What Florida’s Insurance Laws Really Say About ABA Therapy Coverage

What Florida’s Insurance Laws Really Say About ABA Therapy Coverage

A simple guide for parents and schools

If you are a parent of a child with autism, or a school administrator helping families navigate services, you may have heard that Florida passed a “new law” about insurance and ABA therapy. The information online can be confusing, and in some cases, misleading.

Here is the reality, in simple terms: Florida already has a law that requires certain insurance plans to cover ABA therapy, and that law is still in effect. Some changes were proposed in 2025, but most of the major insurance reforms people are talking about did not actually become law.

This article explains what coverage already exists, what did not change, and what families and schools should realistically expect when dealing with insurance in Florida.

First: What Is ABA Therapy?

Applied Behavior Analysis, or ABA, is a type of therapy commonly used to support children with autism. It focuses on building skills such as communication, daily living, emotional regulation, and social interaction, while reducing behaviors that interfere with learning or safety.

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ABA therapy is widely recognized as a medically necessary treatment for autism when prescribed by a qualified professional, which is why insurance coverage matters so much for families.

Florida Already Requires ABA Coverage Under Certain Insurance Plans

Florida has had an autism insurance mandate for years. It is part of state insurance law and is often referred to as the Steven A. Geller Autism Coverage Act.

In plain language, this law says that some insurance plans in Florida must cover autism treatment, including ABA therapy, when it is medically necessary.

Here is what that means.

What insurance plans are required to cover ABA?

Coverage applies to state-regulated health insurance plans, including:

• Fully insured employer plans

• State employee health plans

• Certain large group insurance plans

These plans are regulated by the Florida Office of Insurance Regulation and must follow state mandates.

What plans are not required to follow this law?

Some plans are not governed by Florida insurance law, including:

• Self-funded employer plans (often large corporations)

• Many individual marketplace plans

• Federal or military plans

These plans fall under federal rules instead of state rules, so Florida’s autism mandate does not apply to them.

This distinction is one of the biggest reasons families hear different answers from different insurance companies.

What Exactly Is Covered?

Under Florida law, qualifying insurance plans must cover:

• Autism screening and diagnostic services

• Medically necessary treatment for autism

• Applied Behavior Analysis (ABA), when prescribed and included in a treatment plan

Coverage must be based on medical need, not school placement, income level, or parental choice.

Important Coverage Limits Parents Should Know About

Florida’s autism mandate includes financial caps. These are often the part families find out about too late.

As of now:

• There is an annual coverage cap of approximately $36,000, adjusted periodically for inflation

• There is a lifetime maximum benefit of $200,000

Once a child reaches the lifetime cap, the insurance company is no longer required to pay for ABA under this state law.

Schools should be aware of these limits, especially when helping families plan long-term services.

What Changed in 2025 and What Did Not

In 2025, Florida lawmakers introduced several bills related to autism services. This led to widespread confusion, with many people believing insurance coverage had expanded significantly.

Here is the truth.

A new autism services law was passed, but it does not change insurance coverage

Florida passed legislation focused on early intervention, education, and support services for children with autism. This law expands things like:

• Early Steps eligibility

• Autism-focused education initiatives

• Training and resources for educators

• Statewide coordination of autism services

These are positive developments, especially for younger children and schools. However, this law does not change insurance coverage rules for ABA therapy.

Proposed insurance reforms did not pass

There was a bill that would have expanded insurance coverage by removing age limits and modernizing definitions. That bill passed one chamber of the legislature but did not become law.

As a result:

• Insurance coverage rules for ABA remain largely the same

• Coverage caps and plan exclusions still apply

• Families do not automatically qualify for expanded benefits

If you hear that “Florida removed limits on ABA coverage,” that information is incorrect.

Medicaid Coverage Is a Separate System

Families on Medicaid often have a different experience than those with private insurance.

Florida Medicaid does cover medically necessary ABA therapy for children under federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) rules. However, Medicaid recently moved ABA services into managed care plans.

What this means in practice:

• Providers must be in-network with the child’s Medicaid plan

• Families may face longer waitlists

• Authorizations and renewals are more structured

Coverage still exists, but access can vary depending on provider availability.

What This Means for Schools

Schools play an important role in supporting families, but they are not responsible for insurance approval.

Helpful steps schools can take include:

• Helping parents understand the difference between school services and medical therapy

• Avoiding promises about insurance coverage

• Referring families to qualified providers and advocacy resources

• Encouraging early planning due to coverage caps

Clear communication prevents misunderstandings and builds trust with families.

What Parents Should Do Next

If you are a parent seeking ABA therapy in Florida, here are practical next steps:

1. Ask whether your insurance plan is fully insured or self-funded

2. Request a written summary of autism benefits from your insurer

3. Confirm annual and lifetime caps before starting services

4. Work with providers experienced in insurance authorizations

5. Appeal denials when appropriate

Documentation and persistence matter more than verbal assurances.

The Bottom Line

Florida does require some insurance plans to cover ABA therapy, and that protection remains in place. However, there was no sweeping new insurance expansion in 2025, and coverage limits still exist.

Understanding what the law actually says allows parents and schools to plan realistically, avoid frustration, and focus energy where it matters most, helping children access the support they need.

If you want help explaining insurance options to families, building a parent resource page, or navigating ABA referrals, this is an area where clarity makes a real difference.

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