Family Guide
Does Florida Medicaid cover ABA therapy?
Yes. Florida Medicaid covers ABA therapy, which the state calls behavior analysis services, for children and youth under 21 when the services are medically necessary. For covered and authorized services, eligible families generally pay nothing out of pocket.
That is the short answer. Below is the full path, in the order it actually happens, the way we explain it to parents on the phone every week. If you would rather hear it than read it, call 786-238-5931. We answer in English and in Spanish.
Does Florida Medicaid cover ABA therapy?
Yes. Florida Medicaid covers ABA therapy, officially called behavior analysis services, for children and youth under 21 when the services are medically necessary.
That coverage comes from EPSDT, the federal Early and Periodic Screening, Diagnostic and Treatment benefit, which requires state Medicaid programs to cover medically necessary treatment for people under 21. Medical necessity is not something a parent has to argue on their own. A licensed professional documents it through a diagnostic evaluation and a written treatment plan, and the plan reviews that documentation.
Coverage is not automatic simply because a child has a diagnosis. The evaluation, the treatment plan, and prior authorization all have to be in place first, which is what the rest of this guide walks through.
Which Florida Medicaid plans cover ABA therapy?
Behavior analysis is a covered benefit across Florida Medicaid, and most children receive it through a Medicaid managed care plan rather than through Medicaid directly.
Permuy Diversity Intervention is in network with Humana Florida, Simply HealthCare FL, and Clear Health Alliance FL. Since behavior analysis services moved into Statewide Medicaid Managed Care, the plan on your card decides which providers you can use, so being Medicaid approved and being in network with your specific plan are two different things and both matter.
The underlying coverage rules are the same across plans. What changes is the paperwork, the authorization process, and the network. If you tell us the plan name printed on your card, we will confirm where you stand at no cost.
- Humana Florida
- Simply HealthCare FL
- Clear Health Alliance FL
See the full list of insurance plans we accept, including non Medicaid coverage.
What do I actually pay for ABA therapy with Medicaid?
For covered and authorized services, families eligible for Florida Medicaid generally have no out of pocket cost for ABA therapy.
Two words carry the weight there: covered and authorized. Services that fall outside the authorization, or outside the Medicaid benefit entirely, are not paid by the plan. Every plan is a little different, so we will not publish a number on a web page and let you plan a family budget around it.
What we will do is verify your specific plan with you before you commit to anything, and tell you in plain language what is covered, what is not, and whether anything about your situation is likely to change that.
Do I need a diagnosis before Medicaid will cover ABA?
Yes. Florida Medicaid requires a comprehensive diagnostic evaluation from a licensed professional before behavior analysis services can be authorized.
That evaluation is what establishes medical necessity. It is usually completed by a pediatrician, developmental pediatrician, psychologist, or another licensed diagnostician, and it documents the child's diagnosis and clinical needs. Autism is the most common reason children qualify, though it is not the only qualifying condition.
If your child has already had a full evaluation, you may already have the document the plan is looking for. If you are not sure, call us and we will tell you what you have, what is missing, and where that gap gets resolved.
How do I get ABA therapy started with Medicaid, step by step?
There are five steps: confirm Medicaid is active, complete the diagnostic evaluation, choose a Medicaid approved provider that is in network with your plan, let the provider submit prior authorization, and begin services once the plan approves.
- Confirm your child's Medicaid is active. Check the card and the plan name printed on it. If you are not sure the coverage is current, we can look at it with you on the phone before anything else happens.
- Get the diagnostic evaluation. Florida Medicaid requires a comprehensive diagnostic evaluation completed by a licensed professional before behavior analysis services are authorized. If your child already had a full evaluation, you may already have what you need.
- Choose a Florida Medicaid approved ABA provider. Not every ABA company can bill Medicaid, and under statewide managed care the provider also has to be in network with your specific plan. Permuy Diversity Intervention is an approved Florida Medicaid provider serving Miami-Dade and Monroe counties.
- The provider submits the prior authorization. We assess your child, write the behavior plan, and send the request to your plan. That paperwork is our job, not yours.
- Therapy starts, then renews. Once the plan approves the request, sessions begin at home, at school, or in the community. Before the authorization period ends we reassess and submit the renewal so services do not lapse.
What is prior authorization and how long does it take?
Prior authorization is your Medicaid plan's approval of a specific ABA treatment plan before services begin, and it is required for behavior analysis services in Florida.
The provider submits the assessment and the written treatment plan, including the recommended service hours, and the plan reviews it against medical necessity criteria. Authorizations are granted for a set period rather than indefinitely, so the provider reassesses and submits a renewal before the current period ends.
How long a review takes depends on the plan and on whether the submitted documentation is complete, so we will not quote you a number of days we cannot stand behind. We can tell you where your request is in the process at any point, and incomplete documentation is the most common reason a family waits longer than they expected.
Behavior analysis services are governed by Rule 59G-4.125, Florida Administrative Code. Your provider submits the request to your child's managed care plan if your child is enrolled in one, or to Acentra, the Agency's contracted utilization management vendor, if your child receives services through fee-for-service Medicaid.
