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 and P/FDS Waivers (ODP)

Typical wait: varies — contact your AE

Apply through your county's Administrative Entity (AE) the day of diagnosis — Pennsylvania's waiver list is managed locally.

Find your county AE through the ODP website. The Consolidated Waiver is for higher support needs; P/FDS for family-directed services.

Apply or learn more →

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 ABA therapy in Pennsylvania.

Pennsylvania requires insurance to cover ABA therapy

Act 62 · effective 2008

Through age 21No dollar capDiagnosis required

Covers ABA through age 21 with no dollar cap — a strong mandate. Requires autism diagnosis and treatment supervised by a licensed BCBA. Self-funded employer plans (ERISA) are exempt; verify plan type with HR.

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

Medicaid Waiver

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

Consolidated Waiver / Community Living Waiver

Pennsylvania Office of Developmental Programs (ODP)

Currently closed

Typical wait time

3-7 years (varies by county and waiver type)

Coverage highlights

  • ✓Respite
  • ✓Supported Living
  • ✗Therapy
  • ✓Employment Supports

Pennsylvania ODP manages the Consolidated Waiver (more comprehensive) and the Community Living Waiver (for those wanting to live in the community). PA also offers an Autism Waiver specifically for adults on the autism spectrum who don't have an intellectual disability — an important distinction. Contact your county's Supports Coordination Organization (SCO) to apply.

How to apply

Apply online →717-787-3700

Medicaid Managed Care

How Medicaid pays for ABA therapy in Pennsylvania.

HealthChoices (Pennsylvania Medicaid)

Covers ABA through under 21

How to find your plan

Visit dhs.pa.gov/OMAP or call 1-800-692-7462. Pennsylvania's HealthChoices program uses zone-based plans — your options depend on your county.

Major plans in this state

  • AmeriHealth Caritas Pennsylvania
  • UPMC Community HealthChoices
  • Geisinger Health Plan Community HealthChoices
  • Pennsylvania Health & Wellness (Centene)

Pennsylvania HealthChoices uses regional managed care plans organized into zones. ABA therapy is covered for children under 21 through EPSDT. Physical health and behavioral health MCOs may be different — contact your physical health MCO to understand the ABA authorization process. Prior authorization is always required.

⚠️ Prior authorization is required before starting ABA services.

By county

67 counties