[heading]Medi-Cal: Autism Services Coverage (ABA)[/heading]

It can be difficult to understand the in’s and out’s of your Medi-Cal insurance. Below, we’ve laid out key facts and frequently asked questions about Medi-Cal and autism services. If you don’t find the answers you’re looking for, contact us today.  We’re here to help families navigate their insurance coverage for behavioral health treatment, such as Applied Behavioral Analysis (ABA).

Have questions about Medi-Cal?

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Or call us at 855-295-3276 ext.276

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About Medi-Cal & Behavioral Health Treatment

[heading]Medi-Cal & Autism Service Coverage Laws[/heading]

As of July 1, 2012,  health insurance policies in California are required to provide benefits for specified conditions, including autism. For more information, read California’s Senate Bill, SB 946, about autism insurance law.

California State Senate Bill 946 defines “Behavioral Health Treatment” as “professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism” and meet the following:

  • The child is diagnosed or prescribed a treatment plan by a licensed physician or psychologist
  • This treatment plan is implemented by a qualified autism service provider (such as ALP)
[heading]Things to Consider With Medi-Cal Insurance[/heading]

Autism Learning Partners will utilize your primary insurance plan for coverage of Applied Behavior Analysis services. If your primary insurance plan does not cover Applied Behavior Analysis, you will need to provide a denial letter from your primary insurance to utilize your Medi-Cal insurance plan.

[heading]How to Get Autism Services Approved by Medi-Cal[/heading]

In order for treatment to be approved by Medi-Cal, you will need to provide a prescription from your doctor that includes a recommendation for ABA for your child. This doctor recommendation is required by your insurance.

[heading]Accepted MCO Plans[/heading]

We accept most insurance plans. Don’t see your insurance listed? Contact us and we’ll advocate on your behalf to make sure your child gets access to the treatment they deserve; even if it’s with another agency.

Aetna (Sacramento and San Diego, CA)

 

Autism Services Group / Beacon Health Options

        • Alameda Alliance Health
        • Central California Alliance Health
        • Gold Coast Health Plan
        • Health Plan of San Joaquin
        • San Francisco Health Plan

Blue Shield Promise Health Plan

 

CalOptima

 

Cal-Viva (MHN)

 

Contra Costa Health Plan

 

Health Plan of San Mateo (Magellan)

Holman Group

 

Inland Empire Health Plan

 

LA Care

 

MHN Medi-Cal

 

Molina

 

Partnership Health Plan

 

Santa Clara Family Health Plan

 

Valley Health Plan

[heading]Let Us Help Navigate Your Insurance Coverage[/heading]

Figuring out insurance and payment details can often feel overwhelming, and we realize your time is better spent focusing on the health of your family. Simply fill out this insurance form and we’ll be in touch with the help you need.

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Ready to Move Forward?

Fill out the form below and someone from our team will contact you to discuss the specifics of your Medi-Cal plan as it relates to your child’s needs.

Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Home Phone*

Child Information*




Child DOB*
Diagnosis*
Primary Language*

Frequently Asked Insurance Questions

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Different insurance plans offer different coverage for ABA services and other behavioral health treatments. Some medical plans are governed by state law while others are governed by federal law.  In order to know what services are covered by your insurance plan, we must know what insurance plan you subscribe to.

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Medicaid is an overarching federal healthcare program to which each state has their own individualized program laws. In California, the Medicaid program is referred to as Medi-Cal.

[/toggle][toggle color=”Default” title=”I have a secondary insurance, but my credit card was charged. What should I do?”]

Autism Learning Partners will not initially charge your card for patient responsibility if you have a secondary insurance on file. We will bill your secondary insurance for any outstanding balance, following your primary. You will be billed for any patient responsibility balance remaining after all insurance plans adjudicate your claims. If you recently added secondary insurance or did not list a secondary insurance during your intake process, please contact us. We will verify your secondary coverage and add it to our system.

[/toggle][toggle color=”Default” title=”I have insurance. Why am I being asked to pay?”]

Your patient responsibility portion depends on your insurance coverage. During the Intake process, Autism Learning Partners staff will verify the insurance information you provide as well as the copayment, coinsurance, and deductible related to your plan and provide this information to you. Your patient responsibility portion will be charged or billed to you after your insurance adjudicates your claim to ensure the correct amount. Please contact your insurancecompany or refer to your benefit plan for more information about what your out-of-pocket costs may be related to your care.

[/toggle][toggle color=”Default” title=”Where can I learn more about Medi-Cal eligibility?”]

A great place to learn more about Medi-Cal coverage is the FAQ section of dhcs.ca.gov.

[/toggle][toggle color=”Default” title=”Does ALP accept Medicaid in other states besides California?”]

Yes, we do. If you’re looking for autism services in another state and would like to talk about your insurance options, contact us today.

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