Insurance
ABA therapy with NM Turquoise Care
Turquoise Care is New Mexico's Medicaid managed care program, and it covers ABA therapy for members with autism and for toddlers at risk of autism. We check your child's coverage for free and handle the authorization with your Turquoise Care health plan.
Who is eligible
New Mexico Medicaid pays for ABA therapy for members over 12 months old who are either:
- diagnosed with autism spectrum disorder (ASD), with a documented diagnosis based on the current DSM or ICD, or
- at risk for ASD, meaning a child from 12 to 36 months old with developmental delays on standardized assessments, some early signs of autism, and at least one genetic risk factor. At-risk services are time-limited.
For members from 12 months to 21 years old, ABA is part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
Turquoise Care is the New Mexico Medicaid managed care program that began on July 1, 2024. Most New Mexico Medicaid members are enrolled in a Turquoise Care health plan, and Native American members may choose to opt in.
How to start ABA therapy with Turquoise Care
New Mexico delivers ABA in three stages, after an autism screening.
- Screening. Your child’s primary care provider, another licensed clinician, a Family Infant Toddler (FIT) Program service coordinator, or a school professional screens your child for autism. A positive screening leads to a referral to an autism evaluation provider (AEP).
- Stage 1: evaluation. The AEP confirms the diagnosis with a comprehensive diagnostic evaluation, or an at-risk evaluation for toddlers, writes an Integrated Service Plan, and refers your child to an ABA provider. If your child already has an autism diagnosis, they do not need to be diagnosed again.
- Stage 2: assessment. Our BCBA completes a behavior assessment and works with your family to choose the right ABA model, focused or comprehensive, then writes your child’s treatment plan.
- Stage 3: treatment. We request prior authorization from your child’s Turquoise Care health plan, and therapy begins once it is approved.
Once services start
Treatment continues while your child meets ABA criteria. The BCBA supervises the therapy team, updates the treatment plan, and requests new authorizations as your child’s needs change.
New Mexico expects ABA skills to carry over to everyday life, so Stage 3 can take place at home, in a clinic, at childcare, in the community, or at school when the school district agrees. ABA can also run alongside your child’s other services, such as FIT early intervention, speech therapy, or occupational therapy.
NM Turquoise Care families in your community
NM Turquoise Care ABA therapy FAQs
Yes. New Mexico Medicaid pays for medically necessary ABA for members over 12 months old who are diagnosed with autism spectrum disorder or are at risk for it. For members from 12 months to 21 years old, ABA is part of the EPSDT benefit. Most New Mexico Medicaid members get their coverage through a Turquoise Care health plan.
Possibly. A child between 12 and 36 months old can get time-limited ABA as "at risk" for autism when they have developmental delays on standardized assessments, show some early signs of autism, and have at least one genetic risk factor, such as an older sibling with a documented autism diagnosis.
An autism evaluation provider (AEP) completes the first stage of ABA under New Mexico Medicaid. After a positive autism screening, the AEP confirms the diagnosis through a comprehensive diagnostic evaluation, writes an Integrated Service Plan, and refers your child to an ABA provider.
No. A re-diagnosis is not needed. Your child still needs an Integrated Service Plan and a medical necessity determination for ABA. A licensed provider whose scope of practice allows an autism diagnosis can also refer your child directly for ABA assessment and treatment.
Only if the school agrees. Each school district decides which outside providers it allows on campus, even when ABA is medically necessary. When a district allows it, the ABA provider bills Medicaid for the sessions, not the school.
Hours depend on your child's treatment plan and medical necessity. New Mexico's policy describes focused ABA, usually 10 to 25 hours a week of direct treatment, and comprehensive ABA, often 30 to 40 hours a week. Stage 3 treatment requires prior authorization.
Sources
- Behavioral Health Policy and Billing Manual, Applied Behavior Analysis section (New Mexico Health Care Authority)
- Turquoise Care Overview (New Mexico Health Care Authority)
- Applied Behavior Analysis FAQ, ABA in schools (New Mexico Health Care Authority)
Benefit rules change. Your plan documents and your health plan have the final word on your coverage.
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