ABA insurance and Medicaid coverage in Michigan
Last researched October 21, 2026
Who pays for ABA in Michigan, 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
MCL 500.3406s (Insurance Code of 1956, Act 218 of 1956, Sec. 3406s)
- Age limits
As of 2026-10-21, the statute text reproduced by FindLaw (dated January 1, 2025) and the MDHHS summary indicate that coverage for the treatment of ASD may be limited for an insured or enrollee through 18 years of age. The age limitation concerns treatment, not expressly diagnosis. Current-version confirmation was not possible.
- Annual cap
Per the FindLaw reproduction of the statute (dated January 1, 2025; not independently verified as current on 2026-10-21), an insurer may subject coverage to a maximum annual benefit: $50,000 through age 6; $40,000 ages 7-12; $30,000 ages 13-18.
- Excludes self-funded employer plans
It depends.
- Notes
Applies to an insurer that delivers, issues or renews a health insurance policy in Michigan (per the FindLaw reproduction). Reproduced text indicates no limit on number of visits and that treatment cannot be denied on grounds that it is educational or habilitative. Insurer may require treatment review and a treatment plan, request ADOS results, and request ADOS no more than once every 3 years. Qualified health plans on the exchange need not cover beyond essential health benefits; short-term or one-time policies of 6 months or less are excluded. The MDHHS page identifies self-funded plans as outside the state autism mandate; this does not establish that such plans lack autism coverage, so check the specific plan. These details were corroborated only against a reproduced copy of the statute, not the current official text.
Medicaid ABA coverage
- Medicaid covers ABA
Yes, per the sources below.
- Program
Behavioral Health Treatment (BHT) services for ASD under EPSDT, delivered through the specialty behavioral health system (PIHPs/CMHSPs)
- Agency
Michigan Department of Health and Human Services (MDHHS); Prepaid Inpatient Health Plans (PIHPs) authorize services
- Provider enrollment
We could not verify this yet - check with Michigan Department of Health and Human Services (MDHHS); Prepaid Inpatient Health Plans (PIHPs) authorize services.
Sources (8)
- Michigan Medicaid Provider Manual (MDHHS), version dated Oct 1, 2026
- MDHHS Bulletin MSA 16-23 (Aug 1, 2016) Coverage of Autism Services
- Michigan Medicaid Applied Behavior Analysis Update (MDHHS, rev. 10/3/19)
- MDHHS Bulletin MMP 26-18 (Oct 1, 2026)
- MDHHS Bulletin MSA 16-23 (michigan.gov media copy)
- MDHHS Numbered Letter L 24-78 (QBHP transition deadline)
- Mid-State Health Network (MSHN) policy (1:10 observation/direction ratio)
- MDHHS Bulletin MSA 15-59 (historical 365-day authorization limit)
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
- Prepaid Inpatient Health Plans (PIHPs) / Community Mental Health Services Programs (CMHSPs) - Per the Medicaid Provider Manual, the PIHP's Utilization Management authorizes the level of BHT services before delivery; providers follow PIHP/CMHSP network enrollment procedures.
How to enroll
- We could not verify the Medicaid provider enrollment page for Michigan 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 Michigan.
Related guides for Michigan
Spotted something out of date? Tell us through our editorial policy page. We re-check these guides on a schedule and show the date above.