CHIP for ABA Therapy in Pennsylvania: Your Complete Guide

10 min read · Updated June 2026 · Trusted ABA Therapy editorial team

A parent cheering as a young child proudly builds a tall tower of colorful blocks

In short: CHIP (Children's Health Insurance Program) in Pennsylvania covers ABA therapy for eligible children under 19 with an autism diagnosis. The program typically has no cost-sharing for preventive care, but therapy visits may have a copay. Through Trusted ABA Therapy, you can get matched with a vetted BCBA-led provider that accepts CHIP. We break down how to use your CHIP coverage effectively.

Key takeaways

  • PA CHIP covers medically necessary ABA therapy for children under 19 with a formal autism diagnosis.
  • You need a diagnosis from a qualified professional, then find a CHIP-participating ABA provider.
  • CHIP has no monthly premiums and low out-of-pocket costs, often with copays for therapy visits.
  • Using a free matching service like Trusted ABA Therapy helps you find BCBA-led providers that accept CHIP.

What Is CHIP and How Does It Cover ABA Therapy in Pennsylvania?

The Children's Health Insurance Program (CHIP) in Pennsylvania provides low-cost health coverage for children and teens up to age 19 who do not qualify for Medicaid but whose families earn too much to afford private insurance. CHIP is administered by the Pennsylvania Insurance Department and offers comprehensive benefits, including applied behavior analysis (ABA) therapy for children diagnosed with autism spectrum disorder.

ABA therapy is covered under PA CHIP as a medical necessity. The specific benefits vary by CHIP plan (each plan is offered by a private insurer), but all plans must include coverage for autism services as required by Pennsylvania's Act 62 of 2008. This means that if your child has an autism diagnosis and a doctor has prescribed ABA, CHIP will help pay for those services-subject to prior authorization and medical necessity review.

Because Trusted ABA Therapy is a free matching service, we help families find BCBA-led providers that participate in CHIP plans. We do not provide therapy ourselves, but we can connect you with vetted clinics that accept your coverage.

A diverse family walking together along a tree-lined neighborhood street on a sunny afternoon

🔗 Related reading: ABA vs School for 8-Year-Old with Autism: A Guide · Local ABA Therapy

Who Is Eligible for CHIP and ABA Coverage?

To qualify for CHIP in Pennsylvania, your child must:

  • Be under 19 years old.
  • Be a U.S. citizen or qualified non-citizen.
  • Live in Pennsylvania.
  • Not have health insurance that meets CHIP's minimum standards (or be underinsured).
  • Meet income guidelines: family income up to 314% of the Federal Poverty Level (FPL) for most children, and up to 400% FPL for those under 1 year old.

For ABA therapy specifically, your child must also have a formal diagnosis of autism spectrum disorder from a qualified professional (such as a developmental pediatrician, child psychiatrist, or psychologist). Once you have that diagnosis, CHIP can cover the evaluation, treatment planning, and ongoing ABA sessions provided by a board-certified behavior analyst (BCBA) or under their supervision.

Note: Children under 3 years old may also be served through Pennsylvania's Early Intervention system, which works alongside CHIP. You can contact your local Early Intervention office for an evaluation even if you have CHIP.

Step-by-Step: How to Get ABA Therapy Through CHIP

1. Obtain an Autism Diagnosis

The first step is a comprehensive diagnostic evaluation. This can be done through your child's pediatrician, a developmental specialist, or a diagnostic clinic. If you need help finding a provider who accepts CHIP, reach out to your health plan's customer service or use a free matching service.

2. Apply for CHIP (If Not Already Enrolled)

If your child is not yet enrolled in CHIP, you can apply online through COMPASS (the state's benefits portal), by phone, or by mailing a paper application. The process is straightforward, and eligibility is usually determined quickly. There is a 30-day open enrollment window, but pregnancy and children can apply year-round.

3. Find a CHIP-Participating ABA Provider

Not all ABA clinics accept every CHIP plan. It is essential to check with your specific CHIP plan (e.g., UPMC for Kids, Geisinger Health Plan, Independence Blue Cross) to see their network of providers. This is where Trusted ABA Therapy can help. As a free matching service, we have relationships with BCBA-led clinics across Pennsylvania and can identify which ones accept your CHIP plan and have availability.

4. Obtain Prior Authorization (If Required)

Most CHIP plans require prior authorization for ABA therapy. Your ABA provider will typically handle this paperwork, submitting the diagnosis, treatment plan, and session frequency to the insurance plan. The plan will review for medical necessity. This process can take a few weeks, so begin early. If denied, you have the right to appeal.

An adult and a young child pointing together at colorful picture-learning cards on a table

🔗 Related reading: ABA Therapy Cost in Florida: What Families Pay · Nearby ABA Therapy

Costs and Coverage Details: What Will You Pay?

CHIP is designed to be affordable. There are no monthly premiums for families with income under 250% FPL. For those above that threshold, a small monthly premium may apply. Copays for doctor visits and specialist care are typically low, often $5-$20. ABA therapy visits may have a copay, but caps on out-of-pocket expenses are in place. Importantly, preventive care-including most well-child visits-has no copay.

