ABA Therapy Centers in New Mexico

Turquoise Care Medicaid and the three-stage ABA process

New Mexico Medicaid pays for medically necessary ABA for members with a well-documented autism diagnosis, and for children aged 12 to 36 months who are at risk. For members under 21 it falls under EPSDT. An approved autism evaluation provider completes the diagnostic evaluation and an integrated service plan. An ABA agency then assesses your child and writes the treatment plan, and most treatment hours require prior authorization.

• Turquoise Care health plans: Blue Cross Blue Shield, Molina Healthcare, Presbyterian Health Plan and UnitedHealthcare Community Plan.
• Children in state custody are enrolled in Presbyterian Health Plan.
• Native American members can choose a health plan or fee-for-service Medicaid.

NMSA 59A-22-49 and private insurance

Under NMSA 59A-22-49, individual and group health policies delivered, issued or renewed in New Mexico must cover autism screening and treatment, including applied behavioral analysis. The law bars annual and lifetime dollar limits and bars denying coverage because of age. Treatment must be prescribed by the treating physician under a treatment plan, and the plan can still apply medical necessity review and network rules. Self-funded employer plans follow federal ERISA rules, so ask HR whether your plan is fully insured in New Mexico.

The DD Waiver and Pre-Service Intake

The traditional DD Waiver serves children and adults with intellectual and developmental disabilities, and the Developmental Disabilities Supports Division of the Health Care Authority runs it. Families apply through the Pre-Service Intake Bureau. The date your completed packet arrives is your application date, and eligible applicants receive a Yes Match letter and join the allocation schedule. Waiver supports are separate from the Turquoise Care ABA benefit.

Family Infant Toddler (FIT) Early Intervention

The Family Infant Toddler program, run by the Early Childhood Education and Care Department, serves children from birth to age three who have or are at risk of developmental delay. Evaluation is free, and services are free regardless of income or citizenship. Anyone can make a referral, and you do not need a diagnosis first. A local FIT agency visits your home to evaluate your child and builds a plan with your family.

Who can deliver ABA in New Mexico

New Mexico Medicaid requires ABA assessment and treatment planning to come from a board certified behavior analyst, or a psychologist certified in behavior and cognitive psychology. A board certified assistant behavior analyst or a supervised behavior technician delivers much of the day-to-day therapy. The BACB's list of states that require behavior analyst licensure does not include New Mexico, so certification and Medicaid enrollment are the credentials to ask about.