ABA insurance and Medicaid coverage in Delaware

Last researched October 21, 2026

Who pays for ABA in Delaware, and what a practice has to do to bill them. Coverage details here come from statutes and agency pages we read, not from payer marketing.

Autism insurance mandate

Medium confidence: reputable secondary source

State mandate for autism coverage: Yes, the research found a state autism coverage law.
Statute: 18 Del. C. 3366 (individual health benefit plans) and 18 Del. C. 3570A (group and blanket health benefit plans)
Age limits: Coverage for screening, diagnosis and treatment of autism spectrum disorders in individuals less than 21 years of age (statute text as fetched).
Annual cap: Applied behavior analysis is subject to a statutory base maximum benefit of $36,000 per 12-month period per person, adjusted annually for CPI-U by the Insurance Commissioner. As of 2026-10-21, the checker reports a published ABA maximum of $38,601.65 per person per 12-month period, effective April 1, 2026 through March 31, 2027, applying to policies issued or renewed thereafter. The prior period amount (April 1, 2025 through March 31, 2026) was $37,691.77, per the Department of Insurance notice (28 DE Reg. 690, 03/01/25), and is historical only. No limit on number of visits.
Excludes self-funded employer plans: It depends.
Notes: Text applies to health benefit plans delivered, issued, executed or renewed in Delaware after December 11, 2012. Coverage cannot be denied because treatment is habilitative. 'Autism services provider' in the statute includes practitioners with the national certification of board-certified behavior analyst 'or those working under their supervision', among other licensed professions. Sections 3366 and 3570A contain no express self-funded-plan exclusion; however, the state mandate generally does not bind self-funded ERISA plans under federal law. Not every self-funded plan is necessarily ERISA-covered, so applicability to a specific plan should be confirmed.

Sources (4)

Medicaid ABA coverage

Medium confidence: reputable secondary source

Medicaid covers ABA: Yes, per the sources below.
Program: Delaware Medical Assistance Program (DMAP); Diamond State Health Plan (DSHP) managed care; EPSDT autism behavioral services for beneficiaries under 21.
Agency: Delaware Division of Medicaid and Medical Assistance (DMMA), Department of Health and Social Services (DHSS).
Provider enrollment: https://medicaid.dhss.delaware.gov/provider

Sources (5)

Payers named in our research

Names come from the research behind this page. Appearing here does not mean a payer is accepting new providers or that networks are open. Always confirm directly with the payer.

Medicaid managed care plans

AmeriHealth Caritas Delaware - Listed as a Diamond State Health Plan MCO on the DMMA page (name on page: 'AmeriHealth Caritas'). Whether it covers ABA was not stated on the page.
Delaware First Health - Listed as a Diamond State Health Plan MCO on the DMMA page.
Highmark Health Options - Listed as a Diamond State Health Plan MCO on the DMMA page.

How to enroll

Start at the state Medicaid provider enrollment page: https://medicaid.dhss.delaware.gov/provider.
Ask each commercial payer you want to bill for its credentialing application and timeline. We have not verified payer timelines.
Confirm which staff types the payer reimburses, including whether technicians must hold the RBT credential. See BT vs RBT in Delaware.

Related guides for Delaware

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