Does Texas Medicaid cover ABA therapy in Houston?

Does Texas Medicaid cover ABA therapy in Houston? Yes, for children and young adults age 20 and younger who are enrolled in Medicaid, have a formal autism diagnosis and get a prior authorization from their health plan. The benefit started February 1, 2022, and Houston families get it through one of the managed care plans that serve Harris County. The slow part is usually finding a licensed behavior analyst who takes your plan and getting the paperwork through in the right order.

Who qualifies for Medicaid ABA in Houston?

Three things have to line up.

Age. ABA is a benefit of the Texas Health Steps Comprehensive Care Program for Medicaid members age 20 or younger. Families planning ahead for the end of eligibility can look at ABA therapy for adults listings.

Diagnosis. The child needs a comprehensive autism evaluation done with a standardized diagnostic tool. Texas Medicaid lists who can make the diagnosis: a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or an interdisciplinary team that includes one of those providers. The diagnosis has to be made or reconfirmed within three years of starting or renewing ABA. A screener such as the M-CHAT does not count. If you do not have a diagnosis yet, start with our guide to autism evaluations in Houston.

Medical necessity. The Medicaid handbook says plainly that a diagnosis alone is not enough. The behavior analyst’s assessment has to document the child’s needs, and the treatment plan has to tie its goals to the core features of autism.

You also need active Medicaid or STAR Kids coverage. If your child is not enrolled yet, that comes first. If your family has private insurance as well as Medicaid, the private plan is billed first and Medicaid can cover what is left.

What is the difference between STAR, STAR Kids and CHIP?

These are three separate programs.

• STAR is the standard Medicaid managed care program for most children on Medicaid.
• STAR Kids is Medicaid managed care for children and young adults age 20 or younger who have disabilities. A child qualifies by meeting one of the listed criteria, such as getting SSI or SSI-related Medicaid, being on certain waivers, or being on the Medicaid Buy-In program.
• CHIP is the separate Children’s Health Insurance Program for families who earn too much for Medicaid.

ABA under this benefit is a Medicaid service. Texas Children’s Health Plan states in its member FAQ that the autism benefit is not covered for CHIP members. That FAQ is from 2022, and we could not find a current HHSC statement on CHIP, so call your CHIP plan before assuming anything either way.

STAR and STAR Kids members use the same Medicaid ABA rules. The practical difference is the plan list and phone numbers, shown below.

Which health plans serve Harris County?

HHSC’s managed care map, revised August 2026 and showing plans serving clients as of September 2026, lists these plans for Harris:

• STAR: Community Health Choice, Molina, Texas Children’s, United, Wellpoint
• STAR Kids: Texas Children’s, United, Wellpoint
• CHIP: Community Health Choice, Molina, Texas Children’s, United, Wellpoint
• STAR+PLUS: Community Health Choice, Molina, United

HHSC treats Harris as a service area that also includes Austin, Brazoria, Fort Bend, Galveston, Matagorda, Montgomery, Waller and Wharton counties, so the same plans apply across much of the Houston metro. You can see the metro by city in our directory for Houston, Katy, Pearland and The Woodlands.

Here is each Harris-area plan with the member line HHSC publishes for it.

Phone numbers come from HHSC’s Harris comparison charts for STAR, STAR Kids and CHIP. The number on the back of your child’s ID card is always the safest one to use.

What three of the plans have published about ABA authorization:

• Community Health Choice (2022 guide): the member needs a signed PCP referral. The provider faxes the state CCP prior authorization form, and the plan quotes a 3 business day decision.
• Texas Children’s Health Plan (2022 member FAQ): prior authorization is required for the evaluation and for treatment, and the autism benefit does not cover CHIP members.
• Wellpoint (March 2026 authorization list): ABA needs a current signed physician ABA referral, current clinical documentation, and either its treatment plan request form or the state CCP form.

For Molina and UnitedHealthcare, ask the plan which forms and portal your provider should use. The state rules below apply to every plan.

How do I check whether a provider takes my child’s plan?

“We take Medicaid” is not enough. A provider can be in network with Texas Children’s Health Plan and not with Community Health Choice, or take STAR and not STAR Kids. We rechecked HHSC’s Harris comparison charts on October 25, 2026: they list the same five STAR plans and three STAR Kids plans shown above.

1. Find the plan and program on your child’s ID card. Write down both, for example “Texas Children’s Health Plan, STAR Kids.”
2. Search the plan’s own provider directory for applied behavior analysis or behavior analysts, or call the member number on the card and ask for in-network ABA providers near your ZIP code.
3. Call the provider and name the plan and the program. Ask: “Are you in network with Texas Children’s Health Plan for STAR Kids, and are you taking new clients with that plan?”
4. Ask who requests prior authorization and how long it usually takes with your plan.
5. If your child changes plans, ask the provider again. Network status follows the plan, not the provider.

If you cannot find an in-network provider, tell the member line. Ask them to help locate one and to note the request on your child’s file.

How do you get ABA authorized, step by step?

The state’s Medicaid handbook sets the sequence. Your provider and your plan handle most of it, but knowing the order helps you spot where things stall.

