What Maryland Parents Need to Know About ABA Insurance

Maryland is one of the best states in the country for ABA therapy insurance coverage. The state’s autism mandate has no age limit and no dollar cap, which means your child can receive the treatment they need for as long as they need it. Between the strong commercial mandate, comprehensive Medicaid coverage through HealthChoice, and TRICARE access for military families, most Maryland families have a clear path to getting ABA services covered.

Maryland’s Autism Insurance Mandate (SB 300/HB 1106)

Maryland’s autism insurance mandate is among the strongest in the nation. Here’s what makes it stand out:

• No age limit: Coverage is not restricted by age, so individuals can continue receiving ABA therapy into adulthood if medically necessary
• No dollar cap: There is no annual or lifetime dollar limit on ABA therapy services
• Applies to: All state-regulated commercial health insurance plans, including individual and group policies
• Broad service coverage: Includes diagnosis, assessment, and treatment of autism spectrum disorder

This means if you have a state-regulated commercial plan in Maryland, your insurer cannot deny ABA therapy based on your child’s age or claim you’ve exceeded a dollar limit. Coverage decisions are based purely on medical necessity.

HealthChoice Medicaid Coverage

Maryland’s Medicaid program, HealthChoice, provides ABA therapy coverage through a network of managed care organizations (MCOs). For children under 21, coverage falls under the EPSDT benefit, which requires coverage of all medically necessary services without caps.

HealthChoice MCOs

Maryland Medicaid enrollees are assigned to one of the following MCOs:

• CareFirst Community Health Plan Maryland
• Jai Medical Systems
• Kaiser Permanente
• Maryland Physicians Care
• MedStar Family Choice
• Molina Healthcare
• Priority Partners
• UnitedHealthcare Community Plan

Each MCO manages its own provider network and authorization process, but all must cover ABA therapy when it’s medically necessary. If your child is enrolled in HealthChoice, contact your MCO to understand their specific authorization steps and find in-network ABA providers.

Check our insurance page to see which plans and MCOs we work with in Maryland.

TRICARE Coverage for Military Families

Maryland is home to major military installations, and the state’s proximity to Washington, D.C. means a large population of military families. TRICARE provides comprehensive ABA therapy coverage without caps or age limits.

Key Maryland Military Installations

• Fort Meade (home of NSA and U.S. Cyber Command)
• Aberdeen Proving Ground
• United States Naval Academy (Annapolis)
• Joint Base Andrews (nearby in Prince George’s County)
• National Naval Medical Center Bethesda (Walter Reed)

TRICARE ABA Benefits

TRICARE covers ABA therapy as a medically necessary treatment with no dollar caps. Authorization is handled through periodic reviews, and the process is well-established for families of service members. Many ABA providers in the Maryland/DC metro area have extensive experience with TRICARE.

If you’re a military family in Maryland, contact our team to get started with the TRICARE authorization process.

Commercial Insurance Coverage

All major commercial carriers in Maryland cover ABA therapy under the state mandate. Here’s what to expect from the most common carriers:

CareFirst BlueCross BlueShield

CareFirst is the dominant carrier in Maryland and covers ABA therapy under both individual and group plans. They have the largest provider network in the state and require pre-authorization for ABA services.

UnitedHealthcare (UHC)

UHC covers ABA therapy through their Optum behavioral health network. Authorization and claims are managed through Optum, and your provider will coordinate directly with them.

Cigna

Cigna covers ABA therapy in Maryland and requires a treatment plan and authorization before services begin. They have been expanding their ABA provider network in the state.

Aetna

Aetna provides ABA coverage under the Maryland mandate. Authorization timelines vary, so getting started early in the process is a good idea.

Kaiser Permanente

Kaiser has a significant presence in Maryland, especially in the DC suburbs. Their integrated model means referrals and authorizations may be handled internally, but provider choice can be more limited.

Getting a Diagnosis in Maryland

Before starting ABA therapy, your child needs a formal autism spectrum disorder diagnosis. Maryland has several excellent diagnostic resources, including Kennedy Krieger Institute in Baltimore, which is one of the most well-known autism diagnostic and research centers in the country. Wait times for evaluations can be long, so getting on a waitlist early is important.

Other options include developmental pediatricians, child psychologists, and neuropsychologists who specialize in autism evaluations. Your pediatrician can provide referrals, and your insurance company can help you find in-network evaluators.

Steps to Get Coverage

1. Get the diagnosis. A documented ASD diagnosis from a qualified professional is the foundation for all coverage.
2. Contact your insurance. Confirm ABA therapy is covered (it should be), and ask about the authorization process and in-network providers.
3. Choose your provider. Look for a BCBA-supervised ABA program that’s in-network with your plan and has experience with your carrier.
4. Let the provider manage insurance. A good ABA provider will handle authorizations, submit treatment plans, and manage reauthorizations on your behalf.

Treetop’s Maryland Services

Treetop provides ABA therapy across Maryland, offering both center-based and in-home services. We accept most major carriers and Medicaid MCOs in the state, and we manage the entire insurance process from start to finish.

Visit our Maryland locations page to find services near you.

Get Started Today

Maryland’s strong insurance protections mean your family has access to ABA therapy without worrying about age limits or dollar caps. Let our team at Treetop handle the insurance side so you can focus on your child. Contact us today for a free benefits verification and consultation.