees.

New Jersey regulations also require your insurance card to state if your plan is state-regulated or self-funded. You can contact your insurance provider and send them the documentation from your child’s physician to see how much coverage they will provide.

Self-funded insurance plans

The New Jersey Mandate of Autism Coverage doesn’t apply to self-funded insurance plans because these plans are governed by federal rather than state law. However, insurance coverage for therapies needed by children with autism may be ensured through the Affordable Care Act and the New Jersey Mental Health Parity Act.

The Affordable Care Act (ACA)

The Affordable Care Act prohibits insurance providers from placing annual or lifetime limits as well as rejecting coverage for pre-existing medical conditions.

The New Jersey Mental Health Parity Act

In New Jersey, children with autism are also protected by the New Jersey Mental Health Parity Act. It prohibits insurers from imposing more restrictions on mental health treatments than on other medical treatments. In other words, insurers are not allowed to place limitations on autism therapies if no such limitations exist for the treatment of other medical conditions.

Does New Jersey Have Caps on ABA Coverage?

The New Jersey Mandate on Autism Coverage originally allowed insurers to impose a $36,000 limit on ABA therapy for children with a primary diagnosis of ASD up to the age of 21. Since the enactment of the Affordable Care Act that imposes federal mental health parity requirements on most insurance plans, the Mandate for Autism has no longer monetary or age limitations. These changes were effective as of January 2015.

What Insurance Plans Does Golden Care Accept?

We are currently in-network with the following providers.

Aetna
Cigna
Horizon
Blue Cross Blue Shield (BCBS)

Charities that can help pay for ABA therapy in New Jersey

If you don’t have insurance, the charities listed below can provide financial assistance for ABA therapy for your child.

If you are ready to work with the best ABA therapy provider in New York, New Jersey or Indiana, give us a call at (732) 402-0297. Our dedicated team is ready to help and we will treat you like family.

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