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While autism treatments continue to evolve, applied behavior analysis (ABA) remains one of the most commonly used therapeutics in the United States. ABA is a critical tool for helping children and adults with autism improve important life skills, such as communicating, learning, and interacting socially.
However, while this therapy is essential for people with autism, accessing it isn’t always easy due to insurance, financial considerations, and legislation.
But, thanks to changes in healthcare regulations, employers now have a unique opportunity to play a more active role in supporting employees and their families who rely on ABA therapy — support that Vālenz Health® is proud to make possible as part of our mission to advance smarter, better, faster healthcare for all.
Table of Contents
- Challenges to Accessing ABA Therapy
- Healthcare Mandates Impacting ABA Therapy
- Impact on Employee Access to ABA Therapy
- How Employers Can Support Employees
- Navigate Changing Regulations — and Support Employees — with Vālenz Health® Today
What Is ABA Therapy?
As a treatment for autism, ABA therapy focuses on encouraging positive behaviors rather than punishing undesired behaviors. By rewarding desirable behaviors, board-certified behavior analysts (BCBAs) reinforce actions that help those with autism thrive and develop social, learning, and communication skills that can improve their quality of life.
For example, if a therapist is teaching a child to independently put away an item, they may give the child a small reward when they do so. Similarly, to develop communication skills, a person may be directed to shake hands when meeting someone new or to say thank you when being given an item.
Each child’s program is tailored to their unique needs and goals, as well as their strengths and challenges. As a result, ABA therapy is highly individualized in terms of the skills being taught and the time treatment takes to be effective.
Challenges Affecting ABA Therapy
Although ABA therapy is widely recognized as a critical and helpful treatment, several challenges can prevent patients from receiving the type and amount of care they need.
Rising Costs
Costs can (and often do) deter families from seeking ABA therapy, even when they have insurance.
Healthcare costs in the U.S. have exponentially increased over the last decades, leaving families to juggle a variety of expenses, including prescriptions, doctor visits, and specialist appointments. In 2025, the average out-of-pocket cost for an American family of four in 2025 rose to more than $13,800 (including insurance premiums).
ABA therapy adds significant costs to that number, especially when comprehensive programs often include at least 25 hours of therapy per week for young children. At the same time, insurance coverage can vary greatly, with some plans offering comprehensive coverage of ABA therapy and other plans offering more limited financial support.
All of this can make it difficult for patients to get the ABA therapy they need, simply due to financial restrictions.
Lack of Autism-Specific Providers
Many people with autism don’t have ready access to treatment due to a shortage of certified providers in their area.
Physician knowledge of autism is critical to delivering quality care. However, not all physicians have the specific knowledge that’s essential to screen, diagnose, and refer those with autism to a specialist.
The demand for BCBAs increased by 58% between 2023 and 2024, underscoring not just the recognition of ABA therapy as an effective treatment but also the lack of providers available to handle this demand. In fact, research reveals that 51% of families don’t know where to receive treatment and have limited access to information about the options available to them.
As a result, families who don’t have access to ABA therapy within their community often avoid seeking care due to long-distance travel, additional costs, time commitments, and disruption to work schedules.
Shift Toward Value-Based Care
The shift toward value-based care in ABA therapy means that reimbursement is now tied to measurable patient outcomes, emphasizing quality over quantity. While this approach encourages better, more effective care, it can also create challenges for families seeking timely treatment, which is already challenging due to a lack of providers with autism-specific knowledge.
With a value-based approach, providers are required to meet specific performance metrics, which can lead to longer wait times as they work to demonstrate the efficacy of their services. Families may experience delays in accessing necessary treatments, and securing immediate coverage may become more complex.
Healthcare Mandates Impacting ABA Therapy
Healthcare mandates play a critical role in shaping access to ABA therapy. Federal- and state-level regulations have expanded coverage requirements, helping more families obtain the support they need, but they’ve also introduced new complexities for employers and health plans to navigate.
Insurance Mandates
Many states have enacted laws requiring health insurance plans to cover autism-related treatments, including ABA therapy. These laws mandate that private insurers cover ABA therapy for children with autism, but the specifics vary by state. In some cases, the laws set limits on the amount of coverage provided and the age of the child eligible for coverage, while others provide more extensive benefits.
The introduction of such mandates has made ABA therapy more accessible, reducing the financial burden on families. However, employees may still face gaps in coverage if they live in states with more limited mandates or if their employer-sponsored insurance plan doesn’t fully comply with state regulations.
Medicaid Programs and Waivers
Medicaid programs, which vary by state, are another essential source of coverage for children with autism. Some states have expanded Medicaid benefits to cover ABA therapy, while Medicaid waivers are used in others to provide services. These waivers often have strict eligibility criteria, such as income limits and specific documentation requirements, which can impact access to treatment.
Additionally, individual states determine the maximum number of people who can receive a waiver. Because of this, there are limited spots available, and patients can linger for years on a waiting list before they can receive the care they need.
