Family Shared Challenges & Sample Appeal Templates

Please reach out to your Medicaid managed care plan’s member services listed on your insurance card. Ask for approved Medicaid providers for ABA therapy near your home. ABA may also be called adaptive behavior support services.

As mentioned earlier, the main access challenge is the very limited number of Medicaid-approved ABA providers. If your managed care plan (MCO) could not connect you to ABA providers in your community, please consider filing an appeal with the MCO. At the following link, is a short statement about this challenge you can send with your appeal request. You will find your MCO's contact information for sending the appeal request as well. 

It is great you have found an approved provider, but if ABA therapy cannot start in a reasonable amount of time, consider filing an appeal with your managed care plan (MCO). At the following link is a short statement about this challenge you can send with your appeal request. You will also find your MCO's contact information for sending the appeal request.

If your provider is a Medicaid-approved provider and employs a licensed practitioner to supervise the behavior analyst (BCBA), Medicaid should cover services. 

If your provider is not a Medicaid-approved provider and does not employ a licensed practitioner to supervise the behavior analyst (BCBA), you could ask your provider to consider requesting a single case agreement from your Medicaid managed care plan (MCO). If a single case agreement is denied by your  MCO, please consider filing an appeal. At the following link is a short statement about this challenge you can send with your appeal request. You will also find your MCOs' contact information for sending the appeal request. Link to information.

Some families found ABA providers that met the Medicaid requirements and started ABA therapy. After ABA started, if the provider no longer employed the required licensed practitioner to supervise the behavior analyst (BCBA), your services may have been put on hold.  The family could ask your provider to consider requesting a single case agreement from your managed care plan (MCO). If a single case agreement is denied by your managed care plan, please consider filing an appeal. At the following link is a short statement about this challenge you can send with your appeal request. You will also find your MCO's contact information for sending the appeal request. 

If your Medicaid managed care plan (MCO) denied your Medicaid approved provider’s authorization because your child did not meet medical necessity for ABA for any reason including based on your child’s age or severity, please consider filing an appeal with your MCO. At the following link is a short statement about this challenge you can send with your appeal request. You will also find your MCO's contact information for sending the appeal request. 

We would like to hear about the challenge your family is facing accessing ABA therapy within your Medicaid insurance. Please email us at help@ilasd.com so we can learn more and offer any guidance we can.

A single case agreement could possibly allow your ABA provider to contract with your managed care plan (MCO). ABA providers that are not Medicaid approved or obtained Medicaid approval but no longer employ the required supervisor for the behavior analyst (BCBA) can make a request for a single case agreement. If the single-case agreement is denied, please consider filing an appeal.