Therapy can be an expensive journey to helping your autistic loved one succeed and grow. BCBAs need to dive into practical strategies now more than ever to help their clients and families access ABA services financially. No matter what the barriers might be for your clients’ families, all clients deserve access to quality and effective therapy services, regardless of their financial status or ability to pay.
Insurance
Payment for ABA therapy can often feel like a race; or a marathon for some.
The biggest hurdle to leap over in the beginning tends to be insurance. Families start running the race right after the diagnosis “sounds off”, and as they start to sprint they realize that insurance issues can be a significant obstacle to face.
Most insurance companies now cover ABA therapy, but many Americans are still in the process of getting health insurance coverage. In my experience as a BCBA, some insurance companies are ‘skeptical’ when BCBAs run an evaluation and ask for therapy hours to be covered. Other insurance companies barely ask for any evaluation and sign-off on as many hours as deemed necessary by the BCBA. The wide variety of responses to getting therapy hours authorized across insurance companies creates issues for families and can put a pause in service provision.
If the family is enrolled in Medicaid, they can run into extra barriers depending on what state they live in. Several states do not yet have fully activated Medicaid plans for ABA therapy, Texas being one of them. A map from the Autism Speaks website provides a nice at-a-glance graphic of which states are behind on fully activating Medicaid coverage for ABA therapy.
There are four states that have yet to fully implement their Autism Services Benefit. Simply put, they have not taken the actions needed to put that benefit into effect. These states are New York, Illinois, Texas, and Washington DC. There are also a small number of states that have implemented the Autism Services Benefit, but not fully. For the states that are partially implemented, there are limitations within those states to accessing services. Luckily, most states have activated their Medicaid benefit for Autism Services, and if a client can get to a provider taking new Medicaid patients in their clinic, they can be provided with services.
After an Intake Evaluation, Set up a Meeting to Discuss Insurance
As a BCBA it is important to know about the type of insurance your clients’ families are using and help them better understand what is available to them through their insurance.
So what can you do practically in the world of insurance? Have a meeting upon completing an intake evaluation to specifically talk about insurance. That’s right, a meeting all about finances and the glorious world of insurance. If your clinic or company has a billing specialist, make sure they attend the meeting too to help with questions.
Often families don’t understand what their insurance will cover, or how their insurance works with ABA services. Upon working with a family from Russia at one point in my career, I realized when they came in for evaluation for their son, they never knew insurance would cover as many hours of therapy as it did. This misunderstanding of insurance actually kept them from coming in earlier and kept their son from gaining access to ABA sooner.
Strategies for Dealing With the Co-Pay
As a family makes it over the insurance hurdle, they might find themselves ramping up to jump over the next issue. Co-pay.
Co-pay is required, but many BCBAs do not offer a payment plan on co-pay, a sliding scale, or other unique financial arrangements. Another practical strategy for BCBAs to utilize is creating a unique sliding scale or payment plan option for your clients. Financial needs span wide across the diverse populations that we serve. Set up a document with your billing specialist and operations manager to draft a sliding scale of co-pay based on income. You can also simply create a few options of payment plans for co-pay fees that might help space out or clump together payment for some that need it.
Strategies for Providing Additional Assistance
As a family finally rounds the corner of the financial race, they often miss the help stations along the way that could provide more assistance.
Many BCBAs or ABA professionals are unaware of financial support groups for clients, or special funding options within their state. Many states offer waivers and subsidies for individuals with autism under the age of 21. There are both state-funded and federally-funded options. The United Healthcare Children’s Foundation (UHCCF) is one option. The purpose of UHCFF is to help fill the gap between what medical services and equipment a child needs and what their health insurance benefit plan will pay. UHCCF grants provide financial assistance for families with children, ages 16 and younger that have medical needs not covered or not fully covered by their health insurance plan.1
Another practical strategy for BCBAs to use in helping families access supplemental financial support is simply connecting with your local special funding options. Look at what state you live in and find out what types of waivers, grants, and supplemental support are available to your families. Discuss those during your insurance-based meeting after intake (see the first strategy above). Use that meeting time to make sure your new client’s family feels comfortable, supported, and educated on their options.
I know BCBAs aren’t financial advisors or insurance agents, but finances can be a huge hindrance to accessing ABA services for autism. Our beautiful and strong families within the autism community already face so many challenges, let’s take the financial burden down a few notches on the hurdle bar. As BCBAs, let’s address their questions and point them in the right direction when we don’t have the answers.
As an ABA provider, what kinds of financial assistance or guidance are you offering? We would love to hear your suggestions!
We hope you enjoyed the information in this article. STAGES® Learning also offers free downloadable resources to support teaching and learning with autistic individuals. Start with our free Picture Noun Cards and see our collection of other downloadable resources here!
References
- Wheeler, Marci. “How Do I Fund My Child's Applied Behavior Analysis (ABA)?” Indiana Resource Center for Autism, https://www.iidc.indiana.edu/irca/articles/how-do-i-fund-my-childs-applied-behavior-analysis.html.
