Autism

Autism Services Benefits FAQ

What is Autism?

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior.

When is the autism benefit available and who qualifies for it?

It is available starting February 1, 2022, for STAR and STAR Kids members up to 20 years of age who have been diagnosed with autism by a doctor. Please note: The autism benefit is not covered for CHIP members.

How can I have my child evaluated for autism?

Your child can be evaluated for autism by any of the following health care providers:

• Developmental pediatrician

• Neurologist

• Psychiatrist

• Licensed psychologist

• A team that works with any provider listed above or a Licensed Behavior Analyst (LBA)

To find a provider, please visit texaschildrenshealthplan.org/find-a-provider.

What does the autism benefit include?

Medical evaluation and treatment. Applied Behavioral Analysis (ABA Therapy) by a qualified clinical specialist may be also covered.

What is ABA Therapy?

The goal of ABA Therapy is to increase helpful behaviors such as language, self-care and social skills, as well as reduce harmful behaviors such as aggression and self-injury.

Who can provide ABA Therapy?

• LBAs

• A team (such as Behavioral Technicians) that works under the direction of an LBA

Does this service require prior authorization?

Yes, prior authorization is required for evaluation and treatment.

Is this a Texas Health Steps Benefit?

Yes, autism services are a benefit under the Texas Health Steps-Comprehensive Care Program (THSteps-CCP).

How do I find a provider?

A list of Texas Children’s Health Plan in-network providers can be found at texaschildrenshealthplan.org/doctor or you can visit https://txchfamilyresources.org/. Our Member Services team can also help at 1-866-959-2555 (STAR) and 1-800-659-5764 (STAR Kids).

Where are the providers located?

Texas Children’s Health Plan providers that offer autism services are located throughout our service areas.

The availability of providers changes by service area. Because this is a new benefit, the network is limited. We are actively working to grow our provider network.

To find a provider:

• Your child’s primary care provider (PCP) may be able to recommend a provider that is right for your child’s needs.

• You can also find a provider on our website at texaschildrenshealthplan.org/doctor.

• To access community resources, visit https://txchfamilyresources.org/.

What if I can’t find an in-network provider?

We are committed to the health of your child. That is why we are working on growing our provider network. However, because this is a new benefit, the networks of autism care providers for all health plans are now limited.

Texas Children’s Health Plan is temporarily accepting out-of-network providers to cover this service. This is just one more way to support you and your child.

Please keep in mind that the provider you choose must accept Medicaid for the service to be covered. When booking an appointment with that provider, please ask if they accept Medicaid. If not, you may have to pay the cost of the visit.

To find an autism services provider, a great place to start is with your child’s PCP. They may be able to recommend a provider that is right for your child’s needs. If your child does not have a PCP, you can search for a provider on our website at texaschildrenshealthplan.org/doctor.

What if my current provider is out of network?

We are committed to providing you with the care that you need.  As we work to grow our network of autism services providers, we are temporarily covering services from out-of-network autism services providers.