Medicaid ABA through Child Health Services (EPSDT)
A child qualifies for Medicaid ABA with an autism diagnosis, enrollment in Child Health Services (EPSDT), and an age between 18 months and 21 years. The primary care physician (PCP) signs an evaluation referral, the ABA provider assesses the child, and the PCP then signs a treatment prescription. Acentra gives prior authorization for the assessment and again for the therapy hours. A DDS pre-approval letter is no longer required.
- Diagnosis: two of three licensed clinician types (physician, psychologist, speech-language pathologist) must agree.
- Prescription length: up to six months for ages 18 months to 8 years, up to twelve months for ages 8 to 21.
- One provider delivers all ABA services; you can still change providers.