ABA Therapy Insurance Laws in Georgia

Key Highlights

Georgia’s autism insurance law, known as Ava’s Law, requires many state-regulated health plans to cover autism treatment, including ABA.
Coverage applies to children 20 and younger since the 2018 expansion took effect in 2019.
Plans may limit ABA coverage to $35,000 per year, but the law bars limits on the number of visits.
Self-funded employer plans fall outside the state law, so your plan type matters.
Georgia Medicaid covers ABA for members under 21, with its own authorization and caregiver rules.
Knowing your rights, documenting medical necessity, and filing appeals or complaints can protect your child’s coverage.

When your child is diagnosed with autism, the next question is often practical: will our insurance pay for ABA therapy? In Georgia, the answer is frequently yes, but the details depend on a law passed in 2015, an expansion in 2018, and the type of plan your family has. Parents who rely on old information can easily come away with the wrong idea about what is covered.

This guide walks through the ABA therapy insurance laws in Georgia in plain language. You will learn what Ava’s Law requires, which children and plans it reaches, where the limits are, what Georgia Medicaid adds for eligible children, and what to do if an insurer pushes back.

Laws and policies change, so treat this as a map rather than legal advice. Your own insurance documents and your insurer’s written answers are what finally decide your coverage.

The Short Answer: Georgia Requires Autism Coverage, With Limits

Georgia has a specific autism insurance law, commonly called Ava’s Law, which is part of the state insurance code at O.C.G.A. 33-24-59.10. It requires covered health plans to include autism diagnosis and treatment, and ABA is part of that treatment. The law does not guarantee unlimited ABA, though. It allows a dollar limit on ABA, and it leaves medical necessity decisions to the insurer.

Three questions settle most of what a family needs to know. Is your plan regulated by Georgia or by federal law? Is your child 20 or younger? And has your child’s clinical team documented why the requested therapy is medically necessary? The sections below take each one in turn.

What Ava’s Law Requires

Georgia’s autism coverage law was signed in April 2015 and applied to policies issued or renewed on or after July 1, 2015. It originally covered children 6 and younger, with an annual limit of $30,000. A later bill, Senate Bill 118, became law in May 2018. Effective January 1, 2019, it expanded treatment coverage to individuals 20 and younger and raised the annual amount to $35,000.

Here is what that means in practice:

Assessments and evaluations by a licensed physician or psychologist to diagnose autism are covered.
Treatment, including ABA, is covered when it is medically necessary.
A plan may limit ABA coverage to $35,000 per year, but the statute says the policy cannot include limits on the number of visits.
The insurer determines medical necessity and may require a physician or psychologist to show ongoing need at least once a year.

The $35,000 figure is a ceiling a plan may apply, not an amount every family is guaranteed. Some plans cover more, so check your own policy.

It helps to see how a dollar limit works in real life. For illustration only, if a plan reimbursed a blended $60 per hour across therapy and supervision, $35,000 would fund about 583 hours in a year, or roughly 11 hours a week. Actual rates differ by plan and provider, and because the limit is annual, it resets on a yearly schedule. Asking your insurer for the current limit and how much of it has been used is one of the most useful calls you can make.

Which Plans the Law Covers and Which It Does Not

Ava’s Law is an insurance regulation, so it applies to health plans that Georgia regulates, often called fully insured plans. In a fully insured plan, the employer or individual buys coverage from an insurance company that takes on the financial risk.

It generally does not reach self-funded employer plans. In those plans, the employer pays claims directly and uses an insurance company only to administer benefits. Federal law, not Georgia law, governs them. Many self-funded plans still cover ABA, but the employer decides the terms, including any age or dollar limits. Whether your specific plan falls under the state law can depend on how it was issued, so confirm it with your insurer.

Not sure which kind you have? Ask your employer’s HR department or call the number on your insurance card and ask two questions: is this plan fully insured or self-funded, and can you send me the section on autism and ABA benefits in writing? Self-funded plan members can also request the summary plan description, which spells out what the employer has chosen to cover.

Georgia ABA Coverage at a Glance

Plan type	Rules that apply	Age	Annual ABA limit	Key point
Fully insured private plan	Ava’s Law (O.C.G.A. 33-24-59.10)	20 and younger	Plan may cap ABA at $35,000 per year; no limits on visits	Insurer reviews medical necessity and may ask for proof each year
Self-funded employer plan	Federal law and the plan document	Set by the employer	Set by the employer	Ask HR for the summary plan description
Georgia Medicaid	State Medicaid autism policy manual and EPSDT	Under 21	Based on medical necessity	Authorizations run in 6-month increments

Other Coverage Rules Georgia Families Should Know

Georgia Medicaid. Georgia Medicaid has covered adaptive behavior services for members with autism since January 1, 2018, through its EPSDT benefit for children under 21. The current Georgia Medicaid autism policy manual sets several expectations parents should know:

Diagnosis requires an evaluation using at least two approved measures, and school psychoeducational assessments are not accepted.
Treatment authorizations are requested in 6-month increments, supported by a behavioral assessment completed within the prior two months.
Treatment typically ranges from 10 to 30 hours per week, and requests above 30 hours have been subject to enhanced review since July 1, 2026.
Treatment requires active parent or caregiver participation, with documented caregiver training goals.

