ABA insurance and Medicaid coverage in New Jersey

Autism insurance mandate

State mandate for autism coverage

Yes, the research found a state autism coverage law.

Statute

P.L.2009, c.115 (codified across C.17:48-6ii, C.17:48A-7ff, C.17:48E-35.33, C.17B:26-2.1cc, C.17B:27-46.1ii, C.17B:27A-7.16, C.17B:27A-19.20, C.26:2J-4.34, C.52:14-17.29p, C.52:14-17.46.6b)

Age limits

As enacted in 2009 (legislative history only): ABA and related structured behavioral programs applied to a covered person under 21 whose primary diagnosis is autism. Per the checker's reading of a DOBI rule-adoption summary, individual and small-employer amendments operative January 1, 2015 eliminated the age 21 limit for behavioral intervention benefits, and the opened 2026 individual standard form shows no such age restriction. Screening/diagnosis and medically necessary OT/PT/speech therapy coverage apply for autism or another developmental disability. As of 2026-10-21, the current age rules for other plan types (e.g., large-group, state/school employee plans) were not verified.

Annual cap

Legislative history only: as enacted, the ABA-based behavioral intervention maximum benefit was $36,000 per calendar year through 2011, then adjusted annually by CPI-U change as promulgated by the Commissioner of Banking and Insurance. The checker found that the opened 2026 individual standard form has no ABA-specific dollar cap, and that DOBI Bulletin 10-02 identified the original dollar cap's conflict with applicable group-plan parity requirements; DOBI Bulletin 24-14 subsequently confirmed state parity requirements encompassing autism. No authoritative 2026 CPI-adjusted amount was verified, and locating one would not by itself establish a generally enforceable current limit. The enacted text provides that behavioral interventions are not subject to limits on the number of visits.

Excludes self-funded employer plans

We could not verify this yet - check with your state insurance department.

Notes

The enacted act applies to hospital service corporations, medical service corporations, health service corporations, HMOs, individual and group health insurance policies, individual and small-employer health benefits plans, and the State Health Benefits Program (SHBP) and School Employees' Health Benefits Program (SEHBP) delivered, issued, executed or renewed in NJ. ERISA self-funded employer plans should be distinguished from the public employee programs expressly covered by the act; the act as read does not address private self-funded plans, so whether they are excluded was not confirmed. Later amendments beyond the 2015 individual and small-employer changes were not fully checked.

Medicaid ABA coverage

Medicaid covers ABA

Yes, per the sources below.

Program

NJ FamilyCare Medicaid ABA benefit (effective April 1, 2020)

Agency

NJ Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), with the Department of Children and Families

Provider enrollment

We could not verify this yet - check with NJ Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), with the Department of Children and Families.

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.