Most Minnesota families can get ABA therapy covered — and many pay nothing out of pocket. Coverage runs through the EIDBI benefit, which is funded by Medical Assistance, MinnesotaCare, or MA under the TEFRA option. This page explains every path plainly, including the ones we can't take you down.
The fastest way through it is a phone call — we'll work out what your child already has and what they're missing, for free, before you commit to anything.
Not every ABA provider in Minnesota accepts Medical Assistance. We do. Here is our complete list — short, specific, and the whole truth, so you know in about ten seconds.
Medical Assistance billed directly to the state. If your child has Straight MA, EIDBI is a covered benefit and we bill it directly.
Blue Cross and Blue Shield of Minnesota's public-programs plan — the managed care organization that administers Medical Assistance and MinnesotaCare for many Minnesota families.
TEFRA is Medical Assistance — a different door into the same program. Once your child is on MA-TEFRA, we bill it like any other MA coverage.
Minnesota delivers Medical Assistance two different ways, and most families have no idea which one they have. It is the same benefit either way — what changes is who administers it.
It matters here because coverage questions, prior authorizations, and provider networks all run through whoever is holding the pen. Ability Avenues accepts Straight MA and Blue Plus.
Straight MA
The state pays directly
Also called fee-for-service, or MA-FFS. There is no health plan in the middle: your provider bills the Department of Human Services, and the state pays.
An MCO
A health plan administers it
A managed care organization — often called PMAP. Minnesota pays a health plan, such as Blue Plus, and that plan runs the network and the authorizations.
Find out which one you have: look at your child's insurance card. If it names a health plan — Blue Plus, or another carrier — you're in managed care. If it's a Minnesota Health Care Programs card with no plan name, that's Straight MA. Not sure? Read it to us over the phone.
Every one of these ends in the same place: your child's ABA therapy is funded through Minnesota's EIDBI benefit, and we bill it. They differ only in how you get there. One of them almost certainly fits your family.
The simplest path — and you may already be on it.
For families who earn too much for MA, but not enough for comfort.
The path most middle- and higher-income families have never heard of.
EIDBI eligibility criteria per Minnesota DHS; TEFRA parental-fee elimination per DHS parental fees. Verified July 2026.
If you have been told your family earns too much for Medical Assistance, this is the section to read twice. MA under the TEFRA option qualifies a child with a disability by counting only the child's own income — not the household's. For a young child, that income is usually zero.
And since July 1, 2023, Minnesota no longer charges a parental fee for children on MA-TEFRA who live at home. A path that used to come with a monthly bill now, for most families, does not.
TEFRA is not a formality, and an autism diagnosis alone does not qualify a child. Four things have to be true. We would rather you learn the fourth one here than three months into an application.
TEFRA covers children under 19 who live with at least one parent. (Note the difference from EIDBI, which runs to 21 — TEFRA is the coverage, EIDBI is the benefit that coverage unlocks.)
The State Medical Review Team (SMRT) must certify your child as disabled — or Social Security already has. SMRT reviews medical, psychological, and school records.
This is the requirement families are most often blindsided by. SMRT must find that your child needs a level of care at home comparable to a hospital, nursing facility, or an intermediate care facility for people with developmental disabilities — and that caring for them at home costs less than institutional care would.
This is the good news, and it's the whole point of TEFRA: your household income does not disqualify your child. Eligibility is measured against the child's own income, which for most young children is nothing at all.
Plan for the wait. County processing can take up to 60 days, and a State Medical Review Team determination can take several months on top of that. Start the application before you think you need to — and call us in the meantime, because the CMDE and the rest of intake don't have to wait for it.
TEFRA requirements per the DHS Eligibility Policy Manual and Minnesota DHS. Free one-on-one help with the application is available from Disability Hub MN.
We don't bill commercial plans, so we have nothing to gain by explaining this well. We're going to anyway, because almost nobody does — and a parent who understands the cost model can actually make a decision.
Minnesota law helps you here. Under Minn. Stat. § 62A.3094, health plans issued to large employersmust cover the diagnosis and medically necessary treatment of autism spectrum disorder for children under 18 — explicitly including all types of applied behavior analysis, under an individualized treatment plan. Coverage is not the usual fight.
