Is ABA Therapy Covered in Arizona? (2025 Guide for Families)

If you’re raising a child with autism in Arizona, one of your biggest questions is probably:

“Will insurance—or AHCCCS—actually pay for ABA therapy?”

The short answer:

• Yes. Arizona law requires most state-regulated private health plans to cover autism treatment, including ABA therapy. (Autism Speaks)
• Yes. Arizona’s Medicaid program (AHCCCS) must cover medically necessary services for kids under 21, which can include ABA under the federal EPSDT benefit. (care1staz.com)
• And yes: Treetop ABA is an in-network ABA provider with Mercy Care in Arizona, so Mercy Care members can usually use their benefits with us, subject to eligibility and prior authorizations. (Mercy Care AZ)

Below is a clear breakdown of how ABA coverage works in Arizona, what the Arizona Autism Insurance Act actually says, and what it means if your child has Mercy Care or another Arizona plan.

⚠️ Important: This guide is for general information only, not legal or financial advice. Always confirm your specific benefits directly with your health plan.

What Is ABA Therapy (and Why Do Plans Cover It)?

Applied Behavior Analysis (ABA) is an evidence-based therapy that helps children with autism build skills in:

• Communication
• Social interaction
• Daily living (eating, dressing, toileting, routines)
• Managing challenging behaviors

ABA is structured, data-driven, and individualized. Because strong research supports its effectiveness—especially when started early—ABA is now considered a medically necessary treatment for many children with autism, which is why:

• Arizona law explicitly includes ABA under autism treatment coverage for state-regulated plans. (Autism Speaks)
• Medicaid (AHCCCS) covers medically necessary behavioral health services for kids under 21 through EPSDT. (care1staz.com)

How ABA Coverage Works in Arizona: Big Picture

In Arizona, ABA is usually funded through one of two paths:

1. Private / Employer-Sponsored Insurance (subject to the Arizona Autism Insurance Act if the plan is state-regulated)
2. Medicaid (AHCCCS), delivered through managed care plans like Mercy Care, Arizona Complete Health, UnitedHealthcare Community Plan, and others. (bluegemsaba.com)

Coverage depends on:

• Your child’s diagnosis (usually ASD diagnosis from a qualified provider)
• The type of health plan you have
• Medical necessity as determined by the plan and clinical team
• Whether you use an in-network provider (like Treetop for Mercy Care)

Let’s break down each path.

The Arizona Autism Insurance Act (Private Insurance)

Arizona’s autism insurance law—often called the Arizona Autism Insurance Act or “Steven’s Law”—requires many state-regulated private health plans to cover the diagnosis and treatment of autism spectrum disorder, including ABA therapy. (NCSL)

Which Plans Does the Law Apply To?

The law generally applies to state-regulated:

• Individual plans
• Small-group and large-group plans issued in Arizona

The law does not automatically apply to:

• Many self-funded (ERISA) employer plans
• Certain “grandfathered” or limited-benefit policies

However, many large employers still choose to cover ABA voluntarily, even when they’re not strictly required to by Arizona law. (NCSL)

Age & Dollar Limits in the Law

Under current summaries of the Arizona Autism Insurance Act: (Autism Speaks)

• Coverage for behavioral therapy, including ABA, is required for children with autism under age 17.
• Historically, the law set annual dollar caps on ABA for state-regulated plans:
  • Up to age 9: up to $50,000 per year
  • Ages 9–16: up to $25,000 per year

Some insurers and legal resources still reference these dollar caps. At the same time:

• Mental health parity rules require many plans to treat autism/behavioral health similarly to other medical conditions, which can affect how strictly separate caps are applied in practice. (Autism Speaks)

What it means for you: your child’s plan may:

• Cover ABA with autism-specific annual caps, or
• Cover ABA under broader behavioral health rules with standard copays/coinsurance rather than a separate autism bucket

The only way to know for sure is to check your exact plan’s benefits (more on how to do that below).

AHCCCS (Arizona Medicaid) & ABA Coverage

AHCCCS is Arizona’s Medicaid program. Children and young adults enrolled in AHCCCS are entitled to a federal benefit called EPSDT—Early and Periodic Screening, Diagnostic, and Treatment.

Under EPSDT:

• States must cover “necessary health care, diagnostic services, treatment, and other measures… to correct or ameliorate defects and physical and mental illnesses and conditions” for members under 21. (care1staz.com)
• This includes behavioral health services, and in practice, that can include ABA when it is deemed medically necessary.

AHCCCS delivers services through managed-care plans (health plans) such as:

• Mercy Care
• Arizona Complete Health
• UnitedHealthcare Community Plan
• And others, depending on your eligibility category and county (extranet.azdcs.gov)

How ABA Is Authorized Under AHCCCS

For a child on AHCCCS, ABA is typically authorized when:

1. The child has a formal autism diagnosis.
2. A qualified professional determines that ABA is medically necessary to improve or prevent worsening of the child’s condition. (care1staz.com)
3. The service is delivered by an enrolled provider that meets AHCCCS and the plan’s criteria.

