Medicaid and ABA therapy in Austin: how it works, step by step

We’ve never been on Medicaid — our income is too high — so this isn’t a guide from my own experience the way some of the others are. It’s the guide I went looking for and couldn’t find: how Texas Medicaid actually covers ABA, written for Austin families, in the order things happen. I went to the state’s own manuals and health plan charts so you don’t have to.

If your child has Medicaid and an autism diagnosis, and ABA is part of the plan their doctors recommended, the short version is this: ABA is covered, but only with the right paperwork, through your child’s own health plan, and in blocks of time that have to be renewed. Knowing those three things up front saves weeks.

This guide doesn’t tell you whether ABA is right for your child — that’s a conversation with the professionals who evaluated them. It’s how to get it covered once that decision is made.

Does Texas Medicaid cover ABA therapy?

Yes. Since February 2022, ABA evaluation and treatment have been a Texas Medicaid benefit for children and youth 20 and younger with an autism diagnosis. It sits inside Texas Health Steps, Medicaid’s benefit for children. There’s no set weekly hour cap; the hours are based on your child’s needs and the treatment plan, and larger requests get an extra review.

Two things trip families up. First, a diagnosis alone isn’t enough — the state manual says so in nearly those words. Coverage depends on an evaluation and a plan that show why ABA is medically necessary for your child. Second, ABA goes through your child’s Medicaid health plan, not “Medicaid” in general. That’s what decides which providers you can use.

Which Medicaid plan is your child in?

Most Texas children on Medicaid are in a program called STAR. Children who get SSI, or who are in certain waiver programs, are in STAR Kids. Children in foster care are in STAR Health. Inside each program, a private company — the health plan — runs your child’s coverage, and its name is on your child’s card. If the card doesn’t name a plan, or you’re not sure which one your child is in, check your Your Texas Benefits account or call the enrollment line below.

As of October 2026, the health plans in the Travis County area (which includes Williamson, Hays, Bastrop, Caldwell, Burnet, Fayette, and Lee counties) are:

• STAR: Blue Cross Blue Shield of Texas, Dell Children’s Health Plan, and Superior HealthPlan.
• STAR Kids: Blue Cross Blue Shield of Texas and Superior HealthPlan.
• STAR Health (foster care): Superior HealthPlan, the one STAR Health plan statewide.

The state publishes a chart comparing these plans, but it only compares the extras each plan adds — things like gift cards, YMCA memberships, and help with school plans. ABA isn’t on it, because ABA is a basic Medicaid benefit and is the same in every plan. What differs from plan to plan is which ABA providers are in network.

If you’re reading this from another part of Texas, the programs are the same but the plan names change by region — your card and the state’s enrollment line have yours.

This matters because an ABA provider has to be in network with your health plan, not just “take Medicaid.” A clinic can work with one Medicaid plan and not another. When you call, say the plan name: “Are you in network with Superior STAR Kids?” gets a real answer; “Do you take Medicaid?” often doesn’t.

You can change your child’s Medicaid health plan at any time. Call the state’s enrollment line at 800-964-2777 or change it in your Your Texas Benefits account. A change takes 15 to 45 days to start, so if the ABA provider you want is only in network with a different plan, it’s worth weighing — but ask the provider about their wait first, and don’t switch in the middle of an approval without asking them how it affects your child’s authorization.

If your child also has private insurance, the private plan pays first and Medicaid pays second — many children with Medicaid through a waiver have both. Tell the ABA provider about both plans up front and ask whether they bill both, so the authorization goes to the right plan first.

The steps, in order

1. A diagnosis from a specialist. Texas Medicaid requires a comprehensive diagnostic evaluation — from a specialist such as a developmental pediatrician, neurologist, psychiatrist, or licensed psychologist, or a diagnostic team. The diagnosis has to have been made or reconfirmed within the last three years. If your child was diagnosed a while ago, check the date on the report.
2. A referral for an ABA evaluation. Your child’s doctor — the pediatrician is fine — signs a referral for the ABA evaluation.
3. The ABA evaluation. A Texas-licensed behavior analyst (LBA) assesses your child. The provider gets approval from your health plan first; that approval is good for 60 days, so the evaluation needs to happen inside that window.
4. The treatment plan and a referral for treatment. The behavior analyst writes a plan with goals and recommended hours. A doctor (or another provider the state allows) signs a referral for treatment.
5. Prior authorization. The provider sends the plan to your health plan. A first approval covers 90 days and can be extended for another 90. After that, renewals can cover up to 180 days at a time.
6. Renewals. Each renewal looks at progress. Put the end date of every approval on your calendar and ask the provider when they’re sending the renewal. If services stop for 180 days or more, you start over with a new request.

Most of this paperwork is the provider’s job, not yours. Your job is to know where things stand, keep copies of the diagnosis report and referrals, and ask.

Parent training is part of the plan

Medicaid ABA plans include parent and caregiver training, usually led by the behavior analyst, sometimes without your child in the room. Medicaid can’t deny ABA just because a parent can’t be involved — but when an approval comes up for renewal, the plan looks at whether parents attended at least 85% of the planned training sessions. If the schedule doesn’t work for your family, say so early and ask about other times.

What to ask an ABA provider about Medicaid

• Are you in network with my child’s plan? By name — the plan and the program (STAR, STAR Kids, or STAR Health).
• Is there a wait, and is it the same for Medicaid?
• What do you need from me to start? Usually the diagnosis report, the Medicaid card, and the doctor’s referral.
• Who handles the authorization and the renewals, and how will I know when they go in?
• Center-based, in-home, or both? And for in-home, do you serve our part of town?
• What does parent training look like, and when is it scheduled?

Our ABA therapy in Austin page has more questions to ask any ABA provider, Medicaid or not, and our ABA enrollment guide walks through the full-time and part-time decision.

Rides to appointments

If you don’t have a way to get your child to covered appointments, Medicaid health plans provide non-emergency rides. Call the member services number on your child’s card and ask how to schedule one. For ABA several times a week, it’s worth setting up before therapy starts.

If your child has CHIP, not Medicaid

CHIP is a different program from Medicaid, even though the cards and health plans can look the same. The ABA benefit described in this guide is a Medicaid benefit. If your child has CHIP, call your plan and ask whether ABA is covered before you start the steps above.

If your child doesn’t have Medicaid yet

A diagnosis doesn’t qualify a child for Medicaid on its own — you still apply, and income and other rules apply. Children’s Medicaid has no enrollment window, so you can apply any month. Some children qualify through other paths:

• SSI. In Texas, a child who gets SSI gets Medicaid with it. SSI has its own disability and income rules, through Social Security.
• Medicaid waivers. Some waiver programs set aside parents’ income, but they have long interest lists — often years. No waiver is a fast route, but your place is held by the date you signed up, which is why families sign up early.

Our guide to paying for therapy covers private insurance, the Texas autism insurance law, and what families do while they wait. For children under three, Texas ECI is the first door for developmental support — our ECI guide explains how it works and what it costs.

Finding ABA in Central Texas

Care Connect Kids is free for families. Always. When you add your child’s insurance, you can choose the Medicaid or CHIP plan too, and clinics that name the plans they take are matched to yours. On a clinic’s listing you can see the insurance it lists publicly — always confirm with the clinic, by your plan’s name, before you count on it. Speech, occupational, physical, and ABA therapy all live in one place.

Not sure whether we reach your family yet? Check your zip code. If you are in Central Texas, the Austin metro page shows where we cover today.