No. Texas CHIP does not cover ABA therapy. Applied Behavior Analysis for children with autism is a Texas Medicaid benefit only, and the state’s managed care organizations that administer CHIP confirm the exclusion in their own autism guidelines.1Texas Children’s Health Plan. Autism Services Guideline If your child is on CHIP and needs ABA, you will have to find it through a different program or pay for it another way.
Where the Exclusion Comes From
ABA became a covered service under Texas Medicaid on February 1, 2022, for members age 20 and younger with an autism spectrum disorder diagnosis.2Community Health Choice. Texas STAR Medicaid Plan The Texas Children’s Health Plan autism guideline puts the CHIP carve-out in one line: “The CHIP program is excluded from this benefit.”1Texas Children’s Health Plan. Autism Services Guideline
The reason is structural. Medicaid must provide the Early and Periodic Screening, Diagnostic, and Treatment benefit to all enrolled children under 21, which requires states to furnish any medically necessary service to correct or ameliorate a health condition, even one not otherwise in the state plan.3Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment ABA for autism fits that standard. Texas runs a “separate CHIP” under Title XXI, and separate CHIPs are not required to provide EPSDT unless the state opts in.4MACPAC. EPSDT in Medicaid Texas has not.5KFF. Provide EPSDT in Separate CHIP Federal law does require every separate CHIP to cover a “sufficient” range of mental and behavioral health services, but CMS left the specific list to states, and Texas has not included ABA in its CHIP array.6Medicaid.gov. SUPPORT Act Section 5022 Guidance
The result is a coverage cliff. A child on Medicaid can receive comprehensive ABA from a Licensed Behavior Analyst in the home, a clinic, or a community setting, with parent training and coordination with other therapists built in.7Texas Health and Human Services. Applied Behavior Analysis Flyer A child on CHIP whose family earns slightly more gets none of that through the state-funded plan.
What CHIP Does Cover for a Child With Autism
CHIP is not empty on autism-related care, even without ABA. The program covers checkups, prescriptions, hospital care, labs and imaging, vision and hearing services, specialist visits, and mental health care, along with treatment for pre-existing conditions and service coordination for members with special health care needs.8Texas Health and Human Services. CHIP For a child on the spectrum, the practically useful pieces are usually:
- Speech therapy for verbal and nonverbal communication.
- Occupational therapy for daily living skills, fine motor development, and sensory needs.
- Physical therapy when medically necessary.
- General behavioral health services for emotional and behavioral support.
Mental health and substance use disorder office visits carry no CHIP copay.9Driscoll Health Plan. CHIP None of these substitute for structured ABA, but they do carry real value and should not be skipped while you look for ABA elsewhere.
How to Access ABA Therapy Outside of CHIP
Families on CHIP have several routes to ABA. None are effortless, and most involve waitlists, income tests, or out-of-pocket cost.
The Children’s Autism Program
Texas Health and Human Services operates the Children’s Autism Program, which provides focused ABA services to children ages 3 through 15 with a documented autism spectrum diagnosis.10Texas Health and Human Services. Children’s Autism Program It is capped: 180 hours in any 12-month period and 720 hours over the child’s lifetime, with a required 85 percent attendance rate for both the child and parents.11Texas Health and Human Services. Children’s Autism Program Policy Manual Families pay a cost share set by an HHSC fee schedule, adjusted for existing insurance obligations. Services run through local contractors. To find a participating clinic, call 2-1-1 or use 211Texas.org.
Medicaid Waivers
Texas runs several Medicaid waiver programs that base eligibility on the child’s own income rather than the family’s, which can open Medicaid (and therefore ABA-adjacent behavior support) to a CHIP family that would not otherwise qualify. Several waivers authorize Board Certified Behavior Analysts for behavior support services:
- Home and Community-based Services (HCS): requires an IQ under 70, or under 75 with an autism diagnosis; approves BCBAs for behavior support.
- Community Living Assistance and Support Services (CLASS): for individuals with disabilities originating before age 22, including autism; approves BCBAs for behavior support.
- Texas Home Living (TxHmL): requires an IQ under 70; was the first Texas waiver to approve BCBAs as providers.
- Medically Dependent Children Program (MDCP): serves children under 21 who meet nursing-home level of care; focuses on respite and nursing rather than ABA specifically.
The catch is access. Each program has its own interest list, and some wait times exceed 15 years.12Navigate Life Texas. Texas Medicaid Waiver Programs for Children With Disabilities Put your child on the lists as early as you can. Call 1-877-438-5658 for CLASS, MDCP, or DBMD, and contact your local Intellectual and Developmental Disability Authority for HCS and TxHmL.13Texas Children’s Hospital. General Texas Medicaid Waiver Information
Medicaid Eligibility and the Buy-In
Texas screens applicants for Medicaid before CHIP, so if income drops or circumstances change, your child may move to Medicaid and become eligible for the ABA benefit.14Texas Health and Human Services. Texas Works Handbook – General Policy Texas also runs a Medicaid Buy-In for Children program, though a 2022 Policy Council for Children and Families report found the income ceiling of 150 percent of the federal poverty level limits its usefulness. The council recommended raising the limit to 300 percent and adopting a TEFRA option, which would let children meeting an institutional level of care qualify for Medicaid regardless of family income. Texas has not enacted either change.15Texas Health and Human Services. Policy Council for Children and Families Recommendations
Schools, Parent-Directed Programs, and Private Funding
Under the federal Individuals with Disabilities Education Act, public schools must provide special education and related services. Part C covers early intervention for infants and toddlers with developmental delays; Part B covers ages 3 through 21. School-based services can reinforce ABA goals and stretch limited therapy hours.16Total Care ABA. ABA Therapy Funding Options
Parent-Directed Treatment programs, often offered free through Texas universities and organizations, teach caregivers ABA strategies for home use, typically in virtual sessions focused on communication or behavior.17Texas Children’s Hospital. Behavioral Interventions National and regional nonprofits offer grants toward therapy costs, and some ABA clinics run payment plans or sliding-scale fees. If you have an employer-sponsored plan, a Health Savings Account or Flexible Spending Account can pay for ABA sessions, and unreimbursed ABA expenses may be deductible on federal taxes when total medical costs exceed the applicable threshold of adjusted gross income.
What CHIP Costs, So You Know What You’re Paying For
CHIP in Texas covers children under 19 in families earning too much for Medicaid but no more than 201 percent of the federal poverty level.14Texas Health and Human Services. Texas Works Handbook – General Policy Families at or below 151 percent of the FPL pay no enrollment fee, with $5 office-visit copays and prescription copays from $0 to $5. Above 151 percent, annual enrollment fees are $35 or $50, office visits run up to $25, inpatient care up to $125, and brand-name drugs up to $35. Total annual cost-sharing is capped at 5 percent of family income.9Driscoll Health Plan. CHIP None of that buys ABA.
Where the Policy Stands
The Autism Society of Texas made improvements to the Medicaid ABA benefit a top priority for the 89th Texas Legislative Session in 2025, pointing to low reimbursement rates, too few providers willing to accept Medicaid, and long waitlists. The organization also pushed for ABA via telehealth, especially in rural areas.18Texas Autism Society. Top Legislative Issues 89th Texas Legislative Session No 89th-session legislation appears to have extended ABA coverage to CHIP enrollees, and the Policy Council’s recommendations on a TEFRA option and an expanded Medicaid Buy-In remain unimplemented.15Texas Health and Human Services. Policy Council for Children and Families Recommendations For now, CHIP families needing ABA will keep piecing coverage together from the sources above.