11/07/2025
How 1,000 families funded ABA
I've helped over 1,000 families get coverage for ABA therapy since 2004, starting when my daughter was diagnosed at four and I had to decode this system myself.
Most families I talk to think they have to pick one funding source and pray it works out.
That's not how the families who got approved did it.
They stacked three approaches. In this order:
→ Employer health plans (your primary coverage)
→ Medicaid waivers (covers the gaps insurance won't touch)
→ State mandates (your legal foundation when denials come)
The sequence matters.
You start with employer coverage because that's primary insurance, but here's what trips people up... employer plans technically cover ABA yet they almost always require prior authorization, and they cap the hours. Sometimes at 10 hours weekly when your kid needs 25.
So while you're waiting on that prior auth (which can take weeks), you apply for Medicaid waiver simultaneously. Not after. At the same time.
Because Medicaid waivers in most states pick up what private insurance refuses to cover. The hourly overages, the co-pays that add up to hundreds monthly, the specific services your plan excludes. And Medicaid waiting lists can stretch months, so starting early changes your timeline completely.
Then your state's autism mandate becomes the thing you reference when insurance inevitably pushes back. Federal law now requires ABA coverage in all 50 states as of 2021, but insurers still try to limit hours or deny medical necessity.
The families who got fastest approval?
They called HR benefits first, got the prior auth requirements in writing. Then applied for Medicaid waiver that same week. Then downloaded their state autism mandate and highlighted the coverage language.
Submitted everything as one coordinated package.
Insurance companies saw Medicaid listed as secondary coverage. Medicaid saw insurance as primary. Neither could claim the other should pay first... and the state mandate backed up the medical necessity when either tried to deny.
I've watched this pattern play out across hundreds of cases. Insurance caps at 10 hours, Medicaid waiver covers the additional 15 the BCBA recommended, state mandate stops the denial letters.
Three sources working together.
The system shouldn't force families to become insurance strategists just to access care that's scientifically proven to help their kids. You're already managing therapies, school IEPs, daily routines... now you need a law degree to get coverage?
But until the system fixes itself, this stacking approach is what worked.
What's blocking your approval right now? Insurance denials, prior auth delays, something else? Comment below and I'll point you toward the next step.
Like and share if you know a family stuck in the coverage fight. This stacking strategy cuts months off the process.
