Our son is 5 and newly diagnosed. We are on Medi-Cal in California. The regional center mentioned ABA, and so did his pediatrician, but I keep hearing different answers about who pays.
Does Medi-Cal cover ABA therapy in California? If yes, do we go through the health plan, the regional center, or both?
Top answer, from Sam K.
Read the full answerYes. Medi-Cal covers medically necessary ABA for eligible children. In California, families often end up coordinating two systems: the Medi-Cal managed care plan for the health benefit, and the regional center for developmental services under the Lanterman Act. They are related, but they are not the same paperwork trail. What usually helps: 1) Call your Medi-Cal plan and ask how to request ABA /…
No account needed. One-click unsubscribe in every email.
Yes. Medi-Cal covers medically necessary ABA for eligible children. In California, families often end up coordinating two systems: the Medi-Cal managed care plan for the health benefit, and the regional center for developmental services under the Lanterman Act. They are related, but they are not the same paperwork trail.
What usually helps:
1) Call your Medi-Cal plan and ask how to request ABA / behavioral health treatment for autism, including assessment and prior authorization.
2) Ask which providers are in network and what diagnosis and medical necessity docs they need.
3) Contact your regional center service coordinator the same week. Ask what they can fund, what they expect Medi-Cal to cover first, and how the two should coordinate so you are not stuck in a bounce loop.
4) Get everything in writing: referral, diagnosis report, treatment plan, and any denial.
Medically necessary ABA for a Medi-Cal-enrolled child under 21 should not be categorically refused. Hour amounts, settings, and timelines still vary by plan and provider availability. If one office says "we do not cover that," ask them to put the reason in writing and escalate. California rules are detailed, and the exact handoff between plan and regional center can differ by county, so confirm with both before you wait on either one alone.
Have experience to share? Sign in with just your email. No password needed.