Family Matters
Michigan Department of Education, Oce of Special Education
Fact Sheet
Autism Insurance, Medicaid, and Education
Applied behavior analysis (ABA) therapy is a system of processes and procedures to teach
skills and modify, or change, behaviors. ABA therapy is based on the science of behavior
and how the environment aects behavior. Many children with autism spectrum disorder
(ASD) receive ABA therapy as a medically necessary treatment. However, ABA therapy is
sometimes deemed educationally and medically necessary. Because ABA therapy is covered
by many insurance plans (for ages 0-26 years), schools and insurance providers may
coordinate services to benet students and their families.
October 2021
1-888-320-8384
(OSE information line)
michigan.gov/
specialeducation-familymatters
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michigan.gov
Family Matters fact sheets are intended to enhance public understanding of Michigan's special education
system and are not a substitute for ocial laws and regulations.
Private and Medicaid insurances require a medical
diagnosis to access ABA therapy as a medically
necessary benet to help a child learn to address
behaviors inuenced by his or her environment.
Recommendations are made by a medical provider,
for the number of hours per week that ABA therapy
is needed for each particular child. Both types
of insurance have outlined conditions about ABA
therapy services and education, stipulating insurance
coverage is intended to supplement education, and
not supplant (or replace) education.
School services require a student to undergo a
special education evaluation to determine whether
the student meets educational criteria, under the
Michigan Administrative Rules for Special Education
(MARSE), for a student with ASD. When a student
meets criteria and is determined eligible for special
education as a student with ASD, or other disability,
he or she is then entitled to a free appropriate public
education (FAPE) in the least restrictive environment
(LRE), as required by the Individuals with Disabilities
Education Act (IDEA).
The Individualized Education Program (IEP) Team,
which includes the parents, identies supports and
services that are needed for the eligible student with
ASD to access the general education curriculum.
Behavioral supports provided by a Board Certied
Behavior Analyst (BCBA) or Board Certied Assistant
Behavior Analyst (BCaBA), including ABA therapy
or principles of ABA therapy, are supports the IEP
Team may determine to be educationally necessary
for a student to reduce barriers to learning and
ensure FAPE. Since schools provide special education
services and not a medical treatment, the IEP Team
will determine when ABA therapy or principles of
ABA therapy are warranted for a student receiving
special education services.
Autism Insurance
Michigan provides insurance coverage for
ABA therapy as an evidence-based medical
treatment for individuals with ASD. In 2012,
Michigan passed laws requiring private insurance
coverage of ABA therapy treatments for autism
for state mandated insurance plans. A Medicaid
law was passed the same year. While laws were
passed to cover autism treatments, carriers
of insurance, including Medicaid, set their own
criteria for coverage such as ages, deductibles,
limits, and providers.
Insurance, ABA Therapy, and School
Resources
• Michigan Association of Administrators of Special Education (MAASE)
ABA & Michigan Schools: MORE is MORE
• Michigan Department of Education, Oce of Special Education Guidance
Shortened School Day (2019)
• Michigan Department of Health and Human Services
Medicaid Manual (Jan 2021)
• Michigan Public Acts 99-100 (Senate bills 414/415)
Legislation requiring Blue Cross Blue Shield and other HMO and
private insurers to cover ABA as an autism treatment
Medicaid School Based Services and ABA Therapy
Medicaid recently expanded school-based service (SBS) oerings to include reimbursements for
BCBAs and BCaBAs. When IEP Teams determine it is educationally necessary to provide a medical
treatment during school hours as part of a student’s oer of a FAPE, a percentage of the costs
associated with the providers salary and services may be reimbursed through SBS for a Medicaid
eligible student.
Removal from School for ABA Therapy
Some parents request students be removed for portions of a school day to receive medically
necessary ABA therapy services. When behavior supports provided by a BCBA or BCaBA, including
ABA therapy services or principles of ABA therapy, are not part of a student’s FAPE as determined
by the IEP Team, a shortened school day may violate a student’s rights to a FAPE under the IDEA.
Students who are removed from school to attend ABA therapy are subject to truancy. Each district
has an obligation to provide each student with ASD a full school day alongside their general
education peers.
While withdrawing a student early from their school day may violate their rights under the IDEA and
may be subject to truancy, for students who are age six to 16, parents have the right to choose to
homeschool their child (see the Nonpublic and Home Schools fact sheet). Parents who choose to
homeschool their child with ASD are not bound to attendance or full school day requirements and
may choose to have their child participate in ABA therapy. The child would be entitled to receive
special education services from the school only if the homeschool is registered with the Michigan
Department of Education. Eligible students enrolled in a registered homeschool will receive special
education services through a nonpublic service plan. Although homeschooling is an option for all
Michigan families, it is important to note the academically and socially rich environment the school
setting can provide. Research supports placing students with ASD in school alongside their peers to
promote more successful transitions to community living.
information, support, and education
Michigan Alliance for Familie
s
Michigan Alliance for Families