ABA insurance and Medicaid coverage in Virginia
Last researched October 21, 2026
Who pays for ABA in Virginia, 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
Va. Code 38.2-3418.17
- Age limits
As of 2026-10-21: coverage required for individuals of any age from and after January 1, 2020 (earlier phases covered ages 2-6 and 2-10). Subsection G separately applies the mandate to individual and small-group policies beginning January 1, 2021, with specified issuance, renewal and modification triggers; the exact trigger details were not reproduced here.
- Annual cap
ABA coverage subject to an annual maximum benefit of $35,000 unless the insurer elects a greater amount; coverage is not subject to any visit limits under the section.
- Excludes self-funded employer plans
We could not verify this yet - check with your state insurance department.
- Notes
ABA must be provided or supervised by a BCBA who is also licensed by the Board of Medicine; prescribing practitioner must be independent of the provider. The statute excludes short-term travel, accident-only, limited or specified-disease policies, and short-term nonrenewable policies lasting no more than six months. It also excludes policies/contracts designed for Medicare-eligible persons or similar state/federal governmental coverage. Self-funded plan treatment is not resolved by this section alone; it does not establish a blanket exclusion.
Medicaid ABA coverage
- Medicaid covers ABA
Yes, per the sources below.
- Program
Virginia Medicaid ABA under the Mental Health Services Manual (Appendix D); Cardinal Care managed care
- Agency
Virginia Department of Medical Assistance Services (DMAS)
- Provider enrollment
- https://vamedicaid.dmas.virginia.gov/
Sources (7)
- DMAS ABA Policy and Regulatory Clarifications bulletin (last updated 12/16/2025)
- DMAS ABA Policy Changes bulletin (last updated 07/31/2026): 20 hours/week limit and ASD diagnosis requirement pending CMS approval
- 18VAC85-150-120 Supervisory responsibilities
- 18VAC85-150-130 (unlicensed personnel may be supervised by an LBA or LABA)
- Va. Code 54.1-3614 (psychologist delegation to unlicensed personnel)
- Mental Health Services Manual, Appendix D (updated 7.17.25)
- Mental Health Services Manual, Chapter 4 (updated 10.2.26)
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
- Aetna Better Health of Virginia - Listed in DMAS Cardinal Care managed care contact list.
- Anthem HealthKeepers Plus - Listed in DMAS Cardinal Care managed care contact list.
- Humana Healthy Horizons in Virginia - Listed in DMAS contact list.
- Sentara Community Plan - Listed in DMAS contact list.
- UnitedHealthcare - Listed in DMAS contact list.
How to enroll
- Start at the state Medicaid provider enrollment page: https://vamedicaid.dmas.virginia.gov/.
- 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 Virginia.
Related guides for Virginia
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