How do I Determine if my Insurance is Subject to State Autism Mandates?

To determine if your insurance is subject to state autism mandates, you must first identify your health plan type and the state laws governing it. While many states have mandates requiring coverage for Applied Behavior Analysis (ABA) therapy, these laws do not apply to all plans.

Here are the practical steps to determine your coverage status:

• Identify your plan type: Contact your Human Resources department or benefits administrator to ask if your plan is state-regulated (fully insured) or self-funded (ERISA).
• Understand the ERISA exemption: If your plan is self-funded, it is regulated by federal law (ERISA) and is generally exempt from state mandates. In this case, your employer decides whether to include autism benefits voluntarily.
• Check state-specific limits: If your plan is state-regulated, the mandate details will vary by location. For example, Arizona covers ABA up to age 16, Maryland up to age 21, and Utah has a limited mandate covering only up to age 9.
• Review official documents: Locate your Summary of Benefits and Coverage (SBC) or benefits booklet. Look for terms like “self-funded,” “ERISA,” or “not subject to state regulation.”
• Contact your insurer directly: Call the member services number on your insurance card to ask specifically if ABA therapy is a covered benefit under your unique plan, as mandates represent the baseline but specific policy language can vary.

Because coverage is subject to verification and never guaranteed, working with a provider’s insurance assistance team can help you navigate these complex regulations.

• Autism Insurance Mandate Explained: Essential 2026 Guide