Getting Financial &
Medical Assistance
A guide to the programs and funding sources available to Pennsylvania families seeking support for autism diagnosis and treatment.
You Have More Options Than You May Realize
One of the most common concerns families have after an autism diagnosis is cost. ABA therapy is intensive — and intensive therapy can be expensive. The good news is that Pennsylvania has some of the strongest autism insurance protections in the country, and a range of public programs exist specifically to help families access the services their children need.
At Autism Centers of Pittsburgh, we work with most major insurance carriers, including Medicaid, and our intake team handles the verification and prior authorization process on your behalf. Our goal is to remove as many financial barriers as possible so your child can get the care they deserve.
Below is an overview of the primary programs and funding sources available to families in Pennsylvania.
Key Programs & Funding Sources
These are the primary pathways Pennsylvania families use to fund autism diagnosis and ABA therapy services.
Pennsylvania Medicaid (Medical Assistance)
Pennsylvania's Medicaid program — called Medical Assistance (MA) — covers ABA therapy for individuals with an autism spectrum disorder diagnosis. Coverage is available through both fee-for-service MA and managed care organizations (MCOs). ABA therapy is considered a medically necessary service under PA law, and prior authorization is required before services begin.
- Covers ABA therapy as a medically necessary benefit
- Available through HealthChoices managed care plans
- Prior authorization required — ACP handles this on your behalf
- No age cap for ASD-related ABA services under PA Medicaid
CHIP (Children's Health Insurance Program)
CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but cannot afford private insurance. In Pennsylvania, CHIP covers behavioral health services including ABA therapy for children with an autism diagnosis. Eligibility is based on household income and family size.
- Available for children up to age 19
- Covers ABA therapy and behavioral health services
- Income-based eligibility — families may pay a small monthly premium
- Apply through Pennsylvania's CHIP program or pennie.com
Pennsylvania Autism Insurance Law (Act 62)
Pennsylvania Act 62 requires most private health insurance plans issued in the state to cover the diagnosis and treatment of autism spectrum disorder, including ABA therapy. This law applies to fully insured plans regulated by the Pennsylvania Insurance Department. If your employer provides insurance through a PA-regulated plan, ABA therapy must be covered.
- Applies to most PA-regulated private insurance plans
- Requires coverage for ABA therapy with no arbitrary dollar caps
- Does not apply to self-funded employer plans (governed by federal ERISA law)
- ACP verifies your specific plan's coverage before services begin
Consolidated Waiver (PFDS / Community Waiver)
Pennsylvania's Office of Developmental Programs (ODP) administers Home and Community-Based Services (HCBS) waivers for individuals with intellectual disabilities and autism. The Consolidated Waiver and the Community Living Waiver can fund a range of supports, including behavioral support services. Eligibility requires an intellectual disability or autism diagnosis and a determination of need.
- Funded through ODP — separate from the Medicaid behavioral health system
- Can cover behavioral support services and community participation
- Requires an eligibility determination through your county's MH/IDD office
- A Supports Coordinator helps navigate waiver enrollment and services
Where to Start
Navigating these programs can feel overwhelming. Here is a practical starting point for most families.
Contact Your County MH/IDD Office
Start by contacting your county's Mental Health and Intellectual/Developmental Disabilities (MH/IDD) office. They can help determine eligibility for county-funded services, waiver programs, and connect you with a Supports Coordinator.
Apply for Medical Assistance or CHIP
If your child does not have insurance or is underinsured, apply for Pennsylvania Medical Assistance or CHIP through COMPASS (the PA benefits portal) at compass.state.pa.us or by calling 1-800-692-7462.
Review Your Private Insurance Benefits
If you have private insurance, call the member services number on your insurance card and ask specifically about ABA therapy coverage for autism. Ask about your deductible, copay, and whether prior authorization is required.
Contact Autism Centers of Pittsburgh
Our intake team will verify your insurance benefits, explain your out-of-pocket costs, and handle prior authorization paperwork on your behalf. We prepare a detailed Benefit Summary before services begin so there are no financial surprises.
Helpful Pennsylvania Resources
Official state and federal resources for Pennsylvania families.
We Handle the Insurance Paperwork
When you contact Autism Centers of Pittsburgh, our intake team will verify your benefits, explain your coverage clearly, and manage the prior authorization process from start to finish. You focus on your family — we handle the paperwork.