All parents of autistic children want their kids to have access to the best available care and services. Some of these services may be cost-prohibitive to parents, though. Thankfully, there are ways to access them without paying the full price.
In this comprehensive guide to autism benefits in North Carolina, we’ll provide an overview of the services available to autistic children across the state. We’ll also highlight all the available benefits that can help offset the cost of these services or, in some cases, even cover it in full.
North Carolina Autism Services: an Overview
According to North Carolina autism laws, autistic children and adults in North Carolina (NC), as well as their parents and caretakers, have access to various services tailored to their particular needs. In this section, we will briefly outline some of those services.
Types of Available ASD Therapies in North Carolina
There are several different ASD therapies available to North Carolina citizens.
ABA Therapy
Clinicians across the state recognize applied behavior analysis (ABA) therapy for children as an effective, science-backed approach to autism treatment. Primarily used to treat children on the spectrum, ABA involves a personalized treatment plan that aims to help children of all ages learn the skills and behaviors they need to live more fulfilling lives and achieve more success in school.
TEACCH
Though not as popular as ABA, other therapies are also available to kids with ASD. TEACCH (short for Treatment and Education of Autistic and Related Communication-Handicapped Children) is one such program, developed by researchers at the University of North Carolina.
More Autism Services
Other sought-after autism services include:
- Family support (including ABA training for parents)
- After-school care programs for children
- Recreational opportunities for people with ASD
- Employment support for adults looking for work
- Adult day programs with vocational and social skills training
At Abacus Therapies, we specialize in at-home and school-based ABA therapy, while the center-based will soon be available in Charlotte, NC (this fall). We provide ABA classes for parents as well, as we believe your ABA involvement is of immense importance for the child’s progress.
The programs our trusted BCBAs create are highly individualized ABA sessions, performed by experienced RBTs. As for the group ABA therapies, we will be offering a variety of programs in the Abacus Therapies’ ABA center in Charlotte, NC.
Residential Placement for an Autistic Child in NC
Residential services are intended for children and adults who need round-the-clock care that parents and caretakers are unable to provide. While individual arrangements are also available, these services most often involve group living facilities for kids and adults with ASD.
Residential group living arrangements include:
- Intermediate Care Facilities (ICF/IDD)
- Homes for Developmentally Disabled Adults (DDA)
- Alternative Family Living (AFL)
Services for Autistic Adults in North Carolina
Because both ABA and TEACCH are typically offered until the ages of 18–20, autistic adults have more limited options in terms of the services they can take advantage of.
Vocational and skill training aside, autistic adults over the age of 21 may also have access to the relatively new Research Based – Behavioral Health Treatment (RB–BHT) specifically geared towards them.
To access this service, adults must submit a request via their health insurance provider.
Benefits for an Autistic Child in North Carolina
Now, let us focus on children on the spectrum and autism benefits available in North Carolina.
Autistic children in North Carolina have access to several benefits that could help their parents cover the cost of ASD treatment. Although most families will first look to their health insurance provider to help with the expenses, other financing options are also available.
Let’s explore all of them!
Medicaid for Autism in NC
Based on the July 2014 guidance issued by the Centers for Medicare and Medicaid Services (CMS), all states must cover any ASD therapy deemed medically necessary for children under 21. This includes insurance coverage for ABA therapy, some TEACCH programs, and other treatments for autism, Asperger’s, and pervasive developmental disorders.
What’s more, this rule applies even if the State Medicaid Plan doesn’t cover these services for adults aged 18–21.
In North Carolina, autistic children may be eligible for the following benefits:
- Medicaid Home and Community-Based (HCB) Waiver
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
- Medicaid State Plan Services (provided under the State Medicaid Plan)
- Local Management Entity/Managed Care Organizations (LME/MCO) Non-Medicaid Services
- Medicaid “B3” Services (designed by the LME/MCO using Medicaid funds)
If the child is under 3, a clinician will submit a request for financial help to the Division of Child and Family Wellbeing within the North Carolina Department of Health and Human Services. For children aged 3–21, the request must be submitted to the LME/MCO under the EPSDT benefit.
