Michigan Medicaid Autism Coverage
Michigan's Medicaid Autism Benefit covers ABA for children under 21 through Medicaid Health Plans and Community Mental Health Services Programs. Public Acts 99 & 100 require commercial insurers to cover ABA through age 18 with a tiered annual cap up to $50K for early childhood.
Quick Answer
Michigan's Medicaid Autism Benefit covers ABA for children under 21 through Medicaid Health Plans and Community Mental Health Services Programs. Public Acts 99 & 100 require commercial insurers to cover ABA through age 18 with a tiered annual cap up to $50K for early childhood.
- ABA benefit: covered under EPSDT for under 21 (via the michigan medicaid autism benefit).
- HCBS waivers: 4 relevant waiver options listed on this page.
- Commercial insurance: Michigan has a state autism insurance mandate.
Medicaid ABA Coverage
Yes — EPSDT
Under 21 (via the Michigan Medicaid Autism Benefit)
Insurance Mandate
Yes
Tiered: $50,000 (ages 0–6), $40,000 (ages 7–12), $30,000 (ages 13–18)
HCBS Waivers
4 available
Editorial Review
This page summarizes public Medicaid, waiver, and insurance-mandate information reviewed by the Autism Hearts editorial team.
Medicaid benefits, managed-care rules, and waiver waitlists can change quickly, so families should verify eligibility, prior authorization, and enrollment steps with the administering agency before relying on this page.
Last reviewed 2026-04-21 by Autism Hearts Editorial Team
Michigan Commercial Insurance Mandate
- Statute
- Michigan Public Acts 99 & 100 of 2012
- Year enacted
- 2012
- Age limit
- Through age 18
- Annual cap
- Tiered: $50,000 (ages 0–6), $40,000 (ages 7–12), $30,000 (ages 13–18)
Covered services
Self-funded employer plans (often from large employers) are regulated by federal ERISA law, not state mandates, and may be exempt. Always confirm your plan type on your Summary of Benefits and Coverage.
Medicaid ABA Therapy Benefit
Michigan's Medicaid Autism Benefit (launched 2013) covers ABA for children with autism under 21. Services are delivered through Medicaid Health Plans and accessed via the local CMHSP.
Michigan HCBS Waivers
Children's Waiver Program (CWP)
Covers autismChildren 0–17 with IDD at risk of institutionalization
Habilitation Supports Waiver (HSW)
Covers autismIndividuals with IDD needing extensive support
Children's Serious Emotional Disturbance (SED) Waiver
Medically complexChildren with serious emotional disturbance
MI Choice Waiver
Medically complexAdults 65+ or disabled needing nursing-home-level care
Katie Beckett / TEFRA Option
Available — Michigan Deeming Waiver (Children's Waiver)
The Children's Waiver Program functions as Michigan's Katie Beckett — qualifying children receive Medicaid based on their own income, not their parents'.
Early Intervention (Birth–3)
Early On Michigan (Part C) — Michigan's IDEA Part C program. Children under 3 with developmental delays can access services without a formal autism diagnosis.
Official Sources
Use these primary sources when you need to confirm current Medicaid rules, waiver access, or state-agency guidance in Michigan.