Florida Medicaid covers Applied Behavior Analysis (ABA) for children and young adults under 21 with autism or another qualifying diagnosis. The coverage has not gone away. What changed in 2025 is how you get it: the rules are stricter, the paperwork is heavier, and your health plan, not the state, now makes the decisions. This guide walks through the path we take with every new family.
Who decides now
Since February 1, 2025, ABA is a managed care benefit. If your child is on Molina, Sunshine Health, the CMS Health Plan, Aetna Better Health, Humana, Simply, UnitedHealthcare, Community Care Plan or Florida Community Care, that plan approves the hours, credentials the provider and pays the claims. Children on fee-for-service Medicaid still go through the state's review vendor.
Two practical consequences: your provider must be in your plan's network, and every plan runs its own portal and timelines. A provider who works with several plans every week knows where the delays are.
Step 1: The comprehensive diagnostic evaluation
Before February 2025 a doctor's order was enough to start. Now the plan needs a comprehensive diagnostic evaluation (CDE) by a licensed practitioner: typically a developmental pediatrician, neurologist, psychiatrist or psychologist. The evaluation confirms the diagnosis and describes your child's needs.
If your child already has a diagnosis, ask the office that gave it for a copy of the full report, not just the letter. If your child does not have one yet, ask your pediatrician for a referral to a diagnostic clinic; in Miami-Dade the wait can be months, so start early. We can point you to clinics that take your plan.
Step 2: The physician order
Alongside the CDE, your child's doctor writes an order or referral for ABA. Many pediatricians use a short form; ours is one page and we fax it to the office for you if they prefer.
Step 3: The assessments
Your ABA provider's Board Certified Behavior Analyst (BCBA) meets your child and completes two standardized measures required by Florida Medicaid:
- Vineland-3, an interview with you about your child's daily living, communication and social skills.
- BASC-3 Parent Rating Scales, a questionnaire about behavior at home and in the community (ages 2 to 18).
Together with a functional behavior assessment, these become the treatment plan: the goals, the number of hours, the settings (home, school, community) and the caregiver-training plan. The assessment is billed under CPT code 97151 and does not need prior approval from most plans.
Step 4: Authorization
We submit the plan to your health plan. Approval usually takes one to three weeks. Authorizations run in six-month cycles; the BCBA updates the plan and the assessments and re-submits before each cycle ends so services do not lapse. This is where families most often lose hours with providers who miss the renewal window.
Step 5: Therapy starts
A Registered Behavior Technician (RBT) works with your child at home or at school under the BCBA's supervision. Caregiver training is part of the plan, not an extra.
If the plan says no
Denials and hour reductions can be appealed, and appeals are often successful. Ask for the reason in writing, note the appeal deadline, and call us. We prepare the appeal packet with you.
What to keep in a folder
The CDE report, the physician order, your child's current treatment plan, the most recent Vineland-3 and BASC-3, the IEP or 504 plan if therapy happens at school, and your child's insurance card. If your plan changes, that folder is what makes the transition painless.
Beaton Care Services is in-network with Molina (including the CMS Plan), Sunshine Health, Florida Medicaid and other plans. Call 786-612-1151 or request a call back; a bilingual member of our team responds within one business day.