Secure Funding for Your Child's ABA Program
While self-funding your child’s ABA program is an option for some families, many find privately paying for services to be cost-prohibitive. Fortunately, there are several avenues through which families may access partial or full funding for their children’s programs. Below, please find a general overview of your funding options. We realize that this process may be complicated and confusing. We would be happy to speak with you at any time to guide you through these systems to ensure your child may access treatment.
The vast majority of our families access ABA treatment funding via their health care benefits. ABA is considered a “behavioral health benefit” and is included and deemed medically necessary by both commercial and Medi-Cal plans. Patient responsibility will vary depending on the particular insurance plan to which you subscribe. Often, copayments and coinsurance can be covered via a secondary plan, Medi-Cal, or your local regional center. FirstSteps is in-network with the majority of California health plans. If we are not contracted, you may access out-of-network benefits in some cases, or we may be able to initiate a network or single-case agreement for your child’s services.
After your child receives their diagnosis, you will need to schedule a formal ABA Assessment to include an analysis of your child’s pre-treatment barrier behavior, skill repertories, goals for treatment, and service recommendations to achieve those goals. In order for us to request an authorization from your health plan for the Assessment, we will need to submit your child’s original diagnostic report with the DSM V multiaxial diagnostic codes and the standard forms for your particular policy. A response from your insurance (authorization or denial) is generally provided within 5-10 days of our authorization request.
If your child has already been receiving ABA Services or if an ABA Assessment has been completed, FirstSteps will request an authorization or re-authorization from your health insurance provider for on-going ABA treatment services. Once again, we will need to submit your child’s original diagnostic report, your child’s ABA Treatment Plan with goals and service levels outlined, and the standard authorization forms for your particular policy. A response from your insurance (authorization or denial) is generally provided within 5-10 days of our authorization request.
If your child is age three or older and has special education needs, your local school district will work with you and a team of educational specialists to develop their Individualized Education Program (IEP) – a legal process mandated by the Individuals with Disabilities Education Act (IDEA). Through the IEP process, your child’s educational goals are developed, and related services and supports necessary for goal achievement are designated. If the IEP team (of which you are a member) determines that ABA services are necessary for your child to be able to access the curriculum and meet their IEP goals, your district will offer to contract with a Non-Public Agency (NPA) such as FirstSteps. Generally, services obtained through the IEP process are in place for one school year, with your child’s progress towards their goals and their related continued need reviewed annually. As a certified non-public agency (NPA) with the California Department of Education, FirstSteps contracts countless school districts to support our clients in their school environments where we work to ensure generalization and maintenance of skills learned during their 1:1 treatment while also levering the amazing social learning opportunities provided in the school setting.
In California, services for those with developmental disabilities, including Autism, are coordinated through the Regional Center system overseen by the Department of Developmental Disabilities (DDS). The 21 independently operated Regional Centers are set up to help those with developmental disabilities and their families access services and supports including assessment and diagnosis, counseling, coordination of care, and the purchase of direct services, including behavior intervention services such as those provided at FirstSteps. If your child is under 3 years old, they may be able to access FirstSteps services via your Regional Center’s Early Start Program. If your child is over the age of 3, they will access Regional Center services as indicated by the Lanterman Act.
When considering your funding options, it is important to note that Regional Center is legally considered the “payor of last resort,” meaning that your Regional Center will require you to first pursue ABA treatment funding via your Health Insurance policy and / or school district. However, this does not preclude your family from accessing the many other wonderful services offered by your Regional Center including but not limited to family counseling and support, generic services, IHSS assistance, respite care, and even assistance with your insurance copayments.
The California Department of Developmental Services is the agency through which the State of California provides services and support to individuals with developmental disabilities. The Department of Developmental Services believes the California developmental services community is best served by the open exchange of information and opinions. DDS may be contacted via email or phone: www.dds.ca.gov/complaints or 916.854.1987.