1. Get or confirm the diagnosis. It must be dated within three years of the authorization request.
2. Get a signed referral. Every ABA evaluation and treatment service needs a signed and dated referral from a prescribing provider, usually your child’s primary care provider.
3. Pick an LBA and ask them to request the evaluation. The LBA or the prescribing provider requests prior authorization for the ABA evaluation (code 97151) by sending the diagnostic documentation and the CCP prior authorization form. That form has to be signed within 60 days of the evaluation date. The evaluation authorization is valid for 60 days, and the evaluation is limited to 6 hours.
4. Complete the assessment and treatment plan. The assessment has to include a developmental history, direct observation of the child including at least one natural setting, caregiver interviews, validated cognitive and adaptive testing such as the Vineland, and measurable goals for both child and caregivers. You sign the plan too.
5. The LBA requests the first 90 days of treatment. The evaluation has to be recent, within 60 days of the start of care.
6. Extension and recertification. After the first 90 days, the LBA can request another 90 with attendance logs for child and caregiver and a progress summary. After 180 days, the LBA does a re-evaluation and recertifies.

Providers can start care before approval arrives, but they have to request authorization within 3 business days of the start date, or the earlier days can be denied. Ask each provider how they handle authorization before sessions begin.

How do you find an in-network provider in Houston?

Use three tools, in this order.

1. TMHP’s Online Provider Look-up at opl.tmhp.com. HHSC’s family flyer on Medicaid ABA points families to it to find LBAs and says it includes health plan directories.
2. Your health plan’s provider directory or member line. Ask for ABA providers specifically, and ask whether each is accepting new Medicaid clients in your plan.
3. Our directory. Browse ABA providers that list Medicaid, then narrow by setting: in-home ABA or center-based ABA. For a center near Katy, see centers that list Medicaid in Katy. A listing tells you what a provider says about its services. It does not confirm openings or that they take your specific plan, so call and ask. Our guide to choosing an ABA provider in Houston has more questions and red flags.

Questions to ask each provider:

• Do you accept my child’s specific plan (not just “Medicaid”)?
• Is an LBA enrolled in Texas Medicaid and treating my child directly?
• What is your waitlist for a Medicaid client, and what happens during the wait?
• Do you offer after-school or weekend sessions?
• How often will the LBA personally observe my child, and how is parent training scheduled?

Texas Medicaid also says a behavior technician cannot call themselves a therapist when talking with Medicaid families, and one-on-one direct sessions between a technician and your child must be in person, not by video. If a provider describes it differently, ask them to explain.

How many ABA hours does Texas Medicaid usually approve?

There is no single number. The Medicaid handbook gives frequency guidelines, and requests above them go to a physician for review. Approval depends on age, autism severity level, how serious the target behaviors are, and how long the child has been in ABA.

Source: Texas Medicaid Children’s Services Handbook, October 2026. These are guidelines, not promises, and a plan can approve a different amount for an individual case.

For how those hours fit around a school or pre-K day, see how many hours of ABA per week. Direct treatment is capped at 8 hours a day. Attendance counts too. If a child or caregiver attends less than 85 percent of approved hours, the LBA has to submit more documentation to keep the hours at the same level.

What if the plan denies or cuts ABA?

You can appeal in several ways, and each step has a deadline.

1. Read the denial notice and ask your provider what is missing. The handbook ties approvals to a diagnosis under three years old, a current evaluation and a signed referral, so check those first.
2. File an internal appeal with the plan. Federal Medicaid rules give you 60 calendar days from the date on the denial notice.
3. Consider an external medical review. After the plan’s appeal decision, you can ask for an optional review by an independent organization. HHSC says a standard review is completed within 15 calendar days and an expedited review within two business days.
4. Request a state fair hearing. HHSC says most appeal requests are due within 90 days, or 120 days for actions taken by managed care organizations. You can ask by calling 2-1-1, in writing, or at a local HHSC office. The hearings officer has 60 to 90 days to decide.
5. Call the HHS Ombudsman at 877-787-8999 if you cannot get answers from the plan or hearings staff.

Keep every notice. Write down dates of calls and who you spoke with.

What is the Children’s Autism Program, and is it being cut?

The Children’s Autism Program (CAP) is a separate, state-funded program. It is not Medicaid. It pays local contractors to provide focused ABA, and the Texas Tribune reports that families pay a reduced amount based on income and insurance, with some paying nothing. Children can get up to 720 hours of CAP-funded ABA over their lifetime.

The age range depends on which source you read. HHS’s program page, checked October 25, 2026, still says ages 3 through 15 and up to 180 hours in 12 months. The Tribune reported on October 12, 2026 that the state expanded eligibility to age 21 this year and removed the yearly hour cap. Ask 2-1-1 or the contractor which rules apply when you call.

The proposed cut. On October 12, 2026, the Tribune reported that HHSC’s budget request for the 2028-29 biennium proposes ending all CAP funding. HHSC said it chose cuts with the least direct effect on clients and on federal funding, after state leaders asked agencies to cut spending by 3%. The Legislature has to approve the cut. If it does, HHSC said children would keep getting services through the end of August 2027.

The numbers from that report:

• CAP funded treatment for 583 children in fiscal year 2026.
• Contractors report at least 1,000 more children on waitlists statewide.
• The program works with 16 providers across Texas.
• In the Houston area, the University of Houston-Clear Lake’s Center for Autism and Developmental Disabilities has offered CAP-funded ABA since the program began in 2008. Its CAP programs served 41 families last year and have about 200 families waiting. The center told the Tribune it cannot bill Medicaid or insurance.

What to do now. If your child is in CAP or on a CAP waitlist and has Medicaid, ask your Medicaid plan for an ABA provider now rather than waiting for the budget decision. Medicaid ABA has its own rules, covered above. If your child has no Medicaid, ask your CAP contractor what it plans to do if funding ends. To find the CAP contractor nearest you, call 2-1-1 or search 211texas.org.