Does Medicaid Cover ABA Therapy in New York?
Published April 8, 2026
Yes — New York Medicaid covers ABA therapy for children and adolescents under 21 with an autism diagnosis. New York also has one of the most extensive networks of ABA providers in the country, particularly in New York City, Long Island, and the Hudson Valley. Here's how the system works.
Key takeaways
- NY Medicaid covers ABA for all children under 21 with an autism diagnosis
- Coverage is through Medicaid Managed Care plans (Healthfirst, Fidelis, MetroPlus, Molina, etc.)
- NYC has one of the densest ABA provider networks in the US
- The HCBS waiver provides additional services for children with complex needs
- Adults over 21 can access OPWDD services for behavioral support
How New York Medicaid covers ABA
New York Medicaid operates through a managed care system. Most Medicaid enrollees are assigned to a Medicaid Managed Care (MMC) plan. Major plans in New York that cover ABA include:
- Healthfirst — large provider network in NYC and surrounding area
- Fidelis Care — statewide coverage, strong upstate network
- MetroPlus Health Plan — NYC-focused, large Medicaid enrollment
- Molina Healthcare of New York — statewide
- Affinity Health Plan — serves NYC and Hudson Valley
- WellCare of New York — statewide coverage
What New York Medicaid covers for ABA
Under New York Medicaid, covered ABA services include:
- Initial behavioral assessment and functional behavior analysis
- Direct ABA treatment — individual and group
- BCBA supervision and treatment planning
- Parent and caregiver training
- School-based ABA consultation in some cases
Coverage is based on medical necessity. There is no fixed hour cap — your child's BCBA determines the appropriate level of care and submits a treatment plan for prior authorization.
Steps to access ABA through New York Medicaid
- Confirm your Medicaid plan. Check your Medicaid card or call 1-800-541-2831 (NY Medicaid helpline) to confirm your managed care plan.
- Get an autism diagnosis. A formal DSM-5 ASD diagnosis is required from a licensed psychologist, psychiatrist, or developmental pediatrician.
- Find an in-network ABA provider. Call your MMC plan or use FindABA to find providers in your city that accept your plan.
- Complete intake and assessment. The provider conducts an initial evaluation and develops a treatment plan.
- Prior authorization is submitted. The provider submits the treatment authorization request to your plan — typically 7–14 days for a decision.
- Services begin at no cost to you.
The HCBS waiver for children with complex needs
New York's Home and Community Based Services (HCBS) waiver provides additional support for children with autism who have significant behavioral or medical needs. The waiver can provide services beyond what standard Medicaid covers, including:
- Intensive behavioral intervention
- Respite services
- Community habilitation
- Family support services
To apply for the HCBS waiver, contact your child's Medicaid plan or a designated Children's HCBS Care Manager. There may be a waitlist depending on your county.
Adults with autism in New York
Adults over 21 are not covered for ABA under standard New York Medicaid. However, the Office for People With Developmental Disabilities (OPWDD) provides a range of services for adults with autism, including behavioral support services. Contact OPWDD at opwdd.ny.gov or call 1-866-946-9733 to apply for eligibility determination.
New York resources
- NY State Medicaid: health.ny.gov/health_care/medicaid
- OPWDD (adults): opwdd.ny.gov
- Autism Society of New York: autismny.org
- NY Medicaid helpline: 1-800-541-2831
Find New York ABA providers that accept Medicaid
FindABA lists ABA providers across New York with accepted insurance plans including Healthfirst, Fidelis, and NY Medicaid.
Search New York providers →