Yes. PeachCare for Kids covers Applied Behavior Analysis (ABA Therapy) for eligible children diagnosed with Autism Spectrum Disorder (ASD) in Georgia. PeachCare for Kids is Georgia’s Children’s Health Insurance Program (CHIP) and provides comprehensive health coverage for uninsured children under age 19, including medically necessary behavioral health services.

ABA Therapy is treated as a covered mental and behavioral health service when eligibility, diagnostic, and authorization requirements are met.

What Is PeachCare for Kids?

PeachCare for Kids is a state-sponsored health insurance program created to ensure uninsured children in Georgia have access to affordable, comprehensive medical care. The program began in 1998 following federal authorization under Title XXI of the Social Security Act and continues to serve families whose income exceeds Medicaid limits but remains within program guidelines.

Children enrolled in PeachCare for Kids receive coordinated care through a Georgia Families Care Management Organization (CMO), which manages benefits, provider networks, and authorizations.

ABA Therapy Coverage Through PeachCare for Kids

PeachCare for Kids follows Georgia Medicaid behavioral health guidelines. ABA Therapy is covered when it is deemed medically necessary for a child with Autism Spectrum Disorder and supported by appropriate clinical documentation.

Coverage typically requires:

• A formal ASD diagnosis based on DSM-5 criteria

• Documentation showing ABA Therapy is medically necessary

• A treatment plan developed and supervised by a Board Certified Behavior Analyst (BCBA)

• Prior authorization through the child’s assigned Care Management Organization

Once authorized, ABA Therapy Services may be provided in approved settings based on the child’s individualized treatment plan.

Care Management Organizations (CMOs) and ABA Therapy

Every child enrolled in PeachCare for Kids is assigned to a Georgia Families CMO, which is responsible for coordinating care and approving services such as ABA Therapy. The primary CMOs include:

• Amerigroup Community Care

• CareSource

• Peach State Health Plan

The assigned CMO manages prior authorization, provider networks, and ongoing service approvals for ABA Therapy.

Who Is Eligible for PeachCare for Kids?

Children may qualify for PeachCare for Kids if they:

• Are under the age of 19

• Live in Georgia

• Are uninsured

• Reside in a household with income at or below program limits

Eligibility is income-based and separate from disability status, making PeachCare an important option for families who do not qualify for Medicaid.

Costs, Premiums, and Co-Payments

PeachCare for Kids is designed to remain affordable for families.

• Premiums are resuming as of October 1, 2024, depending on eligibility and renewal status

• Co-payments may apply for some services, typically ranging from low amounts

• No premiums or co-payments apply for children under age six, children in foster care, or American Indian and Alaska Native children

Preventive services, emergency care, immunizations, and routine dental services are not subject to co-payments.

Behavioral Health Services Covered by PeachCare for Kids

In addition to ABA Therapy, PeachCare for Kids may cover other medically necessary services related to autism care, including:

• Mental and behavioral health services

• Speech therapy

• Occupational therapy

• Diagnostic evaluations and follow-up care

Coverage is coordinated through the child’s CMO and primary care provider.

ABA Therapy with Regency ABA Therapy and PeachCare for Kids

Regency ABA Therapy works with families enrolled in PeachCare for Kids to help navigate eligibility, prior authorization, and ongoing coordination of ABA Therapy Services. Support is provided to help families understand requirements, work with their assigned CMO, and move forward with care once coverage is confirmed.

PeachCare for Kids ABA Therapy FAQ

Does PeachCare for Kids require prior authorization for ABA Therapy?
Yes. Prior authorization through the child’s Care Management Organization is required before ABA Therapy Services can begin.

Is ABA Therapy covered for all children with autism under PeachCare?
Coverage depends on meeting diagnostic criteria, medical necessity, and authorization requirements.

Are there out-of-pocket costs for ABA Therapy with PeachCare for Kids?
Costs vary by age and eligibility category. Many children, including those under age six, are exempt from premiums and co-payments.

Who manages ABA Therapy approvals under PeachCare for Kids?
Approvals are handled by the child’s assigned Georgia Families Care Management Organization.

Understanding PeachCare for Kids ABA Therapy Benefits

PeachCare for Kids plays an important role in expanding access to ABA Therapy for uninsured children in Georgia. By understanding eligibility rules, the role of CMOs, and authorization requirements, families can more confidently navigate the process and access medically necessary autism behavioral therapy for their child.