State guide

Pennsylvania

Programs, dollars, and people that serve autism families in Pennsylvania. Federal protections always apply on top of what you see here.

Pennsylvania overview

Pennsylvania's Office of Developmental Programs (ODP) administers Medicaid HCBS waivers — the OBRA Waiver and Consolidated Waiver for adults are the main vehicles. Apply through your County Mental Health/Intellectual Disabilities office early. Pennsylvania has one of the more complex systems to navigate — County MH/ID offices vary significantly. The Pennsylvania Training and Technical Assistance Network (PaTTAN) is the state's PTI network, with offices across the state. The Children's Hospital of Philadelphia (CHOP) Autism Program and the Drexel Autism Institute are national-caliber clinical and research resources.

Verify program names, URLs, and eligibility on official .gov sites — these change.

⏰ Act now — Medicaid waiver waitlist

Consolidated, Community Living and P/FDS Waivers (ODP)

Typical wait: Varies by county and urgency category

Register with your county MH/ID office (your Administrative Entity). Since 2017 autism alone qualifies — you do not need an intellectual disability diagnosis.

Find your county AE through the ODP website. Consolidated is for higher support needs; P/FDS and Community Living are the family-directed options.

Apply or learn more →Compare all 50 states

Statewide resources

These four programs exist in every state and are the fastest entry points for most families.

Insurance Coverage

Whether private insurance must cover autism treatment in Pennsylvania.

Pennsylvania requires insurance to cover autism treatment

Act 62 (40 P.S. 764h) · enacted 2008

Ages:
Under 21.
Limits:
A plan may not limit the number of visits, but it may apply a yearly dollar maximum. Ask your insurer for the amount in force, in writing.

Self-funded employer plans (ERISA) are typically exempt — ask your HR department which type of plan you have.

How to use it, and how to appeal a denial →

Medicaid Waiver

Home and community-based services (HCBS) for autism families in Pennsylvania.

Consolidated, Community Living and P/FDS Waivers (ODP)

Office of Developmental Programs (ODP), through county Administrative Entities — usually the county MH/ID office

Pennsylvanians with an intellectual disability or autism who meet the level-of-care requirement for waiver services.

How autism qualifies

This is the important one. Since July 2017, ODP's waivers include an 'autism only' eligibility category — autistic people of any age who meet level of care can register, without needing an intellectual disability diagnosis. Guidance written before 2017 says otherwise and is out of date.

What it can pay for

  • Respite
  • Community participation supports
  • Supported employment
  • Behavioral support
  • Therapies
  • Residential supports (Consolidated)

How the waiting list is ordered

Every ODP waiver has a waiting list, and your Administrative Entity assesses urgency using PUNS — Prioritization of Urgency of Need for Services. You are placed in Emergency, Critical or Planning need. Enrollment happens as capacity frees up, with the most urgent going first, so your category matters more than your date. If your circumstances worsen, ask your AE to reassess it.

How to apply

Contact your county MH/ID office and make an appointment to register for supports. The AE determines level of care and completes your PUNS assessment. Disability Rights Pennsylvania (1-800-692-7443) can help if you are refused or stalled.

Full Pennsylvania waiver detail and sources →

Verified August 2026 against 4 official sources.

Medicaid Managed Care

How Medicaid pays for ABA therapy in Pennsylvania.

Pennsylvania Medical Assistance (HealthChoices)

ABA covered: Under 21

Find or choose your plan

PA Enrollment Services (HealthChoices and CHIP)

(800) 440-3989Official page →

Plans in this state

  • Geisinger Health Plan
  • Jefferson Health Plans EverWell
  • UPMC for You, Inc.
  • AmeriHealth Caritas Pennsylvania
4 more — see Pennsylvania's full plan list →

You choose a physical health plan from those offered in your HealthChoices zone. ABA is an Intensive Behavioral Health Services (IBHS) benefit for members under 21, delivered through the behavioral health plan the state assigns by county: Community Behavioral Health, Community Care Behavioral Health, Magellan, PerformCare or Carelon. ABA requests go to that behavioral health plan for prior authorization, not to your physical health plan.

⚠️ Prior authorization is required before starting ABA services.

Checked against 5 official sources, September 2026. Plans change when states rebid contracts, so confirm with the state.

Pennsylvania guides

Deeper guides where the facts are genuinely specific to Pennsylvania.

Financial help for autism in Pennsylvania

SSI, Medicaid, the waiver and what insurers must cover — and which to apply for first.

Autism evaluation in Pennsylvania

The two free routes, the deadlines they run against, and verified diagnostic providers.

ABA therapy in Pennsylvania

Verified providers, what the state mandate covers, and the questions to ask.

Pennsylvania insurance mandate

The statute, the caps, and how to complain when a plan ignores it.

By county

67 counties