Medicaid coverage for ABA therapy in Illinois has changed in recent years, and keeping up with regulations and eligibility can be challenging. At Stride Autism Centers, our mission is to help young children with autism build meaningful skills and prepare for kindergarten and beyond. We know that families often have questions about how to pay for care and one of the most common is whether Medicaid covers ABA therapy in Illinois. The short answer is yes, but it’s complicated.
Medicaid Coverage for ABA Therapy in Illinois
Since October 2020, the state of Illinois has recognized ABA therapy as a medically necessary treatment for children and young adults under 21 with autism. That means ABA can be covered under the Medicaid program through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
However, ABA Therapy Medicaid Access in Illinois is still very limited. The state’s reimbursement rates for providers remain low, which makes it financially challenging for many ABA organizations, including Stride, to participate in the program. As a result, families often face long waitlists or difficulty finding local providers who accept Medicaid.
How Families Can Access ABA Therapy Through Medicaid
Even with these challenges, there are steps families can take:
- Developmental screening: Ask your pediatrician for an early autism screening or connect with your local Child and Family Connections office to start the Early Intervention process.
- Obtain a formal diagnosis: A developmental pediatrician, licensed child psychologist, or neurologist can provide the evaluation needed for ABA coverage.
- Work with your Medicaid Managed Care Organization (MCO): Each MCO maintains a list of approved ABA providers. Your pediatrician or an LCSW can help you navigate this process.
Request an ABA assessment: If approved, your child will complete an initial ABA assessment to set goals and recommended therapy hours.
If You Can’t Find a Medicaid Provider
Because ABA Therapy Medicaid Access in Illinois is limited, some families explore additional options:
- Commercial insurance: During your employer’s open enrollment, you may be able to add coverage that includes ABA therapy. We partner with an experienced insurance broker who can help you evaluate affordable plans.
- Government programs: The Illinois Health Insurance Premium Payment (HIPP) Program may help cover the cost of private insurance if you already qualify for Medicaid.
Local resources: Organizations such as the Chicago Autism Network offer Therapy Assistance Grants that can offset ABA expenses.
How Families Can Drive Change
Medicaid coverage for ABA therapy in Illinois has improved thanks to parent and advocate leadership. Until 2023, the state required every hour of ABA therapy for children on Medicaid to be directly supervised by a licensed clinical psychologist or psychiatrist. While intended to ensure quality, this rule created the opposite effect, there weren’t enough licensed professionals available, which left many families facing long waitlists and struggling to access care. Families and advocacy groups, including the Illinois Autism Insurance Coalition, came together to share their stories and push for change, ultimately helping remove this supervision requirement for Board Certified Behavior Analysts (BCBAs).
This update may sound like a small technical detail, but it has had a significant impact on ABA Therapy Medicaid Access in Illinois. By aligning regulations with how ABA is safely and effectively delivered, more providers can now participate and more children with autism can receive therapy through Medicaid. There’s still more work ahead, but this progress shows the power of families speaking up and reminds us that advocacy can directly expand access to the care children and families need.
By continuing to share your stories with local representatives and supporting advocacy groups, you can help expand access to ABA Therapy for more children and families.
At Stride Autism Centers, we’re committed to supporting families every step of the way, from providing resources while you wait for services to advocating for greater access to care across Illinois and the Midwest.
If you have any questions or would like more information, Stride Autism Centers is here to help. Get started today.
