Insurance

ABA therapy with Healthy Blue

Healthy Blue is a Medicaid health plan in North Carolina, and it covers ABA therapy for children with autism under the state's Medicaid autism rules. We check your child's Healthy Blue benefits for free and request the authorization for you.

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Who is eligible

Healthy Blue is one of North Carolina’s Medicaid Standard Plans and is offered statewide. Your child qualifies for ABA when they:

  • are a Healthy Blue member,
  • have an autism spectrum disorder (ASD) diagnosis from a licensed psychologist, licensed psychological associate, or physician, made with a validated tool such as the ADOS-2 or CARS-2, and
  • need ABA for medical reasons, as shown by a written assessment.

Children under three can start with a provisional diagnosis, as long as a full diagnosis follows within six months.

How to start ABA therapy with Healthy Blue

  1. Check the card. Your child’s member ID card shows Healthy Blue and their member number. Share it with our intake team and we confirm the ABA benefit.
  2. Diagnosis paperwork. North Carolina needs a diagnosis and a service order signed by a physician or licensed psychologist, and we tell you what is still missing.
  3. Assessment. Our BCBA meets your child and you, completes the assessments, and writes a treatment plan with goals for your child and for your family.
  4. Prior authorization. We send the treatment plan and assessments to Healthy Blue and request authorization.
  5. Therapy starts. Sessions begin once Healthy Blue approves the plan.

Once services start

The BCBA tracks your child’s progress, updates the treatment plan, and requests reauthorization from Healthy Blue before each authorization period ends.

Parents are part of the plan. North Carolina’s policy requires at least six caregiver training sessions in each 180-day authorization period.

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North Carolina

Healthy Blue ABA therapy FAQs

Yes. Healthy Blue NC is a Medicaid plan, so it covers medically necessary ABA under North Carolina's Medicaid autism policy. The ABA provider has to get prior authorization from Healthy Blue before treatment starts.

ABA falls under the state's Research-Based Behavioral Health Treatment policy for autism (Clinical Coverage Policy 8F).

Healthy Blue in North Carolina: 844-594-5070 (TTY 711). The number is also on your child's member ID card.

No. In North Carolina, a school's educational determination alone is not enough; a licensed psychologist, licensed psychological associate, or physician has to diagnose autism with a validated tool.

Yes, if your child is under three when services start. North Carolina's policy accepts a provisional autism diagnosis for children under three, with a full diagnosis required within six months.

Our intake team confirms your child's Healthy Blue coverage, tells you what diagnosis paperwork is still needed, and submits the treatment plan for authorization once our BCBA completes the assessment.

Sources

Benefit rules change. Your plan documents and your health plan have the final word on your coverage.

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Tell us about your child and your plan. We check your benefits and explain the next steps, at no cost.

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