What Utah Parents Need to Know About ABA Insurance

If your child has been diagnosed with autism in Utah, you have several insurance pathways available for ABA therapy coverage. Utah’s commercial mandate has some limits, including an age cap and annual dollar maximum, but Medicaid offers stronger coverage without those restrictions. Between commercial plans, Medicaid, and TRICARE, most Utah families can find a way to get their child’s therapy covered.

Utah’s Autism Insurance Mandate (SB 57)

Utah passed Senate Bill 57 in 2014, requiring commercial insurance plans to cover ABA therapy for autism. Here are the key details:

• Age limit: Coverage is mandated for children under age 10
• Annual cap: $40,000 per year for ABA therapy services
• Applies to: State-regulated commercial health insurance plans with 51 or more employees (large group), individual, and small group plans

The $40,000 annual cap is relatively generous compared to some states and is usually sufficient to cover a full year of ABA therapy at moderate to high intensity. However, the age 10 cutoff means families with older children may need to look at other coverage options.

Beyond the Mandate

Many Utah employers offer self-funded plans that are not subject to the state mandate. However, increasing numbers of self-funded plans voluntarily cover ABA therapy due to federal parity requirements and employer decisions. Always check your specific plan documents to understand your coverage.

Utah Medicaid Coverage

Utah Medicaid provides ABA therapy coverage without the age and dollar caps that apply to commercial plans. Under the EPSDT benefit, children under 21 are entitled to all medically necessary services, making Medicaid the stronger coverage option for many families.

Utah Medicaid Managed Care Plans

Utah Medicaid operates through managed care in most areas. The primary plans include:

• Molina Healthcare of Utah
• Health Choice Utah (SelectHealth)
• University of Utah Health Plans

Each plan has its own authorization process and provider network. If your child is enrolled in one of these plans, contact them to understand how to get ABA therapy authorized and find in-network providers.

See the full list of insurance plans we accept to check your coverage.

TRICARE Coverage for Military Families

Utah has a notable military presence, and TRICARE provides strong ABA therapy coverage without the caps or age limits of the state commercial mandate.

Utah Military Installations

• Hill Air Force Base (Ogden area, one of the largest Air Force bases in the country)
• Dugway Proving Ground (Tooele County)
• Tooele Army Depot

TRICARE ABA Benefits

TRICARE covers ABA therapy with no dollar caps and no age-based cutoffs. Coverage continues as long as it’s medically necessary, with periodic authorization reviews. For families stationed at Hill AFB or other Utah installations, TRICARE often provides the most straightforward path to coverage.

If you’re a military family in Utah, contact us to learn how we can help with the TRICARE authorization process.

Commercial Insurance Coverage

Utah has a mix of national carriers and strong regional plans. Here are the ones families encounter most often:

SelectHealth (Intermountain Health)

SelectHealth is the dominant regional carrier in Utah, affiliated with Intermountain Health. They cover ABA therapy under the state mandate and have a well-established authorization process for behavioral health services.

Regence BlueCross BlueShield of Utah

Regence covers ABA therapy under the mandate. Pre-authorization is required, and they maintain a network of ABA providers across the Wasatch Front and beyond.

UnitedHealthcare (UHC)

UHC covers ABA therapy through Optum behavioral health. Authorization and provider coordination go through Optum.

Cigna

Cigna covers ABA therapy and requires a comprehensive treatment plan for authorization. Their Utah network has been growing in recent years.

DMBA (Deseret Mutual Benefit Administrators)

DMBA is a Utah-based carrier that provides coverage for employees of The Church of Jesus Christ of Latter-day Saints and affiliated organizations. They cover ABA therapy and have specific authorization requirements.

PEHP (Public Employees Health Program)

PEHP covers state and local government employees in Utah. They provide ABA therapy coverage under the mandate, and their authorization process is managed through their behavioral health team.

Getting Started with ABA in Utah

Here’s a practical roadmap for getting ABA therapy coverage in Utah:

1. Get a formal diagnosis. A documented autism spectrum disorder diagnosis from a licensed psychologist, developmental pediatrician, or neurologist is required by all payers.
2. Check your coverage. Determine whether your child is covered by commercial insurance, Medicaid, or TRICARE, and understand the specific benefits and limitations.
3. Consider Medicaid. If your child qualifies, Medicaid may provide stronger coverage than commercial insurance, especially for children over age 10 or those needing intensive services.
4. Connect with a provider. Choose an ABA provider who is in-network with your plan and will manage the authorization process for you.

What About Children Over Age 10?

Utah’s commercial mandate only covers children under 10, but that doesn’t mean coverage ends at 10. Many commercial plans voluntarily extend ABA coverage beyond the mandate, especially self-funded employer plans. If your child is approaching or past the age limit, check with your insurer about continued coverage, consider Medicaid eligibility, or ask your ABA provider about other options.

Treetop’s Utah Services

Treetop provides ABA therapy throughout Utah through both center-based and in-home models. We work with all major Utah carriers, including SelectHealth, Regence, and Medicaid MCOs, and handle the insurance process from verification through ongoing authorization.

Visit our Utah locations page to see where we offer services.

Get Started Today

Understanding insurance coverage is just the first step. Our team at Treetop is here to help you navigate benefits, handle authorizations, and get your child started with ABA therapy as soon as possible. Contact us today for a free benefits check and consultation.