Yes — in almost every case. All 50 states now have autism insurance mandates that require state-regulated health plans to cover ABA therapy for individuals diagnosed with autism spectrum disorder. The specifics vary by state: Georgia caps annual ABA at $35,000 through age 20, Tennessee's mandate has no age or dollar limit, Virginia's mandate now covers all ages, North Carolina caps annual coverage at $40,000 for kids under 8 (and $30,000 for ages 8–23), and Maryland's mandate has no dollar cap and one of the strongest coverage floors in the country. Self-funded employer plans (governed by federal ERISA law) may be exempt from state mandates, but federal parity law still typically requires meaningful ABA coverage. Below is a side-by-side breakdown for each of Blossom's five service states, plus a walkthrough of how to verify your specific benefits before starting.

The Short Federal Story

Two federal laws set the floor everywhere in the country. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans that cover mental health benefits to do so on parity with medical and surgical benefits — meaning ABA therapy usually can't have stricter dollar caps, visit limits, or age caps than the plan applies to physical health care. The Affordable Care Act (ACA) further requires most individual and small-group plans to cover mental health services as an essential health benefit.

On top of that, every state has passed its own autism insurance mandate specifying what fully insured plans in that state must cover. State mandates only apply to fully insured, state-regulated plans. If your health insurance comes from a large employer that self-funds its plan (governed by ERISA), the state mandate doesn't apply — though MHPAEA usually still does. Below, we break down each of Blossom's five service states so you know what to expect before you ever pick up the phone.

If you'd rather skip the reading and have someone verify your specific plan for you, Blossom's admissions team can do that in one call — no obligation.

ABA Therapy Insurance Coverage: At a Glance

Note: Dollar caps and age caps shown are from the underlying state statute. Under federal MHPAEA parity rules, these caps are often not enforceable in practice for plans that cover mental health services.

Georgia: ABA Coverage Under Ava's Law

Georgia's autism insurance mandate is known as Ava's Law — originally passed as HB 429 in 2015 and strengthened by SB 118 in 2018 (effective January 1, 2019). It's codified at O.C.G.A. § 33-24-59.10.

Under Ava's Law, state-regulated private insurance plans in Georgia must cover the diagnosis and treatment of autism spectrum disorder — including ABA therapy — for individuals through age 20 (under 21). The annual benefit for ABA is capped at $35,000 per year, though federal parity rules under MHPAEA generally override quantitative treatment limits like this.

Georgia Medicaid also covers ABA therapy under its Adaptive Behavior Services (ABS) benefit for children under 21 with a documented DSM-5 diagnosis of ASD, subject to medical necessity and prior authorization. Georgia is also one of the strongest Katie Beckett Waiver states in the country, which lets children with severe disabilities qualify for Medicaid regardless of parental income. For a deep-dive, see our Katie Beckett Waiver in Georgia guide.

For families in Atlanta, Peachtree Corners, Riverdale, and elsewhere across the state, Blossom's team handles ABA insurance verification and authorization directly with your plan.

Tennessee: ABA Coverage Under the 2019 DCI Bulletin

Tennessee's autism insurance coverage rests on a Tennessee Department of Commerce and Insurance bulletin issued August 1, 2019 (with a March 1, 2020 compliance deadline). The bulletin requires fully insured health plans in Tennessee to cover medically necessary ABA therapy under mental health parity. An earlier autism-treatment statute (P.C. 834, 2016) established the underlying framework.

Unlike some states, Tennessee's mandate does not carry a specific age cap or annual dollar cap under current interpretation — coverage follows medical necessity determined by the treating clinician. Prior authorization, medical necessity documentation, and in-network provider requirements still apply on a plan-by-plan basis.

TennCare (Tennessee Medicaid) covers ABA therapy for children under 21 through the federal EPSDT benefit. Tennessee also runs the Katie Beckett Program (Parts A, B, and C) — a §1115 demonstration that provides additional pathways for children with significant disabilities who don't qualify for standard Medicaid.

Blossom serves families across Tennessee and can verify your specific plan's ABA benefits and prior authorization requirements before you start.

Virginia: All-Ages ABA Coverage Under § 38.2-3418.17

Virginia's autism insurance mandate is codified at Va. Code § 38.2-3418.17. It has been progressively expanded since 2011:

• 2012–2015: Ages 2 through 6

• 2016–2019: Ages 2 through 10

• January 1, 2020–present: All ages

The current statute requires fully insured plans in Virginia to cover the diagnosis and treatment of autism spectrum disorder — including ABA therapy — for individuals of any age. Diagnostic assessments including neuropsychological evaluations and genetic testing are also covered. Coverage is subject to plan-specific medical necessity requirements, prior authorization, and in-network provider rules.

