ABA insurance and Medicaid coverage in Rhode Island

Autism insurance mandate

State mandate for autism coverage

Yes, the research found a state autism coverage law.

Statute

R.I. Gen. Laws chapter 27-20.11 (sections 27-20.11-1 through 27-20.11-8)

Age limits

Per 27-20.11-3(b), the statutory mandate's benefits continue until the covered individual reaches age fifteen (15). Neighborhood Health Plan of Rhode Island's payment policy reportedly covers commercial ABA up to age 20; that is a plan's contractual coverage and is not inherently in conflict with the statutory minimum, which sets the mandate's endpoint rather than a ceiling on what a plan may choose to cover. As of 2026-10-21, the Neighborhood policy cited here is a superseded draft and the plan's current terms were not verified.

Annual cap

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

Excludes self-funded employer plans

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

Notes

Applies to group health insurance contracts and policies issued, delivered or renewed in RI on or after Jan 1, 2012. By its terms it does not apply to plans subject to the Small Employer Health Insurance Availability Act, Medical Assistance (chapter 8 of title 40), or the Individual Health Insurance Coverage Act. Covered services include pharmaceuticals, applied behavior analysis, physical therapy, speech therapy, psychology, psychiatric and occupational therapy services for autism spectrum disorders; under 27-20.11-3(a)(1), the listed non-ABA therapies are covered to the extent they are covered for other diseases and conditions. Coverage applies to services delivered in RI, with out-of-state coverage when a pre-authorization process establishes the service is not available in the carrier's RI network. Cost sharing and benefit restrictions may be no more extensive than for other conditions or illnesses (27-20.11-5). 27-20.11-7 requires anyone providing or supervising ABA under the section to be a RI-licensed applied behavior analyst, a licensed assistant behavior analyst acting under supervision, or a licensed psychologist with equivalent experience; psychologists practicing within their scope are also included among the credential categories. No numerical annual ABA cap appears in the current text of 27-20.11-3 that was opened; the annual cap is therefore recorded as unknown rather than as unlimited coverage, and any historical cap should not be assumed to apply. Treatment of self-funded plans was not verified by the cited sources. Statute text for 27-20.11-1 and -3 was read from the RI Legislature website; amendment status beyond the history lines shown was not checked.

Medicaid ABA coverage

Medicaid covers ABA

We could not verify this yet - check with Rhode Island Executive Office of Health and Human Services (EOHHS), which certifies HBTS/ABA providers and administers Medicaid. The Rhode Island Department of Health licenses applied behavior analysts and assistant applied behavior analysts under R.I. Gen. Laws ch. 5-86 and 216-RICR-40-05-28 (active periodic refile effective 01/04/2022). Gainwell Technologies runs the Medicaid provider-enrollment portal..

Program

Home-Based Therapeutic Services (HBTS), inclusive of Applied Behavior Analysis (ABA), under Rhode Island Medicaid fee-for-service and RIte Care. RIte Care contracts in effect on the EOHHS managed-care page are with Neighborhood Health Plan of Rhode Island, UnitedHealthcare of New England, and Tufts Health Public Plans. A 6-month moratorium on newly enrolling HBTS/ABA Medicaid providers began June 16, 2026.

Agency

Rhode Island Executive Office of Health and Human Services (EOHHS), which certifies HBTS/ABA providers and administers Medicaid. The Rhode Island Department of Health licenses applied behavior analysts and assistant applied behavior analysts under R.I. Gen. Laws ch. 5-86 and 216-RICR-40-05-28 (active periodic refile effective 01/04/2022). Gainwell Technologies runs the Medicaid provider-enrollment portal.

Provider enrollment

https://eohhs.ri.gov/providers-partners/provider-enrollment

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.