Family Shared Challenges & Sample Appeal Templates

Please reach out to your Medicaid managed care plan’s member services listed on your insurance card. Ask for approved Medicaid providers for ABA therapy near your home. ABA may also be called adaptive behavior support services.

As mentioned earlier, the main access challenge is the very limited number of Medicaid-approved ABA providers. If your managed care plan (MCO) could not connect you to ABA providers in your community approved by Medicaid, please consider filing an appeal with the MCO. Find the appeal template located on the right of this page called "We cannot Find ABA Providers who take Medicaid." This template includes instructions on how to complete the appeal and where to send the appeal.  

It is great you have found an approved Medicaid provider, but if ABA therapy cannot start in a reasonable amount of time and you are on a long waitlist, consider filing an appeal with your managed care plan (MCO). Find an appeal template located on the right of this page called "We cannot Find ABA Providers who take Medicaid." This template includes instructions on how to complete the appeal and where to send the appeal. 

If your provider is a Medicaid-approved provider and employs a licensed practitioner to supervise the behavior analyst (BCBA), Medicaid should cover services. 

If your provider is not a Medicaid-approved provider and does not employ a licensed professional to supervise the behavior analyst (BCBA), you could ask your provider to consider requesting a single case agreement from your Medicaid managed care plan (MCO). If a single case agreement is denied by your MCO, please consider filing an appeal. Find the appeal template located on the right of this page called "We were denied a single case agreement." This template includes instructions on how to complete the appeal and where to send the appeal. 

Some families found ABA providers that met the Medicaid requirements and started ABA therapy. After ABA started, if the provider no longer employed the required licensed professional to supervise the behavior analyst (BCBA), your services may have been put on hold. If ABA therapy was put on hold, families could ask the provider to consider requesting a single case agreement from the managed care plan (MCO). If a single case agreement is denied by your managed care plan, please consider filing an appeal. Learn more about single case agreements below. Find the appeal template located on the right of this page called "Our ABA therapy started but is now on Hold because of no Supervisor for the Behavior Analyst." This template includes instructions on how to complete the appeal and where to send the appeal. 

If your Medicaid managed care plan (MCO) denied your Medicaid-approved provider’s authorization request for services because your child did not meet medical necessity for ABA for any reason including based on your child’s age or severity, please consider filing an appeal with your MCO. Find the appeal template located on the right of this page called "We were denied ABA due to our Child's Age or Severity" This template includes instructions on how to complete the appeal and where to send the appeal. 

We would like to hear about the challenge your family is facing accessing ABA therapy within your Medicaid insurance. Please email us at help@ilasd.com so we can learn more and offer any guidance we can.

A single case agreement could possibly allow your ABA provider to contract with your managed care plan (MCO). ABA providers that are not Medicaid approved or obtained Medicaid approval but no longer employ the required supervisor for the behavior analyst (BCBA) can make a request for a single case agreement. If the single-case agreement is denied, please consider filing an appeal.