Since February 10, 2025, Florida Medicaid's behavior analysis coverage policy requires a comprehensive diagnostic evaluation with the physician's order before a health plan will authorize ABA. A letter that says "diagnosed with autism" is not enough anymore. This is the single most common reason a referral stalls, so it is worth understanding.
What the evaluation contains
A CDE is a written report by a licensed clinician that documents how the diagnosis was reached. A complete one usually includes the developmental and medical history, direct observation of your child, a standardized diagnostic instrument (the ADOS-2 is the most common for autism, sometimes alongside the ADI-R or CARS-2), a summary of strengths and needs, and the diagnosis with its ICD-10 code (for autism spectrum disorder, F84.0).
The health plan reviewer is looking for three things: a licensed evaluator, a recognized instrument, and a clear statement of the diagnosis and functional impact. If any of the three is missing, the plan sends the authorization back.
Who can perform it
In Florida the evaluation must come from a licensed practitioner working within their scope: developmental-behavioral pediatricians, pediatric neurologists, child psychiatrists, licensed psychologists, and in some cases pediatricians and nurse practitioners with the training to administer the instruments. A BCBA cannot diagnose autism; our role starts after the diagnosis.
Where families in Miami-Dade get one
Diagnostic capacity is the bottleneck. Realistic options, roughly in order of wait time:
- Your pediatrician's network. Many large pediatric groups now have a developmental clinic or a psychologist on contract. Ask first.
- Hospital developmental centers. Nicklaus Children's, the Mailman Center at UM, and Jackson's pediatric programs all evaluate, with waits that can run several months.
- Licensed psychologists in private practice who accept your Medicaid plan. Shorter waits, but check the plan's directory and confirm they produce a full written report.
- Early Steps (birth to 36 months) and FDLRS / Child Find through Miami-Dade County Public Schools (3 and up) provide evaluations for eligibility. These are valuable, but confirm the report includes a formal diagnosis by a licensed clinician; an educational eligibility determination alone does not satisfy Medicaid.
We keep a current list of evaluators who accept Molina, Sunshine, the CMS Plan and Aetna Better Health, and we share it with every family at intake.
If your child was diagnosed years ago
An older evaluation is usually acceptable if it is complete and the diagnosis has not changed. Request the full report from the clinic that did it; the release form takes a week or two. If the report is thin (a one-page letter, no instrument named), a plan may ask for an updated evaluation.
What we do with it
Once we have the CDE and the physician order, our BCBA schedules the assessments (Vineland-3, BASC-3 and a functional behavior assessment), writes the treatment plan, and submits the authorization. From a complete CDE to the first therapy session is typically three to five weeks.
Not sure whether your child's report qualifies? Send us a message or call 786-612-1151; we will read it and tell you within one business day.