ABA Therapy Centers in Virginia

Cardinal Care and EPSDT behavioral therapy

Virginia Medicaid lists Behavioral Health Therapy including Applied Behavior Analysis among the medically necessary services children can get under EPSDT. The benefit reaches children under 21 enrolled in Medicaid managed care or FAMIS Plus. Each request needs a service authorization, decided case by case on medical necessity. In practice your child's health plan handles that decision and keeps the list of in-network ABA providers. The 2026 Appropriation Act (Item 291.WW.2) tells DMAS to cap ABA at 20 hours a week, with more hours allowed when medical necessity is documented under EPSDT, and to require an autism diagnosis before authorizing ABA, with a one-year provisional diagnosis allowed for children 5 and younger. None of it is in effect yet: DMAS says authorizations will not change until CMS approves and DMAS announces an effective date in a later notice.

• Aetna Better Health of Virginia
• Anthem HealthKeepers Plus
• Humana Healthy Horizons of Virginia
• Sentara Health Plans and United Healthcare of the Mid-Atlantic

Va. Code § 38.2-3418.17 and private plans

Virginia requires the insurers, HMOs and subscription plans it regulates to cover autism diagnosis and treatment. Coverage has had no age limit since January 1, 2020, and individual and small-group policies are included for policies issued or changed on or after January 1, 2021. ABA must be provided or supervised by a board certified behavior analyst licensed by the Board of Medicine. A licensed physician or psychologist writes the treatment plan, and that prescriber must be independent of the ABA provider. ABA carries a $35,000 annual maximum unless the insurer elects more. Self-funded employer plans follow federal ERISA, so ask HR whether yours is fully insured.

Family and Individual Supports and Community Living waivers

Virginia runs three developmental disability waivers: Building Independence for adults, plus Family and Individual Supports and Community Living, which serve children and adults. DMAS states that a waiting list exists and slots are assigned by urgency of need. To apply, contact your local Community Services Board (CSB). Waiver supports are long-term services and do not replace an ABA authorization from your health plan.

Infant and Toddler Connection of Virginia

Infant and Toddler Connection (ITC) is Virginia's Part C early intervention program for children from birth to age three who are not developing as expected or have a medical condition that can delay development. Services are available regardless of a family's ability to pay. The Department of Behavioral Health and Developmental Services (DBHDS) runs the program, and 1-800-234-1448 connects you to services in your area. Anyone can make a referral, and a diagnosis is not required.

Licensed behavior analysts in Virginia

Virginia makes it unlawful to practice as a behavior analyst or assistant behavior analyst without a license from the Board. A licensed behavior analyst must hold current BCBA certification, and an assistant must hold current BCaBA certification and work under a licensed behavior analyst's supervision. Because the insurance law ties ABA coverage to a board certified behavior analyst licensed by the Board of Medicine, ask each provider for the supervising analyst's Virginia license.