Losing ABA coverage can upend a family's week overnight. Whether a letter said your child's hours were cut, a plan denied reauthorization, or your child lost Medicaid altogether, there are steps you can take right now. Some of them have short deadlines, so this guide starts with those. It then walks through the other ways Florida families pay for ABA.
First, figure out which situation you are in, because the steps differ:
| What happened | First step | Key deadline |
|---|---|---|
| Your Medicaid plan denied, reduced or stopped ABA, but your child still has Medicaid | Appeal to the plan | 60 days from the notice; 10 days to keep services going |
| Your child lost Medicaid eligibility | Check why and whether to reapply; look at other coverage | 60 days to join a parent's employer plan |
| Your child changed Medicaid plans and the ABA provider is out of network | Ask the new plan about continuity of care | Ask right away |
| Your ABA provider stopped serving Medicaid | Ask your plan for in-network providers | Ask right away |
My child's Medicaid plan denied or cut ABA. What do I do?
Since February 1, 2025, most Florida children receive Medicaid ABA through a Statewide Medicaid Managed Care plan, so the plan makes these decisions and your appeal goes to the plan first. Federal Medicaid managed care rules set the timeline:
- File a plan appeal within 60 calendar days of the date on the notice (42 CFR 438.402). Your provider can help, and you can ask for an expedited appeal if waiting could seriously harm your child.
- To keep services going during the appeal, file on or before the later of 10 calendar days after the plan sent the notice, or the date the change takes effect, and ask for services to continue (42 CFR 438.420). Be aware that if you lose the appeal, the plan may be allowed to recover the cost of services provided only because of the continuation.
- The plan must decide a standard appeal within 30 calendar days (with a possible 14-day extension) and an expedited appeal within 72 hours (42 CFR 438.408).
- If the plan upholds the denial, request a state fair hearing. Federal rules give you between 90 and 120 days from the plan's appeal decision; your notice states Florida's exact deadline. If the plan misses its own deadlines, you can go straight to a fair hearing.
Gather the same evidence you would for any ABA appeal: the physician's order, the comprehensive diagnostic evaluation, the behavior plan, progress data and a letter from your child's doctor. See the Medicaid fair hearing guide.
For help, call the Florida Medicaid Helpline at 1-877-254-1055. Complaints about a managed care plan can also be filed at flmedicaidmanagedcare.com/complaint.
My child lost Medicaid eligibility. What now?
Start by reading the eligibility notice. Coverage sometimes ends because a renewal form was missed or a document was not received, which may be fixable. If your household's circumstances changed, look at other coverage quickly, because the windows below are short.
A parent's employer plan: 60 days
Federal law gives a special enrollment right in employer group health plans when a child or employee loses Medicaid or CHIP eligibility. The employee must request coverage "not later than 60 days after the date of termination of such coverage" (29 U.S.C. 1181(f)(3)). Tell HR right away and ask about the plan's ABA coverage. If the employer plan is fully insured, has 51 or more employees and is issued in Florida, Florida's autism mandate requires ABA coverage for eligible children. See fully insured vs self-funded plans.
A HealthCare.gov plan: special enrollment
HealthCare.gov says families who lost Medicaid or CHIP coverage in the past 90 days may qualify for a special enrollment period. Open enrollment for 2027 plans also runs November 1, 2026 to January 15, 2027. Marketplace plans in Florida are not required to cover ABA, so check each plan's benefits before you choose. See Marketplace plans and ABA.
Florida KidCare
Depending on income and age, a child who no longer qualifies for Medicaid may qualify for another part of Florida KidCare. Coverage of ABA differs across KidCare programs. See KidCare and autism therapy.
My child changed plans or lost the provider. Can therapy continue?
When Medicaid ABA moved to managed care plans, AHCA required plans to offer a continuity-of-care period during which out-of-network ABA providers could still be paid. If your child is switching plans, ask the new plan in writing whether a transition period applies and how long it lasts. If your provider has left your plan's network, ask the plan for a list of in-network ABA providers who are accepting new clients in your area, and ask your current BCBA to send the treatment plan and recent data to the new provider. See switching from Medicaid to a commercial plan.
What other ways can we pay for ABA?
- TRICARE. If a parent is active duty, retired military or in certain Guard and Reserve programs, the child may be eligible for ABA through the TRICARE Autism Care Demonstration, which tricare.mil says is authorized through December 31, 2028. See the TRICARE ACD guide.
- FES-UA scholarship. Florida's Family Empowerment Scholarship for Students with Unique Abilities lists ABA among the specialized services it can pay for, delivered by approved providers. Step Up For Students reports an average award of about $10,000. It is not available to students enrolled full time in public school. For 2026-27, new applications are accepted until November 15, 2026. See FES-UA for Medicaid families.
- Self-pay. Some providers offer self-pay, sometimes with a sliding scale. Self-pay does not depend on a plan's authorization, and you have the right to a Good Faith Estimate of costs. Ask whether a smaller program, such as parent training plus fewer direct hours, could cover your child's top goals. See sliding scale and self-pay.
- State support. Florida's regional Centers for Autism and Related Disabilities (CARD) offer consultation and training for families, and the Agency for Persons with Disabilities (APD) serves some children and adults with developmental disabilities. These are not ABA programs, but they can help in the gap. See CARD centers in Florida.
A one-week action plan
- Day 1: Read the notice. Write down the date and every deadline on it.
- Day 1 to 2: If it is a denial or cut, call the plan to file an appeal and request continued services. Tell your ABA provider.
- Day 2 to 3: If eligibility ended, call the number on the notice to ask why and whether you can fix it. Ask HR about adding your child to an employer plan.
- Day 3 to 5: Check HealthCare.gov or KidCare options, and TRICARE if it applies.
- Day 5 to 7: Ask providers for benefits checks or self-pay estimates so you can compare.
For a legal question about your rights, Disability Rights Florida or a Florida attorney can advise.
How Hope Center can help
If your child now has, or can get, commercial insurance or TRICARE, Hope Center for Behavior Change can check benefits for free and tell you what ABA would cost under that plan. We are in network with Blue Cross Blue Shield (Florida Blue), Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East, and we offer self-pay for all services with a sliding scale. If your child still has Medicaid, self-pay at Hope Center is not an option (center policy), but your family can add employer or Marketplace insurance, which we accept. We have no waitlist, and services usually start within 3 to 5 business days after insurance approves the plan. Your costs depend on your plan. Contact us for a free consultation, see insurance at Hope Center, or call 561-337-8865.