While there’s usually no age limit as to when an autistic child can start applied behavior analysis (ABA) therapy, federal and state laws define the age limit for receiving insurance coverage for this type of treatment. The state-mandated limits vary, but they’re typically in the 19–21 range.
In this regard, the ABA therapy age limit in North Carolina is currently set at 19 years. This means that, according to state laws, kids with autism spectrum disorder (ASD) have access to insurance coverage for ABA therapy and other autism treatments only if they’re 18 or younger.
ABA Therapy Age Limit: When to Start?
Extensive scientific research points to better outcomes in children who start ABA therapy early, which is why experts recommend beginning treatment as soon as the child receives a formal autism diagnosis. Thanks to modern diagnostic tools, this is possible at just 18 months of age. Statistics on autism in North Carolina report that the median age for autism diagnosis is 38 months.
Kids with ASD should ideally begin ABA therapy around the age of 2. Daily ABA sessions at this age will set the child on the right developmental path, help them acquire all the age-appropriate habits and skills they need, and lead to a reduction in harmful or otherwise negative behaviors.
Unfortunately, many kids don’t receive their diagnosis until school age—but this doesn’t mean they can’t benefit from ABA therapy. Starting ABA around the age of 6 or older can still lead to positive outcomes, especially in regard to the child’s communication and social skills.
Does ABA Therapy Work on Older Kids?
This therapy can still be highly effective by the time children reach adolescence (10 years and above), but the treatment usually begins at a younger age. ABA is usually a years-long process, so children who have begun treatment at an early age may still have regular daily sessions when they enter adolescence.
Of course, as the kids grow and successfully acquire new skills and habits, the therapist will keep adjusting the treatment plan by setting new, more age-appropriate goals.
There’s no rule as to how long a child will need to attend ABA therapy. Every autistic kid makes progress at their own pace, meaning that some may need more time to achieve their goals than others.
At Abacus Therapies, the child’s therapist will constantly track their progress and decide when it’s time to stop ABA therapy.
Age Limit for ABA Therapy Insurance Coverage
Under Medicaid, the US federal government health insurance program, coverage for autism treatment — including ABA therapy — is available to all persons under the age of 21.
The rule applies to all Medicaid holders in North Carolina, as long as the treatment is deemed medically necessary and the request for coverage is submitted by a certified clinician. While Medicaid itself doesn’t enforce any caps in terms of maximum annual coverage, individual states may do so.
State-Mandated ABA Insurance Coverage
As mentioned, state-regulated plans in North Carolina also provide insurance coverage for ABA therapy and other autism treatments. With these plans, the coverage is only available to kids under the age of 19, and the maximum annual coverage for ABA is currently capped at $40,000.
One of the key requirements for state-regulated insurance is that the therapy is conducted by Board Certified Behavior Analysts (BCBAs) and Registered Behavior Techinicians (RBTs).
In 2020, the government of North Carolina introduced provisions to the existing laws requiring additional qualifications for these state-certified therapists to conduct sessions. These harsher certification requirements resulted in a lower number of therapists legally allowed to work in North Carolina, which made it significantly more difficult for parents to access ABA services for their children. This is especially true in areas that don’t have an ABA therapy center nearby.
Abacus Therapies Is Here to Help
At Abacus Therapies, we have a growing team of highly qualified BCBAs and RBTs with years of professional experience and a strong dedication to helping your child live a better life.
We currently provide at-school and at-home ABA sessions, so you don’t have to travel to ensure your child has the best possible care. With the upcoming opening of our ABA therapy center in Charlotte, NC, you’ll also have access to center-based ABA therapy in your neighborhood, and group ABA therapies as well.
To get started, simply schedule a free consultation with one of our therapists. Send us a text at 954-758-8748, call us at 954-400-3251, or send us an email via our contact form. We’ll be happy to help!