The catch is the cost model. “Covered” is not the same as “free,” and with ABA the gap between those two words is unusually wide. ABA is delivered in a lot of hours per week, and a commercial plan charges you against every one of them, in this order:
What you pay yourself before the plan pays anything. ABA is delivered in many hours per week, so a family starting therapy in January typically burns through the full deductible within the first weeks of treatment — not over the course of a year.
After the deductible, you keep paying a share — often a percentage of every session. A modest-sounding percentage behaves very differently against 20 or 30 therapy hours a week than it does against an annual physical.
The ceiling. Once your spending hits it, the plan covers 100% of covered services for the rest of the plan year. Because ABA is intensive, most families who use it heavily reach this ceiling — which is why the out-of-pocket maximum, not the copay, is the number that actually describes your year.
On the first day of the new plan year, the deductible and the out-of-pocket maximum both reset to zero, and you climb the same hill again. Therapy that felt free in November is expensive again in January.
Self-funded plans. Many large employers pay claims out of their own pocket and hire a carrier only to administer them. Those plans are governed by federal law, not Minnesota's mandate — so the state autism law above may not bind your plan even though the card in your wallet says a familiar name. Most self-funded plans still cover ABA. You have to ask.
Network status. In-network and out-of-network are different worlds at ABA hour counts. Ask before you fall in love with a provider — including us.
Call the member number on your card and ask these, in this order. Write the answers down — you'll need them for every provider you talk to.
This is the most common situation we can't answer in one line, so here is the honest version — the parts that are simple, and the part that isn't.
A child can be enrolled in commercial insurance and Medical Assistance at the same time. Applying for MA or TEFRA does not mean giving up your employer plan — and in most cases you shouldn't. Keep it.
Minnesota treats Medical Assistance as the payer of last resort. Your commercial plan stays primary: it pays first for what it covers, and MA wraps around it, picking up what's left under MA's rules (Minn. R. 9505.0070).
Because we don't bill commercial plans, what your primary coverage means for therapy with usdepends on your specific plan. We won't guess at that on a web page. Call us and we'll work it out together, before anything is scheduled.
Ask your carrier the five questions in the section above. You need to know what you already have before you go looking for something else.
Call your county or tribal agency and say you want to apply for Medical Assistance for your child and be considered under the TEFRA option. Say TEFRA out loud — it isn't always offered.
Get free help with the paperwork. Disability Hub MN does this every day, at no cost, and they are genuinely good at it. There is no reason to do it alone.
Call us in parallel. Don't wait for a determination letter to start the conversation. We'll tell you honestly whether we think the path works for your family.
The whole page in one table. If you only read one thing, read the last two rows.
| Comparison point | Straight MA | MA / MinnesotaCare via Blue Plus | MA through TEFRA | Commercial insurance |
|---|---|---|---|---|
| Who it fits | Families whose income qualifies for Medical Assistance. | MA or MinnesotaCare families enrolled in the Blue Plus health plan. | Children with a significant disability whose family income is above the MA limit. | Families with coverage through an employer or the individual market. |
| What decides eligibility | Household income. | Household income, plus your choice of health plan. | The child's own income only — plus a SMRT disability and level-of-care determination. | Your employer's plan terms; for large-employer plans, Minn. Stat. § 62A.3094. |
| Typical cost to the family | No copays for children under 21. | No copays for children under 21; MinnesotaCare may carry a small monthly premium. | No parental fee for children living at home (since July 1, 2023). | Deductible, then coinsurance, up to your out-of-pocket maximum — and it resets each plan year. |
| Covers EIDBI? | Yes — EIDBI is an MA benefit. | Yes — same MA benefit, administered by the health plan. | Yes — TEFRA is MA. | No. EIDBI is a Medical Assistance benefit. Commercial plans cover ABA under their own terms instead. |
| Does Ability Avenues bill it? | Yes. | Yes. | Yes. | No — we do not bill commercial plans. Call us and we'll talk through your options. |
| How to start | Call us — you may already be covered. | Apply through MNsure; choose Blue Plus as your plan. | Apply for MA through your county or tribal agency and ask for a TEFRA determination. | Ask your carrier the five questions below — then call us about MA and TEFRA. |
Table scrolls sideways on small screens. Every claim in it is sourced in the sections above.
Funding navigation is part of intake, not a favor. Here is exactly what we do, and exactly what stays yours.
The full sequence — what to have ready, who you'll talk to, what happens after each call — is on the intake process page.
