ABA insurance and Medicaid coverage in Maryland
Last researched October 21, 2026
Who pays for ABA in Maryland, 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
Md. Code, Insurance Article, 15-835 (habilitative services); COMAR 31.10.39 (implementing regulation)
- Age limits
Coverage of habilitative services for children until at least the end of the month in which the child turns 19 (statute text).
- Annual cap
We could not verify this yet - check with your state insurance department.
- Excludes self-funded employer plans
Yes, self-funded employer plans are generally outside state mandates.
- Notes
As of 2026-10-21 the statute text fetched applies to insurers, nonprofit health service plans and HMOs issuing or delivering policies in Maryland, and defines habilitative services as services and devices, including occupational, physical and speech therapy, that help a child keep, learn or improve skills for daily living. Subsection (e) says that, beginning Nov 1, 2013, medical-necessity determinations for habilitative services used to treat autism/ASD follow regulations adopted by the Insurance Commissioner. The statute text itself does not name applied behavior analysis or state an ASD-specific age limit or dollar cap, and it does not require reimbursement for habilitative services delivered through early intervention or school programs. The implementing regulation, COMAR 31.10.39, expressly includes applied behavior analysis. Section .03D protects prescribed services against denial solely based on their hours at up to 25 hours/week for ages 18 months to under 6, and 10 hours/week for ages 6 to under 19; these are not maximum treatment caps, and a carrier may authorize additional hours of habilitative services. Section .03F also protects medically indicated services in an educational setting while preserving the distinction from IEP obligations. The Maryland Insurance Administration's parents' guide says carriers may not limit coverage for medically necessary habilitative services and that this state mandate does not apply to self-funded and self-insured employer plans (which may still cover ABA voluntarily). No annual dollar cap appears in the reviewed statute or implementing chapter. Full coverage rules for a specific plan still depend on the plan's terms and the regulation's complete text.
Medicaid ABA coverage
- Medicaid covers ABA
Yes, per the sources below.
- Program
Maryland Medical Assistance ABA benefit under EPSDT (COMAR 10.09.28)
- Agency
Maryland Department of Health (MDH); claims/prior authorization run through the Behavioral Health Administrative Services Organization (BHASO), Carelon Behavioral Health
- Provider enrollment
We could not verify this yet - check with Maryland Department of Health (MDH); claims/prior authorization run through the Behavioral Health Administrative Services Organization (BHASO), Carelon Behavioral Health.
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.
Other payers
- Carelon Behavioral Health (Maryland Medicaid BHASO) - Named in the Feb 2026 ABA Provider Manual as the BHASO that handles registration, prior authorization and claims for Medicaid fee-for-service ABA.
How to enroll
- We could not verify the Medicaid provider enrollment page for Maryland yet - check with the state Medicaid agency.
- 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 Maryland.
Related guides for Maryland
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