ABA Therapy Centers in Illinois

Medicaid Adaptive Behavior Support (ABS)

Since October 1, 2021, HFS covers Adaptive Behavior Support for children age 0 through 20 with autism, and ABA is one of the covered interventions. The first prior approval request needs a physician order and referral, and the diagnosis comes from a diagnostic evaluation by a physician or clinical psychologist. Children in fee-for-service Medicaid go through HFS. Children in HealthChoice Illinois go through their health plan, which sets its own prior approval steps.

• Fee-for-service prior approval requests go to HFS.ABS@Illinois.gov.
• Managed care questions go to your HealthChoice Illinois plan, not to HFS.

The 215 ILCS 5/356z.14 autism coverage law

Section 356z.14 of the Illinois Insurance Code requires group and individual accident and health policies and managed care plans to cover autism diagnosis and treatment for members under 21. Treatment includes applied behavior analysis. The law sets a $36,000 annual maximum benefit with no limit on the number of visits, and the Director of Insurance adjusts the maximum each year for inflation. Self-funded employer plans fall under federal ERISA, so ask HR whether your plan is fully insured in Illinois, and ask the plan for this year's cap.

Support Waiver and PUNS

The Support Waiver for Children and Young Adults with Developmental Disabilities serves ages 3 through 21 who live at home and are at risk of institutional placement. It lists Behavior Intervention and Treatment among its services. The point of entry is an Independent Service Coordination (ISC) agency, reached through the Developmental Disabilities Helpline at 1-888-DD-PLANS. IDHS selects people from the PUNS list as appropriations allow, so register early.

Early Intervention through Child and Family Connections

Illinois Early Intervention is the IDEA Part C program for children up to age 3 with a disability or developmental delay. The Illinois Department of Early Childhood now runs it. Anyone can refer a child, and you can go straight to one of 25 regional Child and Family Connections offices to schedule a free evaluation. Call 1-800-843-6154 to find the office for your county.

Behavior analyst licensing in Illinois

The Illinois Department of Financial and Professional Regulation licenses behavior analysts and assistant behavior analysts under the Behavior Analyst Licensing Act, 225 ILCS 6. IDFPR began issuing licenses on January 15, 2025. Under Section 150, a business may not provide behavior analysis services unless every person who delivers ABA holds a valid license. Ask any provider for the clinician's license number and check it with IDFPR.