Getting Autism Therapy Covered by Insurance in New Hampshire

New Hampshire’s mandate

RSA 417-E:2 requires state-regulated health plans in New Hampshire to cover the diagnosis and treatment of autism spectrum disorder, including applied behavior analysis.

Ages covered: No age limit in the current text. New Hampshire previously capped ABA by age band; those limits were removed in September 2022 and do not appear in the statute now.

Dollar cap: None in the current text. The old $36,000 (ages 0-12) and $27,000 (ages 13-21) ABA limits are gone. If your plan documents still quote them, they are quoting a repealed provision.

The statute says coverage shall not be denied on the basis that services are habilitative in nature — that is the clause to quote against a denial reasoning that therapy is teaching new skills rather than restoring lost ones. ABA must be delivered by, or supervised by, someone certified by the national Behavior Analyst Certification Board.

Whether the mandate applies to your plan

This is the question to settle first, because the answer decides whether anything above is enforceable for you. State insurance mandates bind fully insured plans. Self-funded employer plans — where the employer pays claims itself and an insurer only administers them — are generally exempt under federal ERISA, and they cover roughly six in ten people with employer coverage.

Ask your HR department, in writing, which type your plan is. If it is self-funded, RSA 417-E:2 does not compel coverage — but federal parity law may still help, and many large self-funded employers cover ABA voluntarily. Ask what the plan actually covers rather than assuming the answer is no.

The Medicaid route

New Hampshire Medicaid covers ABA for members under 21 through EPSDT. Remember New Hampshire is a 209(b) state: an SSI approval does not enroll your child in Medicaid automatically, and Medicaid is the precondition.

How Medicaid waivers work covers the route for families who do not qualify on income alone.

When you are denied

1. Get the denial reason in writing. Insurers must give a specific reason, and the appeal has to answer that reason rather than restate the diagnosis.
2. File the internal appeal within the deadline on the denial letter, with a letter of medical necessity that addresses the stated reason directly.
3. Request external review if the internal appeal fails. Fully insured plans carry external review rights, and an independent reviewer overturns denials more often than families expect.
4. Complain to the New Hampshire Insurance Department on 1-800-852-3416 if you believe RSA 417-E:2 is being violated. Their consumer pages are here.