What happens if Florida Medicaid denies ABA therapy?
A denial is not the end of the process. Florida Medicaid has a formal appeal path, it costs you nothing to use, and the deadlines are shorter than most families expect. The single most important thing you can do is read the notice you received and act on the date printed on it.
If your child is enrolled in a Medicaid managed care plan, and most Florida children are, you have to go through your plan's own appeal process first. The Agency for Health Care Administration is explicit about this: if you are enrolled in a health or dental plan, you must go through the plan's complaint and appeal process before you can have a Medicaid Fair Hearing. Your denial letter tells you how to file and by when. Call the member services number on your child's plan card and ask them to confirm that deadline in writing.
After the plan's appeal, or directly if your child is not in a managed care plan, you can request a Medicaid Fair Hearing. That is an independent review by a hearing officer who does not work for your plan. Under Rule 59G-1.100, Florida Administrative Code, the Agency must receive a fair hearing request within 120 days of the date your Notice of Plan Appeal Resolution is sent if you are a managed care enrollee, or within 90 days of the date the Notice of Adverse Action is sent if you are in fee-for-service Medicaid. You get written notice of the hearing at least 14 days before the date, and the hearing officer issues a final order within 90 days of the request unless that period is waived or extended.
If your child is already receiving ABA and the denial would stop or reduce it, you can ask for services to continue while you appeal. That request has to be filed no later than 10 days after the unfavorable notice was mailed, or on or before the first day services are scheduled to be reduced, terminated or suspended. One thing to understand before you ask: if services continue and the decision is ultimately upheld, you may be asked to pay for the continued services.
The Florida Medicaid Helpline is 1-877-254-1055. If you are our client, we assemble the clinical documentation your appeal needs, the evaluation, the behavior plan, and the progress data. We cannot file the appeal for you, and we will not tell you how it will turn out, but we can make sure the clinical record behind it is complete.
How often does Florida Medicaid re-approve ABA therapy?
Coverage is approved for a set period and then has to be renewed. Missing that renewal is one of the most common reasons a child's therapy stops, and it is avoidable.
Under Florida Medicaid's behavior analysis coverage policy, the behavior plan must reflect the requested authorization period, up to six months. To renew prior authorization for continued services, a reassessment and an updated behavior plan must be completed at least every six months.
Up to six months is not the same as a fixed six-month cycle. An authorization can be approved for a shorter period. Do not assume a date. Work from the approval letter you actually received, which states your authorization period.
We track your child's authorization end date and start the reassessment and updated behavior plan before it arrives, so the renewal goes in while the current approval is still active. Keep your approval letter, note its end date, and if you have not heard about the reassessment about six weeks before that date, ask your provider directly where it stands.
Does Medicaid cover ABA therapy for adults over 21?
Standard Florida Medicaid coverage for behavior analysis ends at 21, but adults with developmental disabilities may access behavior analysis and related supports through Florida's iBudget Waiver.
The iBudget Waiver is administered by the Agency for Persons with Disabilities and funds an individualized budget based on each person's assessed needs, which can include behavior analysis services when clinically justified. It is a separate application process from regular Medicaid, handled through your local APD regional office or at apd.myflorida.com.
The waitlist is real, and planning before a young adult turns 21 makes a meaningful difference. We are approved to provide iBudget Waiver services and can help a family understand what the transition looks like.
Does Florida KidCare cover ABA therapy?
Florida KidCare is the state's umbrella program for children's health coverage, and one part of it is Medicaid, so whether ABA is covered depends on which KidCare program your child is enrolled in.
Children enrolled through the Medicaid portion of KidCare have the same EPSDT based access to behavior analysis services described above. Children enrolled in the other KidCare programs are covered under those programs' own benefit rules, which are not identical to Medicaid's.
The practical step is the same either way: read the plan name on the card and call us. We will check the actual benefit rather than guess from the program name.
What if my Medicaid plan is not listed here?
Call 786-238-5931 and we will check your specific plan for free before you do anything else.
Plan networks change, families move between plans, and the name on a card does not always match what people expect. A five minute phone call answers the question far more reliably than a list on a web page.
We answer in English and in Spanish, and if your plan is one we cannot serve, we will tell you that directly rather than leave you waiting on a callback.
Want the background on the therapy itself rather than the coverage? Read what ABA therapy is and how it works.
Where we provide Medicaid ABA therapy
Our bilingual team works in your home, at school, and in the community across South Florida. Sessions happen in Hialeah, Kendall, Homestead, across Miami-Dade, and down through Marathon and Key West in the Florida Keys. If Spanish is the language of your household, therapy and parent training happen in Spanish, with no interpreter in between.
If your child is under 21 and has Florida Medicaid, ABA therapy is likely covered.
Call 786-238-5931 and we will verify your plan for free, in English or in Spanish, and tell you honestly what the next step is.
This is general information, not a coverage decision. Eligibility and authorized hours depend on your plan and on a medical necessity determination; we verify your coverage for free. This guide is maintained by the clinical team at Permuy Diversity Intervention, founded by Dr. Luis D. Permuy, LMHC-QS.