Virginia Medicaid (Cardinal Care) covers ABA therapy for children under 21 through EPSDT. Virginia's DD Waivers — Building Independence (BI), Family and Individual Supports (FIS), and Community Living (CL) — provide additional coverage for individuals with developmental disabilities, though they carry significant waitlists. The statewide DBHDS waiver hotline is 1-844-603-9248.

Blossom's Virginia ABA team works directly with commercial insurers and Medicaid managed care plans (Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Sentara Health Plans, UnitedHealthcare Community Plan, and others) to verify benefits and manage authorizations.

North Carolina: ABA Coverage Under SB 676

North Carolina's autism insurance mandate — Senate Bill 676, codified at N.C.G.S. § 58-3-192 — was signed October 15, 2015 and took effect July 1, 2016. It requires state-regulated health plans to cover screening, diagnosis, and treatment of autism spectrum disorder, including ABA therapy, for individuals under age 23.

Annual ABA benefit caps under the statute:

• Under age 8: Up to $40,000 per year

• Ages 8 through 22: Up to $30,000 per year

As with other states, MHPAEA parity rules generally override these quantitative treatment limits for plans that cover mental health benefits. Prior authorization and medical necessity documentation are typically still required. The North Carolina State Health Plan — the plan covering state employees, teachers, and retirees — separately mandates ABA coverage for individuals under age 26.

North Carolina Medicaid covers ABA therapy through EPSDT for children under 21, with no dollar cap when medically necessary. Families of children with significant medical needs may also qualify for CAP/C (Community Alternatives Program for Children) — a §1915(c) waiver that disregards parental income (833-522-5429) — or the long-waitlisted NC Innovations Waiver.

Blossom serves families across North Carolina and can walk you through both commercial insurance and Medicaid pathways for your child.

Maryland: One of the Strongest ABA Mandates in the Country

Maryland's ABA coverage comes from the Habilitative Services Mandate, strengthened by the Autism Insurance Reform Act (SB 946, 2021). Fully insured plans regulated by the Maryland Insurance Administration must cover ABA therapy as a habilitative service, and ABA may not be denied on the basis that it is "experimental" or "investigational."

Maryland is unusual in that its mandate establishes a coverage floor, not a coverage cap. Insurers can't deny coverage based solely on the number of hours prescribed, as long as prescribed hours are within these floors:

• Children 18 months through age 5: Up to 25 hours per week must be covered

• Children age 6 through age 18: Up to 10 hours per week must be covered

Additional hours may still be authorized if medically necessary. In 2026, many Maryland insurers have reclassified ABA therapy as a mental health benefit rather than a habilitative service, which has often meant lower copays and simpler prior authorization for families.

Maryland Medicaid (HealthChoice) covers ABA for all eligible children under 21 through EPSDT, administered through Carelon Behavioral Health. Maryland also has a §1915(c) HCBS Autism Waiver specifically for children with ASD — one of the only autism-specific waivers in the country — though it currently has a significant waitlist (call 866-417-3480 to join). The Autism Waiver serves eligible children from age 1 through the end of the school semester in which they turn 21.

Blossom serves families across Maryland and coordinates with commercial insurers, Medicaid MCOs, and TRICARE for military families.

What a Typical ABA Insurance Benefit Covers

Across all five states, a typical fully insured plan will cover:

• Diagnostic evaluations — the initial autism assessment by a licensed provider

• Behavioral health assessments — the ABA functional behavior assessment (FBA) that drives the treatment plan

• Direct ABA therapy hours — 1:1 sessions delivered by a Board Certified Behavior Analyst (BCBA) or a Registered Behavior Technician (RBT) under BCBA supervision

• BCBA case supervision — periodic supervision hours where the BCBA oversees the treatment plan

• Family / parent training — sessions teaching caregivers how to reinforce ABA strategies at home

What isn't always covered:

• Copays, coinsurance, and deductibles — even a well-covered plan can leave hundreds or thousands in annual out-of-pocket cost

• Out-of-network care — usually reimbursed at a lower rate, if at all

• Non-medical support services — respite, transportation, and similar services often need to be pursued through Medicaid waivers rather than commercial insurance

• Services beyond age or dollar caps — although MHPAEA usually overrides these, they can still surface at renewal time

How to Verify Your ABA Insurance Benefits Before Starting

Verifying benefits before you begin is the single best way to avoid surprise bills. Here's what a thorough verification looks like:

1. Get your child's autism diagnosis in writing. Most plans require a DSM-5 diagnosis of ASD from a licensed clinician (developmental pediatrician, psychologist, or neurologist) before authorizing ABA.

