ABA insurance and Medicaid coverage in Hawaii
Last researched October 21, 2026
Who pays for ABA in Hawaii, 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
- State mandate for autism coverage
Yes, the research found a state autism coverage law.
- Statute
HRS 431:10A-133 (L 2015, c 235, s 3)
- Age limits
As of 2026-10-21, the statute covers individuals under fourteen years of age covered under the policy (statute as fetched from capitol.hawaii.gov HRS current). This describes the statute, not every plan's actual benefits.
- Annual cap
ABA is subject to a maximum benefit of $25,000 per year for services for children ages thirteen and under. Payments for other care do not count toward the maximum. This figure describes the statute, not every plan's actual benefits.
- Excludes self-funded employer plans
We could not verify this yet - check with your state insurance department.
- Notes
Applies to individual or group accident and health or sickness policies issued or renewed in Hawaii after January 1, 2016; excludes disability, accident-only, Medicare, Medicare supplement, student accident and health or sickness insurance, dental-only, vision-only policies and policies of six months or less. Treatment must be provided by an autism service provider licensed by a state licensure board. If no licensing board is available, the statute (subsection (l)(2)) permits either BACB certification (valid no more than one year) or meeting any existing credentialing requirements determined by the insurer. Insurers may only network providers who cleared state and federal criminal background checks as determined by the insurer. Coverage excludes services provided outside the State, services by family or household members, custodial care, clinically inappropriate services/supplies, and experimental treatments (subsection (i)). Statute text does not address ERISA self-funded plans.
Medicaid ABA coverage
- Medicaid covers ABA
Yes, per the sources below.
- Program
Med-QUEST Intensive Behavioral Therapy (IBT), including medically necessary ABA for children under 21 with ASD through EPSDT. The agency's provider-memo index lists QI-2431 / FFS 24-13 as replacing QI-2301 / FFS 23-01. Its health-plan directory names AlohaCare, HMSA, Kaiser Permanente, 'Ohana Health Plan and UnitedHealthcare Community Plan as Medicaid managed-care plans as of this research date.
- Agency
Department of Human Services, Med-QUEST Division
- Provider enrollment
- https://medquest.hawaii.gov/en/plans-providers/become-a-medicaid-provider
Sources (6)
- Med-QUEST Provider Memos: QI-2431 / FFS 24-13 listed as replacing QI-2301 / FFS 23-01
- AlohaCare MP-37 Applied Behavior Analysis Services, QUEST Integration; effective March 22, 2026; revision date May 8, 2026
- Med-QUEST Be a New Provider: HOKU enrollment
- Med-QUEST Health Plans: official Medicaid managed-care plan list
- Med-QUEST QI-2527 / FFS 25-12 / CCS-2509, Telehealth Implementation, December 8, 2025
- Carelu Hawaii Medicaid ABA coverage guide, updated October 2026; secondary summary of QI-2431 / FFS 24-13
Payers named in our research
We could not verify named payers for Hawaii yet - check with the state Medicaid agency.
How to enroll
- Start at the state Medicaid provider enrollment page: https://medquest.hawaii.gov/en/plans-providers/become-a-medicaid-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 Hawaii.
Related guides for Hawaii
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