If you’re a New York state employee or public school teacher, you may be covered under NYSHIP—the New York State Health Insurance Program. One of the most common questions we hear from families is: Does NYSHIP cover ABA therapy for children with autism? The short answer is: Yes, in most cases NYSHIP does provide coverage for ABA therapy when specific requirements are met.
Let’s break it down in simple terms, so you know what to expect and how to get started.
What is NYSHIP?
NYSHIP (New York State Health Insurance Program) is the state’s employee health plan. It provides insurance coverage to:
- New York state employees
- Public school district staff
- Participating local government workers
- Retirees and eligible dependents
The most common plan under NYSHIP is The Empire Plan, which offers extensive medical benefits including behavioral health services like ABA therapy.
Read more: Does Medicaid Cover ABA Therapy in New York?
Does NYSHIP Cover ABA Therapy?
Yes, ABA therapy is generally covered under NYSHIP’s Empire Plan as part of its behavioral health services. ABA, or Applied Behavior Analysis, is an evidence-based therapy widely recommended for children diagnosed with Autism Spectrum Disorder (ASD).
However, to receive coverage, certain conditions must be met:
- Your child must have a formal ASD diagnosis from a qualified healthcare professional.
- The ABA services must be deemed medically necessary.
- Services should be provided by a licensed or credentialed ABA provider.
- Preauthorization or prior approval may be required for coverage to begin.
Why Families Trust ABA with NYSHIP
If you’re using NYSHIP insurance, the good news is that ABA therapy can often be accessed with little to no out-of-pocket costs, depending on your specific benefits plan. That said, insurance policies can be complex. This is why working with an ABA provider who understands NYSHIP is so important.
At ABC Achieve, we work directly with families covered by NYSHIP to:
- Confirm eligibility
- Handle benefits investigation
- Obtain necessary pre-authorizations
- Submit claims and manage approvals
Our goal is to make the process as smooth and stress-free as possible, so your child can start receiving services without delay.
Read More: What’s the Difference Between Fidelis, Healthfirst, and UHC?
What If NYSHIP Denies ABA Therapy?
If you’re denied coverage, don’t give up. There are a few things you can do:
- Ask for a detailed explanation of the denial.
- File an appeal—many decisions can be overturned with additional documentation.
- Work with your ABA provider to supply necessary records or assessments.
- Check if alternate plans (like spousal insurance or Medicaid waivers) may help cover services.
Tailored Support for NYSHIP Members
We understand how important it is to get your child the care they need especially when you’re juggling a career in public service. Our experienced team supports families like yours every step of the way, whether you’re a teacher, state employee, or retiree.
With in-home ABA therapy across New York, we make it easier for working families to access high-quality, compassionate autism care right from the comfort of home.
Final Thoughts
Navigating NYSHIP ABA therapy coverage doesn’t have to be overwhelming. If you have questions, we’re here to help. Our team at ABC Achieve will guide you through the process, advocate on your behalf, and provide your child with the expert care they deserve. Contact us today to find out if your NYSHIP plan covers ABA therapy for your child.
You Might Also Like:
- What Insurance Covers ABA Therapy in New York?
- Anthem Blue Cross Blue Shield ABA Coverage for New York Families
- UnitedHealthcare ABA Therapy Coverage in NY: What You Need to Know
Starting January 1, 2014, the Empire Plan (under NYSHIP) includes coverage for Applied Behavior Analysis (ABA) services for children with Autism Spectrum Disorder. This coverage allows for up to 680 supervised hours per year, applicable to both in-network and out-of-network services. (Source: Stony Brook Education)