On the first call, we work out what coverage your child actually has — Straight MA, a managed care plan, MinnesotaCare, commercial, or nothing yet. Most families are not certain, and that is completely normal.
Including when the answer is “not this one.” If TEFRA is unlikely to clear the level-of-care requirement for your child, you'll hear that from us early, not after months of waiting.
Verifying coverage, facilitating the CMDE through our partner agencies, building the treatment plan, and filing for authorization. The county application is yours to submit — we'll help you make sense of it, and point you to free navigators who do this all day.
Some of this waits on the state, and no provider controls that. SMRT determinations in particular can take months. We give you a current, realistic picture rather than a number that sounds good on a phone call.
Don't take a provider's word for what your child is entitled to — not even ours. These are the official sources behind every claim on this page.
The program's official home: who's eligible, what's covered, and current policy — straight from the Department of Human Services.
The state's own page on TEFRA: eligibility, the application, and how the option works for children with disabilities.
Plain-language help with TEFRA, plus free one-on-one navigation by phone or chat. If you call one number on this page that isn't ours, make it this one.
A parent-facing walkthrough of the TEFRA application, the SMRT process, and what to do if your child is denied.
The offices that process Medical Assistance and TEFRA applications. Your county financial worker is the person who starts a TEFRA determination.
Where you apply for MA and MinnesotaCare, and where you choose Blue Plus as your health plan.
The statute requiring large-employer health plans in Minnesota to cover autism treatment, including all types of applied behavior analysis, for children under 18.
The money questions Minnesota families actually ask — with answers that don't dodge. More on the full FAQ page.
For many families, yes — and we understand why that sounds too good to be true. ABA delivered through Minnesota's EIDBI benefit is covered by Medical Assistance, and children under 21 on MA have no copays for covered services. What we won't tell you is that it's free for everyone: it depends on the coverage your child has, and getting that coverage is sometimes the hard part. That part is what this page — and our first phone call — is for.
Same benefit, two different administrators. With Straight MA — also called fee-for-service — the state pays your child's providers directly. With a managed care organization(an MCO, sometimes called PMAP), the state pays a health plan instead, and that plan runs your network and your prior authorizations. Blue Plus is one of those plans. The practical test: look at your card. If it names a health plan, you're in managed care. If it's just a Minnesota Health Care Programs card, you're on Straight MA. We accept both.
This is the single most common reason a Minnesota family gives up on coverage, and it's usually the wrong reason. Ask about MA under the TEFRA option: it lets a child with a disability qualify for Medical Assistance counting only the child'sincome, not yours. Since July 2023 there is no parental fee for children on MA-TEFRA living at home. It is not automatic — the State Medical Review Team has to certify both a disability and an institutional level of care — but for the families it fits, it changes everything.
No — and we'd rather say so on our own website than waste your time. Ability Avenues bills Straight MA and Blue Plus. We do not bill commercial plans. Call us anyway: many families with private insurance alsoqualify for Medical Assistance through the TEFRA option, and that's a path we can walk with you.
Yes — and you generally don't have to give up your private plan to get MA. Minnesota treats Medical Assistance as the payer of last resort: your commercial plan pays first for what it covers, and MA covers what's left, under MA's rules (Minn. R. 9505.0070). What that means for therapy with us depends on your specific plan, so it's a conversation, not a formula. Call us before you assume it rules you out — or that it doesn't.
It's the payer saying “yes” in advance. Your child's Board Certified Behavior Analyst submits an Individual Treatment Plan — the goals, and the hours it takes to reach them — and Medical Assistance or your health plan authorizes those hours for a set stretch of time. When it runs out, we submit an updated plan and it's reviewed again. We file all of this; it's not paperwork you chase.
It depends on where you're starting, and we'd rather be honest than encouraging. If your child already has MA, this moves quickly. If you're applying for MA or TEFRA first, county processing can run up to 60 days, and a SMRT determination can take several months on top of that. None of that is in a provider's control. What we can do is start on day one, carry the parts that are ours, and tell you where things actually stand.
A denial is a step, not a verdict — and it's more common than people admit. You have the right to appeal, and denials are sometimes reversed when the documentation is stronger the second time. You don't have to do it alone or pay anyone: Disability Hub MN gives free one-on-one help at 1-866-333-2466, and The Arc Minnesota publishes a guide to appealing a TEFRA denial.
Call us. We'll help you figure out eligibility, coverage, and next steps. The first conversation needs no paperwork at all.
