It can be difficult to understand the in’s and out’s of your Medi-Cal insurance. Below, we’ve laid out key facts and frequently asked questions about Medi-Cal and autism services. If you don’t find the answers you’re looking for, contact us today. We’re here to help families navigate their insurance coverage for behavioral health treatment, such as Applied Behavioral Analysis (ABA).
Medi-Cal: Autism Services Coverage (ABA)
Have questions about Medi-Cal?
About Medi-Cal & Behavioral Health Treatment
Medi-Cal & Autism Service Coverage Laws
As of July 1, 2012, health insurance policies in California are required to provide benefits for specified conditions, including autism. For more information, read California’s Senate Bill, SB 946, about autism insurance law.
California State Senate Bill 946 defines “Behavioral Health Treatment” as “professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism” and meet the following:
- The child is diagnosed or prescribed a treatment plan by a licensed physician or psychologist
- This treatment plan is implemented by a qualified autism service provider (such as ALP)
Things to Consider With Medi-Cal Insurance
Autism Learning Partners will utilize your primary insurance plan for coverage of Applied Behavior Analysis services. If your primary insurance plan does not cover Applied Behavior Analysis, you will need to provide a denial letter from your primary insurance to utilize your Medi-Cal insurance plan.
How to Get Autism Services Approved by Medi-Cal
In order for treatment to be approved by Medi-Cal, you will need to provide a prescription from your doctor that includes a recommendation for ABA for your child. This doctor recommendation is required by your insurance.
Accepted MCO Plans
We accept most insurance plans. Don’t see your insurance listed? Contact us and we’ll advocate on your behalf to make sure your child gets access to the treatment they deserve; even if it’s with another agency.
Aetna (Sacramento and San Diego, CA)
Autism Services Group / Beacon Health Options
- Alameda Alliance Health
- Central California Alliance Health
- Gold Coast Health Plan
- Health Plan of San Joaquin
- San Francisco Health Plan
Blue Shield Promise Health Plan
Contra Costa Health Plan
Health Plan of San Mateo (Magellan)
Inland Empire Health Plan
Partnership Health Plan
Santa Clara Family Health Plan
Valley Health Plan
Let Us Help Navigate Your Insurance Coverage
Figuring out insurance and payment details can often feel overwhelming, and we realize your time is better spent focusing on the health of your family. Simply fill out this insurance form and we’ll be in touch with the help you need.
Ready to Move Forward?
Fill out the form below and someone from our team will contact you to discuss the specifics of your Medi-Cal plan as it relates to your child’s needs.
Frequently Asked Insurance Questions
Different insurance plans offer different coverage for ABA services and other behavioral health treatments. Some medical plans are governed by state law while others are governed by federal law. In order to know what services are covered by your insurance plan, we must know what insurance plan you subscribe to.
Medicaid is an overarching federal healthcare program to which each state has their own individualized program laws. In California, the Medicaid program is referred to as Medi-Cal.
Autism Learning Partners will not initially charge your card for patient responsibility if you have a secondary insurance on file. We will bill your secondary insurance for any outstanding balance, following your primary. You will be billed for any patient responsibility balance remaining after all insurance plans adjudicate your claims. If you recently added secondary insurance or did not list a secondary insurance during your intake process, please contact us. We will verify your secondary coverage and add it to our system.
Your patient responsibility portion depends on your insurance coverage. During the Intake process, Autism Learning Partners staff will verify the insurance information you provide as well as the copayment, coinsurance, and deductible related to your plan and provide this information to you. Your patient responsibility portion will be charged or billed to you after your insurance adjudicates your claim to ensure the correct amount. Please contact your insurancecompany or refer to your benefit plan for more information about what your out-of-pocket costs may be related to your care.