How many hours of ABA per week your child gets depends on the behavior analyst’s assessment and what your health plan approves. For Houston families on Texas Medicaid, the state’s guidelines run from 2 to 4 hours a week for maintenance up to more than 20 hours a week for intensive programs, with a cap of 8 hours of direct treatment a day. This guide covers how those levels work, what Medicaid looks at when it approves hours, and how to fit ABA around school or pre-K.
The short version
- Texas Medicaid has four guideline levels: more than 20 hours a week, 6 to 20, 5 or fewer, and 2 to 4 for maintenance. Requests above the guidelines go to a physician for review.
- Younger age, autism severity level 2 or 3, serious safety behaviors and the first years of ABA all support more hours.
- Direct treatment is capped at 8 hours a day. Parent training is counted separately.
- Attendance matters. If your child or you attend less than 85% of scheduled sessions, the provider has to justify keeping the same hours.
- Texas schools must excuse an autistic student’s absence for an ABA appointment, but TEA says regularly scheduled daily or weekly absences are a matter for the ARD committee.
How many hours does Texas Medicaid approve?
The Texas Medicaid Children’s Services Handbook (October 2026, section 2.3.7.14) gives these guidelines. A request within a level does not need extra review. A request above it goes to a physician to decide medical necessity. Each level needs documentation showing two or more of the listed points, except maintenance, which needs all of them.
| Level | Hours per week | What supports it |
|---|---|---|
| High frequency, intensive | More than 20 | Age 6 or younger; severity level 2 or 3; severely impairing elopement, aggression or self-injury; first 2 years of ABA |
| Moderate | 6 to 20 | Age 12 or younger; severity level 2 or 3; moderately impairing elopement, aggression or self-injury; first 4 years of ABA |
| Targeted or focused | 5 or fewer (or 20 or fewer a month) | Age 20 or younger; severity level 1, 2 or 3; specific targeted skills or issues |
| Maintenance or consultative | 2 to 4 or fewer | Ages 1 through 20; severity level 1, 2 or 3; goals about using skills in daily life; documented risk of regression after more intensive ABA |
The handbook says these are guidelines, and all levels “may be considered” case by case. It also says frequency must match the child’s clinical needs and is “not for the convenience” of the parents or the provider. Your plan can approve a different number.
For the authorization steps behind these hours, see our Texas Medicaid ABA guide. Commercial plans set their own rules, so ask yours for the hour limits in writing.
How are hours approved and renewed?
The first approval covers 90 days. To extend it another 90 days, the behavior analyst sends attendance logs for your child and for you, plus a progress summary. The analyst re-evaluates every 180 days to recertify.
Attendance is part of every renewal. The handbook expects children and caregivers to attend at least 85% of their scheduled sessions. Below that, the provider has to send justification to the plan for physician review before the same hours continue. So a schedule your family can keep every week is worth more than a larger number of hours you will often miss.
Parent training (procedure code 97156) is a separate part of the plan. It does not count toward the weekly levels above, and your child does not have to be present for it.
How do I fit ABA around school or pre-K?
Start with the hours your child is not in school, then work backward.
Ask the provider which slots are open. Ask which days and times are open now, not which ones the provider offers in general.
Do the math before you agree to a number. Ten hours a week could be two hours on each school day, or three hours on Monday, Wednesday and Friday plus one on Saturday. Twenty hours a week after school means four hours every weekday afternoon. Picture your child at the end of that day.
Ask about pre-K and half days. If your child attends pre-K or an early childhood special education class for part of the day, ask the campus for the exact schedule. The rest of the day may leave room for center-based or in-home sessions.
Ask about school-day appointments. Texas Education Code 25.087(b-3) treats an appointment for a generally recognized autism service, such as ABA, speech or occupational therapy, as a temporary absence, and TEA says a school must excuse those absences. TEA also says districts cannot treat regularly scheduled daily or weekly absences for ongoing treatment as temporary absences. If you want ABA during school hours on a regular basis, raise it with the ARD committee. TEA says the committee decides whether to shorten a student’s instructional day, with input from parents, and how the student will make up missed work.
Ask how the provider handles fatigue. A child who held it together all day may arrive tired. Ask how sessions change when that happens.
Plan for school events. Early release days, testing weeks and holidays change your week. Ask the provider for its cancellation policy and whether missed sessions can be made up.
Can ABA happen at school?
Not as a classroom aide under Medicaid. The handbook excludes services from a behavior technician who works in the school setting as a shadow, an aide or general support, and it excludes ABA aimed at academic goals. The same handbook expects the treatment plan to include a plan to coordinate with school services once you sign a release. For school permission and IEP participation, see our guide to Houston school districts and autism services.
Do more hours mean better results?
We do not publish outcome claims, and research on dose is outside the scope of this guide. Ask the behavior analyst why they recommended the number they did, which goals the hours target, and what data would lead them to raise or lower the hours at the next review. The handbook also lists reasons for discharge, such as goals being met, when progress stalls after repeated changes, or when gains do not carry over to daily life.
Where can I find providers with the hours I need?
Browse in-home ABA and center-based ABA in the directory, or providers that list Medicaid. Profiles do not show open hours, so call and ask. Our guide to choosing an ABA provider in Houston has the full question list.
Frequently asked questions
Is 40 hours a week of ABA required?
No. The Texas Medicaid guidelines start at 2 to 4 hours a week for maintenance, and the top level is “greater than 20 hours.” Direct treatment is capped at 8 hours a day. The right number depends on the assessment and what the plan approves.
Can my child get ABA during school hours?
A Texas school must excuse an absence for an ABA appointment for a student with autism under TEC 25.087(b-3). Regular daily or weekly absences for ongoing treatment are different, and TEA says the ARD committee should address them in the IEP. Medicaid does not pay for a technician to act as a classroom aide.
Does parent training count toward my child’s hours?
Not toward the weekly levels. The handbook lists parent training as a separate service, and your child does not need to be there.
What happens if we miss a lot of sessions?
If your child or you attend less than 85% of scheduled sessions, the provider has to send extra justification to keep the same hours. Tell the provider early if the schedule is not working.
Can hours go down over time?
Yes. The maintenance level exists for children who have finished more intensive ABA, and the handbook lists discharge criteria such as goals being met.