You will not pay for the initial autism evaluation if it is performed by a CHIP-participating provider and deemed medically necessary. Once ABA therapy begins, you may have a copay per session, but the plan will cover a significant portion of the cost. If cost is a concern, some CHIP plans offer additional subsidies or reduced copays for lower-income families.

Because each CHIP plan is different, we recommend calling the number on your insurance card or checking your member handbook for specific copay amounts for behavioral health services.

CHIP vs. Medicaid vs. Private Insurance: What's the Difference?

Pennsylvania offers several paths to coverage for ABA therapy:

  • Medicaid (Medical Assistance): For families with very low income. Medicaid covers ABA with no copays.
  • CHIP: For families with moderate income (above Medicaid limits but below 314% FPL). Low cost, but may have copays.
  • Private Insurance: Employer-sponsored or individual plans. Many are subject to Pennsylvania's autism insurance mandate but may have higher deductibles and copays.

If your child qualifies for both CHIP and private insurance, CHIP can sometimes be used as a secondary payer to cover costs the primary plan does not. Trusted ABA Therapy can help you navigate these options.

A parent and a delighted young child blowing soap bubbles together in a sunny backyard

Tips for Success: Navigating CHIP for ABA

  • Start early. The diagnostic and authorization process can take months. Begin as soon as you suspect a need for ABA.
  • Check your plan's ABA coverage details. Log into your member portal or call customer service to ask about session limits, copays, and network requirements.
  • Use a free matching service. Let Trusted ABA Therapy do the legwork of finding BCBA-led clinics that accept your CHIP plan and have openings.
  • Prepare for waitlists. Many BCBA-led clinics have waitlists due to high demand. Being willing to travel a bit or explore telehealth options can help.
  • Keep records. Save all correspondence with insurance, prior authorization letters, and treatment plans. This helps if you need to appeal a denial.
  • Ask about in-home or community-based ABA. Some CHIP plans cover ABA in settings other than a clinic, which may be more convenient and available sooner.

Common Mistakes to Avoid

  • Assuming all CHIP plans cover ABA exactly the same way. Even though Pennsylvania mandates autism coverage, each plan can define medical necessity and session limits. Always verify with your specific plan.
  • Delaying the diagnostic evaluation. Without a formal diagnosis, ABA cannot be authorized. If your child is exhibiting signs, pursue an evaluation early-even if they are very young.
  • Not checking the provider's availability before starting the authorization process. Some clinics are full. Use a matching service to find providers with current openings.
  • Ignoring the appeals process. If your request for ABA is denied, do not give up. You have the right to request an internal appeal, and if that fails, an external review.
  • Overlooking Early Intervention for children under 3. Early Intervention can provide additional supports and often coordinates seamlessly with CHIP.

Additional Resources and Support

For more information, visit the Pennsylvania Insurance Department's CHIP page or call 1-800-986-KIDS. You can also contact the Pennsylvania chapter of the Autism Society of America for parent support groups and advocacy.

As a final reminder, Trusted ABA Therapy is a free matching service dedicated to helping families like yours find vetted, BCBA-led ABA providers that accept CHIP in Pennsylvania. We do not provide therapy directly, but we simplify the search so you can focus on your child's progress. Start your free search today by visiting trustedabatherapy.com and clicking 'Get Matched'.

Sources & further reading
About this guide. Written and reviewed by the Trusted ABA Therapy editorial team. This article is general educational information, not medical advice - please consult a qualified professional such as a BCBA or your pediatrician about your child's needs. Last updated June 2026.

Frequently asked questions

Is ABA therapy covered under Pennsylvania CHIP?

Yes, PA CHIP covers medically necessary ABA therapy for children under 19 with a formal autism diagnosis. Plans must follow the state's autism insurance mandate, though specific copays and session limits vary.

Do I need a referral from my child's doctor for ABA through CHIP?

Not always, but a prescription for ABA is typically required. Your child's pediatrician or specialist can provide a written order supporting medical necessity. This is often needed for prior authorization.

What is the age limit for CHIP coverage of ABA?

CHIP covers children up to age 19. However, some plans may impose lower age caps (e.g., age 21) for certain services. For ABA specifically, coverage usually continues until the child ages out of CHIP or no longer meets medical necessity criteria.

Can I use CHIP if I also have private insurance?

Yes, CHIP can serve as secondary insurance. Your primary plan (such as an employer plan) will pay first, and CHIP can cover remaining costs like copays or deductibles. Make sure both plans coordinate benefits.

How long does prior authorization for ABA take with CHIP?

Typically 2-6 weeks. The timeline depends on your plan and how quickly the provider submits the required documentation. Starting early and using a provider experienced with CHIP can help speed things up.

Does Trusted ABA Therapy place children with CHIP only?

No, we match families with vetted BCBA-led providers regardless of insurance type. We include CHIP plans in our network, but also work with Medicaid, private insurance, and self-pay families. Our service is always free.

More from the blog

More ABA guides from across our network

From across our ABA network

Ready to find ABA care near you?

Free, fast, and no obligation.

Get matched now →