Insurance Coverage at Achieve ABA

We've Got You Covered

Every child deserves the opportunity to thrive - and that includes having access to the therapy they need. Navigating insurance coverage can feel overwhelming, but we're here to make the process a breeze.

NCDHHS insurance ABA therapy coverage

Every child deserves the chance to build new skills and discover their strengths. Through NC Medicaid, families in North Carolina can access ABA therapy as a covered benefit, helping make that growth possible.


At Achieve ABA, we know how heavy insurance paperwork and authorizations can feel. That’s why we work with families step by step, turning uncertainty into clarity and making sure you never walk the journey alone.

NCDHHS coverage for ABA therapy

North Carolina Medicaid, through the Division of Health Benefits, covers Applied Behavior Analysis (ABA) therapy under a service called Research-Based Behavioral Health Treatment (RB-BHT).



This coverage is designed to give children and young adults with autism access to care that meets their unique needs.

Here’s what families can expect:

✓ ABA therapy is covered as a medically necessary service for children with autism.

✓ Children and young adults under 21 are eligible through EPSDT (Early and Periodic Screening, Diagnostic, and Treatment).

✓ Adults 21 and older may also qualify if services are evidence-based and medically necessary.

✓ Prior authorization is required, usually approved in six-month periods.

✓ Therapy can take place anywhere your child learns best—at home, in school, in a clinic, or through telehealth.

Who qualifies for NCDHHS ABA therapy?

Eligibility for ABA therapy through NC Medicaid includes:

✓ A formal autism spectrum disorder (ASD) diagnosis from a qualified provider

✓ For children under 3, a provisional autism diagnosis is often enough to begin services, with confirmation required later

✓ A treatment plan developed by a Licensed Qualified Autism Service Provider (LQASP) or BCBA

✓ Prior authorization from NC Medicaid before therapy begins

Even if you’re still in the process of getting a diagnosis, you don’t have to wait to explore next steps. We regularly help families begin the journey, no matter where they are.

What ABA therapy through NCDHHS includes

With Medicaid, ABA services are designed to support children in the places they live and learn every day:

✓ A thorough initial assessment by a BCBA

✓ An individualized treatment plan based on your child’s strengths and needs

✓ In-home ABA therapy to build skills in familiar environments

✓ School-based autism support to help children thrive in classrooms

✓ Parent and caregiver training to strengthen your role at home

✓ Regular progress updates and re-authorizations to ensure continued care

These supports work together to create a strong circle of care—centered around your child and your family.

How families begin with NCDHHS and Achieve ABA

Starting therapy with Medicaid can feel overwhelming, but families often find relief once they have a clear guide. Here’s how we make it easier:

1. We learn your story - your child's needs and strengths come first.

2. We guide your coverage - we explain NC Medicaid benefits in simple, clear terms.

3. We handle the logistics - from paperwork to authorizations, we manage the details.

4. We begin services - your child starts therapy with a caring team - in home, in school, in clinic or online.

Parents often tell us that once they connected with us, the weight lifted. What once felt overwhelming became a path forward, filled with hope and support.

FAQs about NCDHHS ABA therapy coverage

  • Does NCDHHS cover ABA therapy for autism?

    Yes. ABA is covered under RB-BHT for beneficiaries under 21 and beyond if medically necessary.

  • Is a full autism diagnosis required to start?

    A full diagnosis is required, but children under 3 can begin with a provisional diagnosis while waiting for confirmation.

  • Do I need prior authorization for ABA?

    Wellcare may cover in-home ABA therapy, school-based autism support, or clinic/community settings.

  • How many hours are covered?

    Yes. NC Medicaid requires pre-approval of services, typically authorized in 180-day increments.

  • Where can ABA therapy take place?

    Services may be covered in-home, in schools, in clinics, and through telehealth when appropriate.

  • Does NCDHHS coverage include parent training?

    Yes. Parent and caregiver training is considered a vital part of ABA therapy under NC Medicaid.

Walking through this journey together

Behind every insurance form is a parent who just wants the best for their child. With NC Medicaid and Achieve ABA, the journey to ABA therapy becomes easier, clearer, and filled with support.

We’ll guide you through Medicaid coverage and help your child begin therapy with confidence.