EIDBI vs ABA: How Minnesota's Program Helps Families Access ABA Therapy
Short version:
ABA is a therapy approach. EIDBI is Minnesota's Medicaid benefit that can fund ABA (and a few related, evidence-based services) for eligible kids and young adults. It removes cost barriers and gives a structured path to care for families who qualify.
What is ABA therapy—quickly and clearly
Applied Behavior Analysis (ABA) uses teaching strategies (reinforcement, prompting, shaping, data-guided decisions) to help kids build communication, daily living, play, flexibility, safety, and more. Sessions can be in-home or in-center, one-to-one or small-group, and include parent training so progress continues between visits.
At Ability Avenues, we offer both in-home and center-based ABA.
What is EIDBI—and how is it different from ABA?
EIDBI = Early Intensive Developmental and Behavioral Intervention, a Minnesota Health Care Programs benefit for people under 21 with autism or a related condition when services are medically necessary. It's not a therapy by itself—it's the coverage framework that helps pay for services like ABA after eligibility steps are completed.
To use EIDBI, families typically need:
- A qualifying diagnosis and a Comprehensive Multi-Disciplinary Evaluation (CMDE) that documents medical necessity
- Enrollment in MA, MinnesotaCare, or MA-TEFRA (TEFRA often helps middle-income families qualify because it counts the child's income/disability needs)
- An Individual Treatment Plan (ITP) developed and updated by qualified providers
- A child under the age of 21
What EIDBI actually covers
EIDBI covers a small set of defined services that fit together across the care journey. Here's how they show up for families:
1) Comprehensive Multi-Disciplinary Evaluation (CMDE)
- Purpose: Establishes medical necessity and EIDBI eligibility; it's required to start and keep services authorized.
- What families experience: Record review, standardized/functional assessments, clinical observation, and a written summary with recommendations and intensity.
- By whom: A DHS-qualified CMDE provider (or supervised trainee) completes the evaluation and shares the report.
2) Individual Treatment Plan (ITP) development & progress monitoring
- Purpose: Turns CMDE findings into measurable goals, service types/intensity, settings, provider roles, and data procedures; then monitors progress and updates over time.
- What families experience: Clear goals, how/where therapy happens, how data are collected, and a predictable review cadence using DHS forms (e.g., DHS-7109).
3) Coordinated care conference
- Purpose: A structured meeting to align family, EIDBI clinicians, school, and medical teams—review progress, clarify roles, and adjust strategies so everyone rows in the same direction.
- What families experience: Documented participants, purpose, discussion points, and action items—billed only when it meets EIDBI criteria (not general admin).
4) Intervention (individual, group, higher intensity)
Purpose: The direct, individualized therapy time (e.g., ABA) that targets CMDE-identified needs and ITP goals.
What families experience:
- Individual sessions: tailored skill building and behavior support
- Group sessions: social/play/communication practice when clinically appropriate
- Higher-intensity: more staffing/structure when needs warrant; typically requires strong clinical justification and, in some cases, prior authorization
5) Intervention observation & direction (clinical supervision for the person's benefit)
- Purpose: A qualified provider observes active intervention, reviews data, models procedures, and gives real-time direction to improve outcomes and maintain fidelity.
- What families experience: On-the-spot coaching and protocol refinements tied to the child's plan (not generic staff training).
6) Family/caregiver training & counseling
- Purpose: Equips caregivers with strategies to support plan goals at home and in the community (visuals, prompting, reinforcement, transitions, community outings, bedtime routines, etc.).
- What families experience: Teaching + coaching tied to the ITP, documentation of topics, practice, feedback, and next steps.
Modalities: EIDBI recognizes multiple treatment modalities (ABA is one), and DHS periodically updates this list.
Telehealth, settings & compliance (what to expect)
- Where services happen: Home, clinic/center, and appropriate community locations. Some activities can be telehealth when clinically appropriate and compliant with DHS policy.
- Paper trail that matters: CMDE → ITP → services delivered → progress monitoring—each billed unit maps to a documented need/goal.
- Qualified providers & supervision: DHS-recognized roles with required supervision structures; agencies must meet MHCP requirements (and Minnesota is rolling out provisional licensure for EIDBI agencies).
EIDBI vs ABA—how they fit together
| Question | ABA Therapy | EIDBI (Minnesota program) |
|---|---|---|
| What is it? | A therapy approach delivered by trained clinicians (often BCBA-led teams). | A Minnesota Health Care Programs benefit that funds medically necessary services (like ABA) for eligible kids/youth. |
| Who decides the plan? | Your ABA team creates an ITP with measurable goals and family input. | State policy defines required elements; the CMDE and ITP drive what can be authorized and billed. |
| Who pays? | Private insurance or out-of-pocket if not covered. | MA/MinnesotaCare/MA-TEFRA coverage when EIDBI criteria are met. |
| What else is included? | Direct therapy + caregiver coaching. | Adds structured elements such as coordinated care conferences, mandated progress monitoring, and documentation links across CMDE → ITP → services. |
A realistic timeline from "we think we need help" to "we've started"
- Screen & refer → Ask your pediatrician or contact EIDBI providers; they'll explain current waitlists.
- CMDE → Evaluation that establishes medical necessity and EIDBI eligibility.
- Insurance step → If you're not on MA, explore MA-TEFRA (often the path for middle-income families).
- ITP & start of services → Your team crafts goals, schedules therapy (home/center), sets caregiver coaching, and coordinates with school/medical partners.
Heads-up on updates: Minnesota has been refining EIDBI policy, supervision expectations, and agency licensure steps. Providers should keep families informed as changes roll out.
What this looks like in Minneapolis/Twin Cities
Many families use a blend of in-home (great for daily-routine goals and caregiver coaching) and center-based sessions (helpful for structured learning and small-group practice). The mix is based on the CMDE and ITP—your child's needs and your family's routines lead.
How Ability Avenues can help (coverage & access)
- We provide in-center and in-home ABA across the Twin Cities.
- Current estimated waitlists (today): ~2–4 months for in-home; ~6–8 months for center-based.
- Part-time and full-time enrollment options to align with school schedules.
(When you contact us, we'll verify benefits and timelines for your specific plan.)
Simple next steps (parents say these help)
- If you suspect eligibility: Ask your pediatrician about an EIDBI referral and begin the CMDE step.
- If MA isn't set up yet: Explore MA-TEFRA so coverage is in place when your spot opens.
- While you wait: Start parent-coaching basics (routines, visuals, first-then language), and gather IEP/school notes to speed up goal-setting on day one.
FAQ (quick)
Is EIDBI only for young kids?
No—EIDBI is for birth through age 20 (under 21). Plans are individualized to age and goals.
Do we need a new diagnosis for EIDBI?
You need a CMDE that meets DHS requirements and shows medical necessity; it can incorporate existing diagnostic info.
Can EIDBI cover parent training?
Yes—caregiver training and counseling tied to the ITP are covered services under EIDBI.