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Sproutwell ABA

ABA therapy in Texas

Texas Medicaid covers ABA for eligible kids, and the state has required private insurance to cover autism care since 2007. Here’s how it actually works — and how we handle the messy parts for you.

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Does Medicaid cover ABA in Texas? Yes.

THE COVERAGE PATHWAY

Autism Services benefit (ABA evaluation and treatment) added Feb 1, 2022 under the Texas Health Steps Comprehensive Care Program (THSteps-CCP/EPSDT) for ages 20 and younger; delivered fee-for-service via TMHP and through STAR/STAR Kids MCOs

WHO RUNS IT

Texas Health and Human Services Commission (HHSC); claims and prior auth through TMHP — tmhp.com, 800-925-9126

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

Getting approved, in three steps

Texas 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 Texas — 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 (Texas’s exact rules)

Licensed Behavior Analyst (LBA/BCBA) submits the CCP Prior Authorization Request with an ASD diagnosis, completed ABA evaluation, and treatment plan; requires referring/ordering provider; periodic reauthorization with updated plan

Coverage details in Texas

How many hours a week?

Direct treatment capped at 8 hours/day (32 units combined across 97153/97154/97155/97158); comprehensive vs focused treatment per policy

Private insurance has to help too

Not on Medicaid? Texas’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: 2007 (HB 1919, group plans ages 2-6); expanded 2009 and 2013 — SB 1484 removed the age cap but allowed an annual ABA max (~$36,000, verify) for enrollees age 10+

Waiver programs worth knowing

Waivers can add services or open Medicaid eligibility even when family income is too high. In Texas: HCS, Texas Home Living (TxHmL), CLASS, MDCP, and YES waivers — all with multi-year interest lists

What does ABA actually cost in Texas?

Texas Medicaid reimburses ABA providers roughly $58 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 Texas costs

Texas questions, answered

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

READY WHEN YOU ARE, TEXAS.

“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.

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“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.

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“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.

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Biggest cities in Texas

Local pages for Texas’s largest communities — what settings are realistically available in each, how far the nearest city is, and which county’s rules apply to you. We cover 804 towns and cities across Texas; the rest are listed on their county pages.

Counties we serve in Texas

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

Looking for a different state?

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