Medicaid policies are revised often, so ask your provider to confirm the current requirements.

Georgia’s Mental Health Parity Act. Signed in 2022, this law requires insurers to treat mental health coverage on par with physical health coverage, and the Georgia Office of Insurance and Safety Fire Commissioner enforces it. It does not replace Ava’s Law, but it gives families another reason to question a coverage decision that seems stricter than what the plan applies to medical care.

What We’ve Seen: A Real Example From Practice

In our sessions with Georgia families, we have seen how often outdated information delays care. One family waited to start ABA for their nine-year-old because an older article said Georgia’s mandate only covered children 6 and younger. When they finally called their insurer, they learned that the expanded law covers children up to age 20.

Their plan was fully insured, so the BCBA built the treatment plan with the annual $35,000 limit in mind. The team prioritized communication and safety goals first, tracked claims against the limit throughout the year, and shared progress data so the insurer could see why services were medically necessary at the annual review. The family also kept their physician’s order current. (Details have been changed to protect the family’s privacy.)

The lesson is simple: the law may already cover more than you think, and good planning helps you make the most of it.

How to Put the Law to Work for Your Family

Confirm your child’s diagnosis was made by a licensed physician or psychologist, and keep the written report.
Ask your insurer whether your plan is fully insured or self-funded, and request the autism and ABA benefit details in writing.
Ask for the current annual ABA limit, your child’s age limit, and any prior authorization requirements.
Request a written order or treatment recommendation from your child’s physician or psychologist.
Choose a provider whose supervising clinician is a board-certified behavior analyst, and ask how they handle insurance review.
Track your benefits during the year so you know how much of the annual limit has been used.
Mark your calendar for the annual review, and send updated progress data early to avoid gaps in services.

Keeping a folder with every letter, authorization, and explanation of benefits makes each of these steps easier.

Share the annual limit with your child’s clinical team at the very start. A good BCBA will use it to prioritize goals, such as communication and safety skills, and will plan the intensity of services so that coverage lasts through the plan year instead of running out unexpectedly. If a gap does appear, your team can talk with you about options early rather than at the last minute.

What to Do If Coverage Is Denied or Reduced

A denial is not the end of the road. Families can take several steps:

Ask for the denial in writing, including the specific reason and the criteria the insurer used.
Ask your provider about a peer-to-peer review, where the BCBA speaks directly with the insurer’s reviewer.
File an internal appeal with progress data and a letter from your child’s physician or psychologist explaining medical necessity.
If your plan is regulated by Georgia and you still disagree, you can file a complaint with the Georgia Office of Insurance and Safety Fire Commissioner.
If your plan is self-funded, ask HR or your plan administrator about the appeal and external review rights that federal law provides.
If your child has Georgia Medicaid, ask for written notice of the decision and the steps to appeal it.

Appeals have deadlines, so act quickly and keep copies of everything you send.

Get Clear Answers and the Support Your Child Deserves

Georgia’s ABA insurance laws give many families real protection, but the details of age, dollar limits, and plan type decide what that protection looks like for your child. At Kennedy ABA, we help autistic children build communication, daily living, and social skills through individualized ABA programs, and we support families as they work through the assessment and insurance process so the plan fits what their child needs. We proudly serve families across North Carolina, Virginia, Georgia, and Alaska. If you are trying to understand your child’s coverage or are ready to start services, contact us today and let us help you take the next step.

Frequently Asked Questions

1. Does insurance cover ABA therapy in Georgia?

Often, yes. Georgia’s autism law requires covered, state-regulated health plans to include autism diagnosis and treatment, and ABA is part of that. Self-funded employer plans follow their own terms, and Georgia Medicaid covers ABA for eligible members under 21.

2. What age does Ava’s Law cover?

Since January 1, 2019, the law covers treatment for individuals 20 and younger. Before that, it covered children 6 and younger, which is why older articles can be misleading.

3. Is there a limit on ABA visits or hours in Georgia?

The statute says policies cannot limit the number of visits. However, a plan may cap ABA coverage at $35,000 per year, and insurers decide medical necessity, so the dollar limit and the insurer’s review often shape how many hours are approved.

4. Does Ava’s Law apply to my employer’s plan?

Only if the plan is fully insured and regulated by Georgia. Self-funded plans follow federal rules and the employer’s plan document. Ask HR which type you have, and request the ABA benefit details in writing.

5. Does Georgia Medicaid cover ABA therapy?

Yes, for eligible members under 21. Georgia Medicaid covers adaptive behavior services through EPSDT when treatment is medically necessary and properly authorized. Authorizations are requested in 6-month increments, and the program expects active caregiver participation. Ask your provider whether they are enrolled with Georgia Medicaid before you begin.

Sources:

https://senatepress.net/senator-renee-unterman-commends-senate-bill-118-becoming-law.html
https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/Autism%20Spectrum%20Disorder-Q3%20July%202026%2020260702131100.pdf
https://www.legis.ga.gov/api/legislation/document/20132014/133687
https://codes.findlaw.com/ga/title-33-insurance/ga-code-sect-33-24-59-10/