Mental Health Parity and Addiction Equity Act
Initially passed in 2008 and updated in 2024, the Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that insurance coverage for mental health and behavioral health services, including ABA therapy, is no less favorable than coverage for medical and surgical services. The law requires insurers to offer equal coverage for autism treatments, such as ABA therapy, preventing plans from limiting access to necessary services based on the type of care.
The MHPAEA helps families access the same level of benefits for ABA therapy as they would for other medical treatments, making it easier for employees to seek treatment without facing discrimination in their health plans. However, enforcement can sometimes be inconsistent, and employees may still face challenges in securing coverage due to variations in insurer interpretation of the law.
Impact on Employee Access to ABA Therapy
While these regulatory changes have increased access to ABA therapy, there are still significant challenges and barriers to receiving care. Employees may experience disparities in coverage based on where they live, what’s included in their employer’s health plan, or whether their state has adopted comprehensive autism coverage mandates.
In addition, while legislation mandates coverage, there can still be variations in the number of therapy hours allowed, the types of qualified providers covered, and the age limits for therapy.
As a result, employees seeking ABA therapy for their children may need to navigate complex insurance policies and regulations, with potential obstacles such as denials, age restrictions, or insufficient therapy hours covered. Additionally, with changes in how insurers process and approve claims for ABA therapy, employees might encounter delays or require additional documentation to secure the appropriate care for their children.
How Employers Can Support Employees
Understanding these challenges and potential solutions puts employers in a prime position to support employees through the changing healthcare landscape.
Employers can help connect employees with the autism treatment and care they need in a few different ways.
Provide Access to High-Quality ABA Therapy
As ABA therapy becomes more recognized as a successful treatment for autism, employers should anticipate greater demand for this service. A growing number of employees may seek coverage for their child’s needs or their own. Understanding the nuances of their health benefits can make a huge difference in their ability to do so.
As an employer, you can help by adjusting health benefits to ensure ABA therapy services are accessible. By offering comprehensive coverage that includes therapy, testing, and necessary follow-up treatments, you can make it easier for employees to get the help they need.
Providing employees with tools to help navigate the process, such as care navigation solutions, can also help alleviate some of the stress of locating the right provider for their needs.
Valenz Precision Care can help employees find high-quality, affordable care with professional guidance. Care navigators work one-on-one with members to guide them toward in-network facilities and providers, answer questions about benefits and out-of-pocket expenses, and assist members with claims.
This support can be enhanced with Valenz Bluebook’s cost and quality solution, which empowers members to search for a procedure, physician, or facility to quickly find high-value care. This easy-to-use solution clearly displays provider costs in a green-yellow-red format, with green providers in the top third of cost and quality ratings.
Through this transparency platform, employers can provide members with the tools they need to reduce their out-of-pocket costs — and, more importantly, select providers who are proven to deliver higher-quality care that results in better health outcomes over time.
Learn more about our Precision Care and Valenz Bluebook solutions here.
Invest in ABA Repricing Services
The high costs of ABA therapy can be mitigated with strategic payment integrity initiatives, such as repricing strategies designed specifically for these services.
For example, as part of the Valenz Out-of-Network Repricing solution, our Payment Integrity team frequently leverages the ABA Repricing feature on behalf of employers and plan sponsors. Through an efficient, easily implemented repricing program (informed by the industry-leading Valenz Market-Sensitive [VMS®] Repricing methodology), our team delivers predictable vendor fees that minimize out-of-network spend on ABA therapy — for an average savings of 85%.
Employers that invest in strategic repricing services like these not only minimize overall plan spend; they also reduce the likelihood of out-of-pocket costs for employees, making ABA therapy more affordable for the populations that need it most.
Learn more about how Out-of-Network Repricing supports employers like you by contacting our team today.
Understand Legal and Compliance Considerations
Employers need to understand the legal obligations for providing autism treatment coverage. Complying with state and federal mandates related to ABA therapy benefits is crucial for avoiding legal issues and ensuring employees’ access to necessary care.
Employers should also make sure their benefits portal is clear and easy to understand. Employees must be able to quickly find all relevant coverage information and communications about benefits in easily accessible customer accounts.
Beyond portal communications, employers should also regularly schedule meetings, send emails, and offer direct access to HR and benefits coordinators.
Navigate Changing Regulations — and Support Employees — with Vālenz Health® Today
Evolving healthcare regulations present employers with challenges and opportunities, especially when it comes highly sought after ABA therapy. Those who are dedicated to providing high-quality healthcare benefits to their employees should consider the tools and support available for this therapeutic treatment — and, when possible, provide those to plan members to ensure proper access and availability of this important treatment.
By staying informed, adjusting benefits plans, and offering additional support tools, such as Precision Care Navigation and Valenz Bluebook, you can make a meaningful impact on your employees’ well-being and help them live strong, vigorous, and healthy lives.
Learn more about how we can support your plan and address the increasing demand for ABA therapy by contacting a Valenz team member today.
