California BlueShield ABA settlement with Dept. of Insurance

Last October California formally ended autism insurance discrimination by passing SB 946 requiring insurance companies and health care service plans to provide coverage of medically necessary treatments for autism as a medical benefit.

California Insurance Commissioner Dave Jones applauded passage of the bill  within days of passage. “Behavioral therapy is widely considered to be an essential and effective method for treating children with autism, and it’s a long overdue development for insurers to offer coverage for this treatment,” said Commissioner Jones. “SB 946 represents a major step forward in ensuring that children withutism get the treatment they need in order to live the high-quality lives they deserve.”

Last week Blue Shield of California reached a settlement agreement with the California Department of Insurance to provide coverage of medically necessary behavior therapy including Applied Behavior Analysis (ABA) when provided by all appropriately credentialed, Board Certified Behavior Analysts, as well as those providers with ABA services training and experience in serving children with autism.

CA BlueShield Agreement with California Department of Insurance 012612

This is a HUGE step towards ensuring an adequate network of ABA providers for California’s children involved with ASD’s.

In Washington State , Network Adequacy Laws and Mental Health Parity in theory offers Washingtonians with ASD’s similar levels of protection as those children in California and the other 29 states that now make it illegal for carriers to discriminate against those with autism.  Yet, families like ours continue to collect stacks of denied claims for medically necessary ABA and other structured behavior therapies month after month, year after year. If your loved one with ASD does not have coverage of  medically necessary treatments through private insurance or Medicaid, please visit WAA Family Forum for potential resources. Please share this link with your neurodevelopmental and behavior therapy providers and ask them to share with clients who have been denied coverage of medically necessary treatments.

Thank you for standing with us for change!


Arzu Forough

Washington Autism Alliance & Advocacy


One thought on “California BlueShield ABA settlement with Dept. of Insurance

  1. As a mum of an autistic child, I am disgusted that my son’s applied behavioral analysis medically necessary treatment is NOT covered by medi-cal. This is an outrage. Thousands of families with autistic children who are adults, and rely on medi-cal to help them, are being told they must pay co-pays for their adult autistic children who have medically prescribed ABA, applied behavioral analysis. This should be ILLEGAL. IF the ABA treatment is deemed medically necessary then of course the co-pay should be paid by Medi-cal, what illogical garbage would even think it couldn’t be? How much would it cost for our autistic adult children to have a month long hospital stay if they don’t receive the home support they need? Much more than what it costs to provide home care support, that’s for sure, yet California is still lagging behind in its medically prescribed medi-cal A ABA support for ABA in the home!

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