Instead of a fixed statewide hour limit, AHCCCS and its contracted plans authorize:

• The amount and intensity of ABA based on clinical need, as documented by evaluations and treatment plans, rather than a one-size-fits-all hourly rule. (care1staz.com)

Mercy Care & ABA Coverage (And Where Treetop Fits In)

Mercy Care is one of the main AHCCCS health plans in Arizona. Its materials explicitly list ABA therapy as a covered behavioral health service when it is medically necessary for members with autism. (Mercy Care AZ)

Key points:

• Mercy Care covers ABA for eligible children with autism as part of its behavioral health benefit.
• Services must be medically necessary, authorized, and provided by in-network providers. (Mercy Care AZ)

And importantly for your family:

Treetop ABA is an in-network ABA provider with Mercy Care in Arizona (listed as “TreeTop Therapy” for home and community-based ABA in Mercy Care’s provider directory). (Mercy Care AZ)

That means:

• If your child is enrolled with Mercy Care and meets clinical criteria for ABA, you can typically access services with Treetop as an in-network provider (subject to Mercy Care’s authorizations and policies).
• AHCCCS plans for children often have little or no copay for covered services, but you should confirm any cost-sharing directly with Mercy Care.

In practice, many Mercy Care families at providers like The Treetop pay little or nothing out-of-pocket for ABA once services are approved, but exact costs depend on your specific eligibility and plan rules.

Is ABA Therapy Free in Arizona?

ABA therapy is rarely “free” in the sense that there is no cost to anyone—but many Arizona families pay very little or nothing out-of-pocket.

Here’s why:

• Without insurance, ABA can cost $120–$150 per hour, with annual costs of $62,400 to $249,600 for intensive programs. (The Treetop)
• With private insurance, families usually pay:
  • Deductibles
  • Copays (like a specialist visit)
  • Or a percentage of the session cost (coinsurance)
• With AHCCCS/Mercy Care, covered children often have minimal or no copays, depending on the program.

[Inference] Because ABA is so expensive without coverage, the biggest financial difference usually comes down to whether your plan covers ABA and whether you’re using an in-network provider.

How to Check Whether Your Plan Covers ABA in Arizona

Here’s a simple way to verify your benefits.

Step 1: Identify Your Plan Type

Look at your insurance card to find:

• Plan name (e.g., Mercy Care, Blue Cross Blue Shield of Arizona, Ambetter, etc.)
• Whether it references AHCCCS (Medicaid) or is labeled as employer/individual coverage.

Step 2: Call the Number on the Back of Your Card

Ask to speak with Member Services and have your card handy.

You can use a script like:

“My child has an autism diagnosis. I need to know if my plan covers Applied Behavior Analysis (ABA) therapy in Arizona and what my out-of-pocket responsibilities would be.”

Key questions to ask:

1. Do you cover ABA therapy for autism for my child’s age?
2. Are there any age limits or annual dollar limits on ABA? (e.g., $50,000 or $25,000 caps) (Autism Speaks)
3. What needs to happen first? (Referral, evaluation, prior authorization)
4. What are my copays or coinsurance for ABA?
5. Is Treetop ABA in-network with my plan?
   • For Mercy Care members, Treetop is listed as an in-network ABA provider. (Mercy Care AZ)

Write down:

• The representative’s name
• Date of the call
• Any reference number they give you

[Inference] Many families also ask their ABA provider to help double-check benefits in writing, so they’re not relying solely on a phone conversation.

What If Your Child Doesn’t Have Coverage (or You’re Between Plans)?

If your child does not currently have insurance or AHCCCS:

• ABA out-of-pocket costs in Arizona can run $62–$250 per hour, depending on provider and setting. (Total Care ABA)
• Full-time ABA (20–40 hours/week) can reach $60,000–$250,000 per year in billed charges. (The Treetop)

Some families explore:

• Applying for AHCCCS if income-eligible
• Checking if an employer plan can be added during a qualifying life event
• Looking into grants, non-profit support, or sliding-scale options

[Inference] Even if you’re not sure your child will qualify for AHCCCS or a particular plan, it’s often worth applying or discussing options with a social worker or financial counselor.

How Treetop ABA Supports Arizona Families

Treetop’s mission is to make high-quality ABA therapy accessible to families who need it—not just families who can afford to pay out of pocket.

From publicly available information about Treetop’s coverage: (The Treetop)

• Treetop accepts a wide range of insurance plans, including Medicaid-related coverage.
• Mercy Care is one of the plans where Treetop is an in-network ABA provider in Arizona. (Mercy Care AZ)

[Inference] When you contact Treetop, their team can usually:

• Review your insurance information
• Confirm whether they are in-network for your plan
• Help you understand the next steps for evaluation, prior authorization, and scheduling

Key Takeaways

• ABA therapy can be covered in Arizona—through both many private insurance plans (via the Arizona Autism Insurance Act) and AHCCCS (through EPSDT). (Autism Speaks)
• State-regulated private plans often follow age and annual dollar limits (historically $50,000/year under age 9, $25,000/year for ages 9–16), though mental health parity rules and plan design may affect how caps apply. (Autism Speaks)
• AHCCCS plans like Mercy Care cover ABA as a medically necessary behavioral health service for children under 21. (care1staz.com)
• Treetop ABA is in-network with Mercy Care, so Mercy Care members can typically access ABA with Treetop subject to eligibility and authorizations. (Mercy Care AZ)
• Because ABA is expensive without coverage, the most important step is to verify your specific benefits and use in-network providers whenever possible.

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