Yes, Virginia Medicaid (DMAS) does have specific guidelines regarding weekly hour limits for ABA therapy in 2026. Under the EPSDT benefit, which ensures children under 21 can access medically necessary services, the following limits typically apply based on the service setting:
- Home-based ABA therapy: Generally covered for up to 20 hours per week.
- Center-based ABA therapy: Often limited to 15 hours or fewer per week and may require additional medical necessity reviews.
- School-based consultation: Typically limited to 10 hours or fewer per week and requires a school support plan.
- Parent training: Usually includes up to 2 hours per week and is integrated into the child’s overall treatment plan without needing a separate authorization.
All services require prior authorization to verify they meet the DMAS medical necessity criteria. We understand that navigating these limits can feel overwhelming, but at Brighter Care ABA, our insurance management team handles the authorization and paperwork for you because you’re not on your own.
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