ABA Therapy Centers in North Carolina

NC Medicaid Policy 8F and your health plan

Policy 8F covers ABA as one form of Research-Based Behavioral Health Treatment for a member with an autism diagnosis. A physician (MD or DO) or licensed psychologist must sign a service order, valid for one year, and the provider needs prior approval before treatment starts. Plans of 16 hours a week or fewer are reviewed at least every 180 days. Plans above 16 hours are reviewed at least every 90 days. Members in a managed care plan direct benefit questions to that plan.

• Standard Plan: the NC Medicaid managed care plan that offers the same services as a Tailored Plan, and lacks the specialty services only Tailored Plans offer.
• Tailored Plan: a child with an intellectual or developmental disability can ask to move to one, and it is the only plan that offers Innovations waiver services.
• NC Medicaid Direct: the fee-for-service option that also covers RB-BHT.
• Eastern Band of Cherokee Indians members: prior approval runs through the Cherokee Indian Health Authority.

Private insurance under G.S. 58-3-192

North Carolina requires health benefit plans to cover autism screening, diagnosis and treatment, including adaptive behavior treatment ordered by a physician or psychologist. A plan can cap ABA at up to $40,000 per year and limit it to members 18 or younger. The cap is indexed to the Consumer Price Index each year, so ask your insurer for this year's figure. The mandate does not reach non-grandfathered individual and small group plans that must cover the essential health benefit package, and self-funded employer plans follow federal ERISA rules.

NC Innovations waiver and 1915(i) services

NC Innovations serves children and adults with intellectual or developmental disabilities, including autism. Anyone can apply regardless of age, income or insurance, and NC Medicaid says the wait is long, so apply early. Applicants call the LME/MCO that serves their county. While you wait, NC Medicaid 1915(i) services can provide some support, and your place on the waitlist is not affected. Waiver supports sit apart from the clinical ABA benefit in Policy 8F.

NC Infant-Toddler Program from birth to three

The NC Infant-Toddler Program gives support and services to families of children from birth to three who have special needs. A local Children's Developmental Services Agency (CDSA) delivers the services, and the state site offers a referral form and a CDSA directory. Medicaid accepts early intervention documentation of concern when it supports a provisional autism diagnosis, so a CDSA record can help a clinic start ABA before age three.

Licensed behavior analysts in North Carolina

North Carolina licenses behavior analysts and assistant behavior analysts through the North Carolina Behavior Analysis Board. Practicing or advertising as a behavior analyst without a license is a Class 2 misdemeanor, with exceptions that include behavior technicians working under a licensed supervisor. A licensed behavior analyst must hold active Board Certified Behavior Analyst status. Ask a clinic who designs and supervises the treatment plan and whether that person holds a North Carolina license.

ESA+ and the Opportunity Scholarship

ESA+ is a state scholarship for students with disabilities who attend a nonpublic school, and home schools can take part. NCSEAA slides list a base award of $9,000 a year and up to $17,000 for students with designated disabilities, including autism, on the IEP eligibility determination. Allowable therapies include ABA when a school offers it as a supplemental service. Families must re-evaluate every three years. The Opportunity Scholarship is separate and income-based.