MaineCare Section 28 Specialized Services
MaineCare covers ABA for any child or youth up to age 21 with an autism spectrum disorder diagnosis through the Specialized tier of Section 28, Rehabilitative and Community Support Services. The service builds daily living and behavior skills at home and in the community. Providers must enroll with MaineCare for Section 28 and employ behavioral health professionals who work under a supervising BCBA. A BCBA cannot enroll alone to bill Section 28.
- Specialized Services must be delivered in person; telehealth is allowed only when something unforeseen blocks a visit, such as bad weather.
- Providers must hold a license under the Behavioral Health Organizations Licensing Rule, 10-144 CMR Ch. 123.
Maine's autism insurance law, 24-A M.R.S. § 2847-T
Group health policies must cover autism diagnosis and treatment, including ABA, for a covered person who is 10 years of age or under. Individual policies carry the same rule under § 2768. A plan can cap ABA at $36,000 per year, but it cannot limit visits. A physician or psychologist must find the treatment medically necessary and can be asked to confirm that each year. ABA must come from, or be supervised by, a nationally certified behavior analyst. Self-funded employer plans follow federal ERISA rules, so ask HR whether your plan is fully insured.
Section 21, Section 29 and Katie Beckett
The Office of Aging and Disability Services runs two MaineCare waivers for people with intellectual and developmental disabilities or autism: Section 21 and Section 29. You can enroll in only one at a time, and you must first qualify for MaineCare. Ask your case manager to start the application, or email HCBS.Waiver@maine.gov for the forms. The state posts waitlist counts each quarter, so check them before you plan around a waiver. A child with private insurance can still apply for MaineCare through the Katie Beckett Program if the child has a serious physical or mental health condition.
Early Intervention for ME, birth to three
Child Development Services runs Early Intervention for ME for children from birth through age two, and school-based services for ages three through five. The state is divided into regional sites, and the site that covers your town contacts you within three business days of a referral. Call 877-770-8883, use the online form, or fax 207-624-6661. You do not need a pediatrician's referral, and the program can screen your child's skills at no cost.
Who can deliver ABA in Maine
Maine does not license behavior analysts: it is absent from the BACB table of states that require licensure. Credentials come from other rules instead. The insurance law requires ABA to come from, or be supervised by, a nationally certified behavior analyst, and MaineCare requires a supervising BCBA plus an organization licensed under the state behavioral health rule. Ask any provider who the supervising BCBA is and whether the organization is enrolled in MaineCare Section 28.
