ABA insurance and Medicaid coverage in Florida

Last researched October 21, 2026

Who pays for ABA in Florida, 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: Fla. Stat. 627.6686 (and 641.31098 for HMOs), the 'Steven A. Geller Autism Coverage Act'
Age limits: Eligible individual: under 18, or 18 or older and in high school, diagnosed with a developmental disability at age 8 or younger (Fla. Stat. 627.6686 and 641.31098, plus the CFO page).
Annual cap: As of 2026-10-21, the statutory base limits for ABA and other listed treatments are $36,000 annually and $200,000 in total lifetime benefits (627.6686). Section 641.31098 refers to 'total benefits' rather than expressly 'lifetime' benefits. The statutes provide for a January 1 adjustment using the medical component of the CPI-U, but the current adjusted dollar amounts are not verified. These figures should not be presented as universally enforceable caps: the CFO page describes the amounts as minimum benefits, which differs from the statutory limitation language, and federal parity requirements may also apply.
Excludes self-funded employer plans: It depends.
Notes: Florida Dept. of Financial Services states it has no authority over self-insured ERISA plans, so the exclusion applies to self-insured ERISA plans specifically; the statute expressly includes the state employee group program. The statute's definition of 'health insurance plan' as fetched excludes individual-market, individually underwritten and small-employer plans. The CFO page separately says individual and small group plans are covered under ACA requirements, but it expressly distinguishes required mental-health benefits from guaranteed ABA coverage, so applicability of the ABA mandate to those market segments should be confirmed. ABA must be delivered by providers certified under s. 393.17 or licensed under chapters 490 or 491. Neither 627.6686 nor 641.31098 expressly addresses telehealth. Applies to plans issued or renewed on or after April 1, 2009.

Sources (3)

Medicaid ABA coverage

Medium confidence: reputable secondary source

Medicaid covers ABA: Yes, per the sources below.
Program: Florida Medicaid Behavior Analysis (BA) Services, Rule 59G-4.125 F.A.C.; Florida Medicaid Behavior Analysis Services Coverage Policy (December 2024)
Agency: Agency for Health Care Administration (AHCA)
Provider enrollment: https://portal.flmmis.com/flpublic/Provider_ProviderServices/Provider_Enrollment/tabid/42/desktopdefault/%2B/Default.aspx

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

Aetna Better Health of Florida - Publishes a Medicaid BA provider FAQ (rev. 2/21/2025).
Sunshine State Health Plan - Currently operates the Children's Medical Services (CMS) Plan; AHCA says members move to Molina Healthcare of Florida on October 1, 2026.
Molina Healthcare of Florida - Named by AHCA as taking over the CMS Plan effective October 1, 2026. The full list of 2025-2030 SMMC plans was not retrieved from an official page.

How to enroll

Start at the state Medicaid provider enrollment page: https://portal.flmmis.com/flpublic/Provider_ProviderServices/Provider_Enrollment/tabid/42/desktopdefault/%2B/Default.aspx.
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 Florida.

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