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Sproutwell ABA

ABA therapy in Georgia

Georgia Medicaid covers ABA for eligible kids, and the state has required private insurance to cover autism care since 2015. Here’s how it actually works — and how we handle the messy parts for you.

Does Medicaid cover ABA in Georgia? Yes.

THE COVERAGE PATHWAY

Adaptive Behavior Services (ABS) under EPSDT since 1/1/2018 for under-21 with documented DSM-5 ASD diagnosis; delivered FFS via DCH/GAMMIS and through the four Georgia Families CMOs which authorize and reimburse in-network

WHO RUNS IT

Dept. of Community Health (DCH), medicaid.georgia.gov; GAMMIS portal mmis.georgia.gov

You don’t have to memorize any of this — we work with Georgia’s system every day.

Getting approved, in three steps

Georgia requires paperwork before therapy is covered. Here’s the whole process from your side of the table — we do the rest.

  1. 1

    Round up the diagnosis paperwork

    An autism diagnosis from a qualified provider is the key that opens coverage. Already have it? You’re ahead. If not, we’ll help you find an evaluation.

  2. 2

    We build and submit the plan

    Your BCBA assesses your child and writes the treatment plan. Then we file it with the right reviewer in Georgia — forms, follow-ups, and all.

  3. 3

    Coverage confirmed. Therapy starts.

    Once the plan signs off, sessions begin. Most families who qualify start within 2–3 weeks. Approvals renew on a schedule — we track it so you never think about it.

The fine print, if you want it (Georgia’s exact rules)

PA required before services: ASD diagnosis from licensed physician/psychologist plus provider-submitted treatment plan approved by DCH or the member's CMO

Coverage details in Georgia

How many hours a week?

Georgia doesn't publish a fixed weekly-hours number. Hours are set child by child: your BCBA writes a treatment plan, and the reviewer approves the hours that plan supports. We'll tell you what to expect for your child on the first call.

Private insurance has to help too

Not on Medicaid? Georgia’s autism insurance law makes state-regulated private plans cover autism care — you’d pay your plan’s normal deductible and copays. The rule on the books: Ava's Law (HB 429) enacted 2015 covering under age 6; SB 118 (2018) expanded to age 20 and younger; permitted $35,000/yr ABA benefit cap

Waiver programs worth knowing

Waivers can add services or open Medicaid eligibility even when family income is too high. In Georgia: Katie Beckett (TEFRA) deeming pathway; NOW (New Options Waiver); COMP (Comprehensive Supports Waiver) — both waitlisted

What does ABA actually cost in Georgia?

Georgia Medicaid reimburses ABA providers roughly $62–$151 per hour for one-on-one therapy (rates differ by clinician credential and setting). That's what the state pays us — with Medicaid, most families pay nothing out of pocket.

See Georgia costs

Georgia questions, answered

Program rules change; this page describes Georgia’s public coverage rules in plain English and isn’t legal or benefits advice. Call us and we’ll check your exact plan.

READY WHEN YOU ARE, GEORGIA.

“I’m worried, but there’s no diagnosis yet.”

That’s where most families begin. Tell us what you’re seeing and we’ll help you figure out the next step — even if it isn’t us.

Help me figure it out

“We have a diagnosis. What does ABA cost?”

For most families it’s covered — Medicaid in every state, and every state has an autism insurance law. See exactly how yours works.

Check my state + insurance

“I just want to talk to a person.”

One 15-minute call. A real human who does this every day, no pressure and no obligation.

Call (800) 555-0134

Counties we serve in Georgia

Every corner of Georgia — pick your county for local answers on coverage, in-home care, and how to start.

Looking for a different state?

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