Texas CHIP does not cover ABA therapy. Applied Behavior Analysis is a Texas Medicaid benefit, and the state’s own autism services guidelines spell out that CHIP enrollees are excluded from it.1Texas Children’s Health Plan. Autism Services Guideline If your child is on the Children’s Health Insurance Program in Texas and has an autism diagnosis, ABA will not be paid for through that coverage, and you will need to look at Medicaid eligibility, a state autism program, Medicaid waivers, or private funding to access it.
Why Medicaid Covers ABA and CHIP Does Not
ABA became a Texas Medicaid benefit on February 1, 2022, delivered under the Texas Health Steps–Comprehensive Care Program for members age 20 and younger with an autism spectrum disorder diagnosis.2Community Health Choice. Texas STAR Medicaid Plan Medicaid has to cover services like this because federal law requires every state Medicaid program to provide the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit to enrolled children under 21. EPSDT compels states to furnish any medically necessary service to correct or ameliorate a child’s health condition, even if the state plan does not otherwise list it.3Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
Texas CHIP sits outside that rule. Texas runs a “separate CHIP” funded under Title XXI of the Social Security Act rather than as a Medicaid expansion, and separate CHIP programs are not required to provide EPSDT unless the state elects to.4MACPAC. EPSDT in Medicaid Available data does not show Texas making that election.5KFF. Provide EPSDT in Separate CHIP The SUPPORT Act of 2018 does require all separate CHIPs to cover mental and behavioral health services broadly, but federal guidance left states to design their own benefit arrays and demonstrate sufficiency.6Medicaid.gov. SUPPORT Act Section 5022 Guidance Texas has concluded its CHIP behavioral health package meets that bar without including ABA.
What CHIP Does Cover for a Child With Autism
CHIP is not useless for autism-related care. It covers regular checkups, prescription drugs, hospital care, lab and imaging, vision and hearing care, access to specialists, and mental health care, plus service coordination for members with special health care needs.7Texas Health and Human Services. CHIP For a child with autism, the practical pieces are:
- Speech therapy for verbal and nonverbal communication.
- Occupational therapy for daily living skills, fine motor development, and sensory challenges.
- Physical therapy when medically necessary.
- General behavioral health services, which are not a substitute for ABA but can address emotional and behavioral support.
None of these replaces the structured, intensive behavioral intervention that ABA provides, so if ABA is part of your child’s treatment plan, you will be looking outside CHIP to pay for it.
How to Access ABA Therapy Outside CHIP
Check Medicaid Eligibility First
Texas tests every applicant for Medicaid first and only moves ineligible children to CHIP.8Texas Health and Human Services. Texas Works Handbook – General Policy If your household income has dropped or your circumstances have changed since you first enrolled, it is worth reapplying. The state also runs a Medicaid Buy-In for Children, though a 2022 policy council report flagged that its usefulness is limited by an income ceiling of 150 percent of the federal poverty level. That council recommended raising the ceiling to 300 percent and adopting a TEFRA option (which would let children meeting an institutional level of care qualify for Medicaid regardless of family income); Texas has not enacted either change.9Texas Health and Human Services. Policy Council for Children and Families Recommendations
The Children’s Autism Program
Texas Health and Human Services operates the Children’s Autism Program, which provides focused ABA to children ages 3 through 15 with a documented autism spectrum diagnosis.10Texas Health and Human Services. Children’s Autism Program It is limited in scope. Services cap at 180 hours in a 12-month period and 720 hours over the child’s lifetime, and the program requires 85 percent attendance by both the child and the parents.11Texas Health and Human Services. Children’s Autism Program Policy Manual Families pay a cost share set by an HHSC fee schedule, adjusted for any existing insurance deductibles or copays. To find a participating clinic, call 2-1-1 or visit 211Texas.org.
Medicaid Waiver Programs
Several Texas Medicaid waivers base eligibility on the child’s own income rather than the family’s, which lets higher-income households qualify. Some authorize Board Certified Behavior Analysts to deliver behavior support services:
- Home and Community-based Services (HCS). Requires an IQ under 70, or under 75 with an autism diagnosis. Approves BCBAs for behavior support.
- Community Living Assistance and Support Services (CLASS). Serves individuals with disabilities originating before age 22, including autism. Approves BCBAs for behavior support.
- Texas Home Living (TxHmL). Requires an IQ under 70. Was the first Texas waiver to approve BCBAs as providers.
- Medically Dependent Children Program (MDCP). Serves children under 21 who meet a nursing-home level of care. Covers children with autism but focuses on respite and nursing rather than ABA specifically.
The catch is access. Families have to sign up for each program’s interest list separately, and some lists exceed 15 years.12Navigate Life Texas. Texas Medicaid Waiver Programs for Children With Disabilities Call 1-877-438-5658 to join the CLASS, MDCP, or DBMD interest lists, or contact your local Intellectual and Developmental Disability Authority for HCS and TxHmL.13Texas Children’s Hospital. General Texas Medicaid Waiver Information Get on the lists as early as possible, because the clock only starts when you sign up.
Schools, Parent Training, and Private Funding
Under the federal Individuals with Disabilities Education Act, public schools provide special education and related services. Part C covers early intervention for infants and toddlers with developmental delays, and Part B covers children ages 3 through 21. School-based services often overlap with ABA goals and can extend limited therapy hours.14Total Care ABA. ABA Therapy Funding Options
Parent-Directed Treatment programs, often free through Texas universities and nonprofit organizations, teach caregivers ABA strategies for home use, typically in virtual sessions focused on communication or behavior management.15Texas Children’s Hospital. Behavioral Interventions National and regional nonprofits offer grants for therapy and related expenses, and some ABA clinics offer sliding-scale fees or payment plans. If you have an employer-sponsored plan, a Health Savings Account or Flexible Spending Account can pay for ABA sessions, and unreimbursed medical expenses including ABA may be deductible on federal taxes once they exceed the applicable share of adjusted gross income.
Where Policy Stands
Advocacy groups continue to press for broader autism coverage. The Autism Society of Texas named improving the Medicaid ABA benefit a top priority for the 89th Texas Legislative Session in 2025, citing low reimbursement rates, too few providers willing to accept Medicaid, and long waitlists, and pushed for ABA by telehealth, particularly for rural families.16Texas Autism Society. Top Legislative Issues 89th Texas Legislative Session No legislation from that session appears to have extended ABA coverage to CHIP enrollees, and the Policy Council for Children and Families’ recommendations on TEFRA and the Medicaid Buy-In remain unimplemented.9Texas Health and Human Services. Policy Council for Children and Families Recommendations For now, a CHIP family seeking ABA still has to piece together coverage from somewhere other than CHIP itself.