Eligibility for autistic children benefits in North Carolina varies. For example, the HCB Waiver eligibility isn’t based on parental income — but other state-funded programs may take it into consideration. In cases where parental income matters, the state may offer co-pays or deem the child ineligible for the benefit in question if this income exceeds a specified threshold.
For the most accurate information on the eligibility criteria, we encourage you to contact your Medicaid administrator.
Private and Special Insurance for Autism in North Carolina
Under North Carolina state law, all major private insurers must provide autism treatment coverage for children aged 18 and younger. The maximum coverage is set at $40,000 per year.
However, it’s important to note that not all insurance plans are covered by this regulation, so it is best to contact your plan administrator or the North Carolina Department of Insurance for information.
Other private and special insurance plans that offer autism treatment coverage include:
- Tricare (includes ABA)
- North Carolina State Health Plan (ABA included; capped at $36,000/year)
- Federal Employee Health Benefit Plans (all plans include ABA)
Employer-provided self-funded health insurance plans are not subject to North Carolina state laws and thus might not offer coverage for autism treatment. If you have a self-funded plan, you should contact the US Department of Labor or your insurance plan administrator for information.
Other Autism Treatment Financing Options in NC
Numerous charity and advocacy organizations provide grants and other forms of assistance for families with autistic children. However, when talking about autism benefits by state, some of them may not be available in North Carolina. For eligibility, it is best to contact individual organizations.
Additionally, autistic teens and adults in North Carolina, as well as their parents and caretakers, may have access to several other benefits, including the following:
- Health Savings Accounts (HSA)
- North Carolina Vocational Rehabilitation Services
- Achieving a Better Life Experience (ABLE) accounts
Some employers and work organizations also offer the “private payment” option. This involves a private trust that helps employees with their children’s educational expenses, which also include ABA therapy. While this payment method won’t cover the treatment costs in full, depending on the household income and other factors, it can help reduce the associated expenses.
Abacus Therapies in Charlotte, NC
We hope we have provided you with a comprehensive overview of all the benefits available to your child in the Tar Heel State. As you can see above, there are quite a few options available to children with autism and it may take some time to find those that your child qualifies for and decide on the best ones in your particular case.
If you’ve decided ABA therapy is the right fit for your child and need help navigating the range of autism benefits in North Carolina, Abacus Therapies is the partner you’ve been looking for. Inspired by our own autism story, we have been helping families with autism across the US since 2017.
Our team of experienced, highly qualified ABA therapists offers personalized sessions at home, school, and, very soon, in our new ABA center in Charlotte, NC, too. We’re proud to announce our ABA center will also be offering several options for group ABA therapies
To start your ABA journey in Charlotte NC, schedule a free consultation now. We’re here to help!
FAQs
What benefits do autistic children get in NC?
Autistic children in NC and their parents have access to a range of benefits, including various treatment options, after-school care programs, residential placement with round-the-clock care, and recreational opportunities. Financial benefits include insurance coverage, scholarships and grants, and health savings accounts.
Can a child with autism get Medicaid in NC?
Yes, Medicaid in North Carolina covers any ASD treatment deemed medically necessary for children under the age of 21. This includes ABA and other autism therapies, as well as treatments for Asperger’s and other pervasive developmental disorders.
Can I get paid to stay home with my autistic child in North Carolina?
Some Medicaid options and Supplemental Security Income (SSI) provide a monthly stipend to parents of autistic children to help cover the cost of treatment and care. While the stipend might be enough to cover all the expenses, thus allowing you to leave work and take care of your child full-time, you must meet the eligibility requirements for your chosen financing option.
There may also be cash and counseling programs that allow you to become your child’s paid caregiver.
