For families in Michigan, accessing ABA therapy services through Medicaid can make a significant difference in ensuring their loved ones receive the care they need without financial strain. Here’s a guide on how to navigate ABA therapy services through Michigan’s Medicaid program.

Understanding Medicaid Coverage for ABA Therapy

In Michigan, Medicaid provides coverage for children and young adults under 21 years old to have access to medically necessary services, including ABA therapy for those diagnosed with ASD.

Steps to Access ABA Therapy Through Medicaid

1. If you have a case manager/supports coordinator: If you are already established with a case manager/supports coordinator, they can help walk you through this process.
2. If you not already established: Identify the county you reside in and contact their Access Center or other point of contact for screening and referral

Clinton, Eaton & Ingham Counties: 517-346-8200

Genesee County: 810-257-3705

Kent County: 616-336-3909

Macomb County: 855-996-2264

Oakland County: 248-464-6363

Shiawassee County: 989-723-6791

Wayne County: 800-241-4949

3. Initial Screening: You will complete an initial intake and screening with the county, based on  your screening, you may be referred to diagnostic testing for ASD.
4. Diagnosis and Referral: Obtain a formal ASD diagnosis from a qualified healthcare professional. This diagnosis is essential for Medicaid coverage of ABA therapy. Additionally, a referral from your child’s primary care physician or another healthcare provider might be required.
5. Getting established with a case manager/supports coordinator: After the diagnosis, you will be provided with your options for case management and supports coordination.
6. Find an ABA Provider: After receiving the diagnosis, you will be given a list of providers that are contracted with their network. 

From here, the steps are identical regardless of Medicaid or commercial insurance.

Paperwork 

Next, you’ll complete intake forms and provide necessary documentation. This may include:

• Your child’s medical history and developmental milestones.
• A formal autism diagnosis and/or referral from from case manager
• Insurance information for billing purposes.

Completing these forms thoroughly helps the provider understand your child’s background and needs.

Interview & Assessment

During the parent/guardian interview, you’ll meet with a clinician to discuss your child in detail. Topics covered may include:

• Your child’s strengths, preferences, and areas of difficulty.
• Specific goals you have for ABA therapy (e.g., improving communication, reducing challenging behaviors).
• Daily routines, triggers for behaviors, and strategies you’ve tried in the past.

This step helps the Board Certified Behavior Analyst (BCBA) or other qualified health professional gather the context they need to create an individualized therapy plan.

The clinician will conduct a direct assessment of your child to evaluate their current skills and behaviors. This may involve:

• Observing your child in a natural setting, such as at home or in a clinic.
• Using structured activities to assess communication, social skills, and problem-solving abilities.

These observations allow the clinician to identify areas of strength and opportunity for growth.

Functional Behavior Assessment (FBA)

If challenging behaviors are a concern, the clinician may conduct an FBA. This process involves:

• Identifying the function of specific behaviors (e.g., gaining attention, avoiding tasks).
• Collecting data through observation and parent input.
• Developing strategies to address these behaviors effectively.

Developing a Treatment Plan

Based on the information gathered, the clinician will create an individualized treatment plan. This plan outlines:

• Targeted goals for skill development and behavior improvement.
• The methods and techniques that will be used during therapy.
• The recommended number of therapy hours per week.

Authorization & First Day

The treatment plan is submitted to the county for authorization for services. This process can sometimes include additional meetings or reviews. After services are authorized, the first therapy sessions are scheduled and logistics are confirmed, such as session location and times and the assigned team. 

Tips for Navigating the Process

• Start Early: The process of accessing ABA therapy through Medicaid can take time. Starting the process as early as possible can help prevent delays in your child receiving services.
• Stay Organized: Keep all documentation related to your child’s diagnosis, treatment plan, and communication with the county and your ABA provider.
• Communicate with Your Provider: Your ABA provider can be a valuable resource for navigating the Medicaid system. Stay in close communication with them and ask questions if you need clarification.
• Advocate for Your Child: If you encounter any challenges or delays in accessing ABA therapy, don’t hesitate to advocate for your child’s needs. Contact your case manager/supports coordinator for assistance.

By taking these steps and using the resources available, you can work through the Medicaid system and make sure your child gets the ABA therapy they need to grow and succeed.

Wherever you are in the process, our team at Gateway is here to support you. Call, email, or fill out a form today and one of our Intake Coordinators will get in touch. Get Started Here!