2. Confirm whether your plan is fully insured or self-funded. State mandates apply to fully insured plans. Self-funded (ERISA) plans are exempt from state rules — though most still cover ABA under federal parity. Ask your HR department or check your plan's Summary Plan Description.

3. Call the member services number on the back of your insurance card. Ask specifically about:

   • Coverage of CPT codes 97151, 97153, 97155, 97156, 97158 (the main ABA billing codes)

   • Annual visit or hour limits

   • Prior authorization requirements

   • In-network provider requirements

   • Deductible, copay, and coinsurance amounts

4. Request the answer in writing. Reference numbers, email confirmations, or portal messages hold up better than phone-call notes when a claim gets denied.

5. Ask about prior authorization timelines. Some plans require a 5–15 business-day review before treatment can begin.

Ready to Verify Your Benefits?

Every state has autism insurance mandates. What matters for your family is what your specific plan actually covers — the age cap, the annual limit, the copay, the deductible you're up against, the prior authorization requirements — and whether your plan is state-regulated or self-funded. That's the exact work Blossom's admissions team does every day for families across Georgia, Tennessee, Virginia, North Carolina, and Maryland.

Send us your insurance information and we'll come back with a plain-English breakdown of what's covered, what you'll pay, and how quickly we can get your child started. No charge, no obligation.

Call (877) 315-1069 or request a free insurance verification here.

Frequently Asked Questions

Does insurance cover ABA therapy in Georgia? Yes. Under Ava's Law (O.C.G.A. § 33-24-59.10), state-regulated insurance plans in Georgia must cover ABA therapy for individuals through age 20, with an annual cap of $35,000 (though MHPAEA parity usually overrides this in practice). Georgia Medicaid also covers ABA through the Adaptive Behavior Services benefit for children under 21.

Does insurance cover ABA therapy in Tennessee? Yes. Since a 2019 Tennessee Department of Commerce and Insurance bulletin, fully insured plans in Tennessee must cover medically necessary ABA therapy for individuals with an ASD diagnosis. TennCare (Tennessee Medicaid) covers ABA for children under 21 through EPSDT.

Does insurance cover ABA therapy in Virginia? Yes. Under Va. Code § 38.2-3418.17, fully insured plans in Virginia must cover ABA therapy for individuals of any age (since January 1, 2020). Virginia Medicaid (Cardinal Care) also covers ABA for children under 21.

Does insurance cover ABA therapy in North Carolina? Yes. Under SB 676 (N.C.G.S. § 58-3-192), state-regulated plans must cover ABA therapy for individuals under age 23, with annual caps of $40,000 for under 8 and $30,000 for ages 8–22 (though federal parity usually overrides these). North Carolina Medicaid covers ABA through EPSDT with no dollar cap.

Does insurance cover ABA therapy in Maryland? Yes. Maryland's Habilitative Services Mandate and SB 946 (2021) require fully insured plans to cover ABA as a habilitative service, with a coverage floor of 25 hours/week for children under 6 and 10 hours/week for ages 6–18. Maryland Medicaid (HealthChoice) also covers ABA for all eligible children under 21.

What if my insurance is a self-funded (ERISA) plan? Self-funded plans — usually offered by large employers — are exempt from state autism insurance mandates. However, federal MHPAEA parity rules still typically require ABA coverage on parity with medical benefits. Ask your HR department whether your plan is fully insured or self-funded to know which rules apply.

How much will I pay out of pocket for ABA even with insurance? That depends on your deductible, copay/coinsurance, and any dollar or hour caps that apply to your specific plan. Even well-covered families can pay hundreds to a few thousand dollars per year in cost-sharing. A benefits verification calculates the specific projection for your plan.

Does TRICARE cover ABA therapy? Yes, through the Autism Care Demonstration (ACD) — TRICARE's dedicated benefit for eligible dependents of active-duty service members, retirees, and other beneficiaries with an autism diagnosis. Blossom accepts TRICARE and can walk military families through the ACD enrollment process.

How long does insurance verification take? Blossom typically completes benefits verification within 48 hours. Prior authorization for ABA services from your insurer can take an additional 5–15 business days depending on plan.

Sources

1. https://law.justia.com/codes/georgia/2020/title-33/chapter-24/article-1/section-33-24-59-10/

2. https://www.autismspeaks.org/georgia-state-regulated-insurance-coverage

3. https://www.autismspeaks.org/tennessee-state-regulated-insurance-coverage

4. https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3418.17/

5. https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-3-192.html

6. https://pathfindersforautism.org/articles/maryland-services/parent-tips-marylands-habilitative-services-mandate-insurance-for-autism-treatment/

7. https://www.autismspeaks.org/maryland-state-regulated-insurance-coverage

8. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity