Getting Autism Therapy Covered by Insurance in Ohio

Ohio's HB 263 mandate

Ohio House Bill 263, signed into law in 2019, requires all Ohio-regulated health insurance plans to cover ABA therapy for autism spectrum disorder. There is no age cap — coverage applies to children and adults alike. There is no dollar cap on covered services.

Why HB 263 matters:Ohio's mandate was passed after many states had already enacted ABA laws, which meant Ohio's legislature could study how insurers had worked around older mandates. HB 263 includes protections against common tactics like imposing annual hour limits or requiring unnecessary precertification steps.

BCBA requirement: the BCBA delivering ABA services must hold a current Ohio license. Board-certified behavior analysts who moved to Ohio from another state should ensure their Ohio license is active before beginning treatment — coverage depends on it.

ERISA exemption: self-funded employer plans are generally exempt from HB 263 under federal ERISA law. Confirm your plan type before filing a mandate-based complaint.

Prior authorization in Ohio

Prior authorization is required for ABA therapy in Ohio even with HB 263 in effect. Your BCBA or treating physician will submit the authorization request. Documents to prepare:

• Autism diagnosis report (DSM-5 criteria documentation)
• Letter of medical necessity from the diagnosing physician
• BCBA's treatment plan with recommended weekly hours
• BCBA's NPI number and Ohio license number
• Any specific prior auth forms required by your insurer

Get the authorization approval in writing before the first session, and confirm the authorized hours, sessions, and expiration date. Set a calendar reminder for renewal.

Appeals

If your Ohio insurer denies ABA coverage or prior authorization:

1. Request the denial reason in writing — insurers are required to provide a specific reason.
2. File a written internal appealwithin 30 days of the denial. Have your child's physician write a letter of medical necessity specifically addressing the denial reason.
3. Request external review if your internal appeal is denied — Ohio law provides external review rights for fully insured plans.
4. Contact the Ohio Department of Insurance at 1-800-686-1526 if you believe HB 263 is being violated.

Ohio Medicaid

Ohio Medicaid covers ABA therapy for individuals under 21 through Medicaid managed care organizations (MCOs). Ohio Medicaid managed care enrollees must work with their MCO for ABA prior authorization.

Enrollment: apply for Ohio Medicaid through benefits.ohio.gov or your county Job and Family Services office. Children with disabilities may qualify through SSI-linked Medicaid regardless of household income.

Coordinate coverage: if your child has both private insurance and Medicaid, private insurance is billed first. Ohio Medicaid covers remaining costs, significantly reducing out-of-pocket expenses.