Under the Illinois autism insurance mandate 2026, there is no longer a single, fixed number of hours for all patients. Instead, the law has significantly changed how therapy limits are handled to ensure children receive the care they need based on medical necessity.
Key details regarding hour limits under the new mandate include:
- Increased Caps: Annual therapy hour caps have been significantly increased compared to previous insurance standards.
- Removal of Limits for Severe Cases: In severe cases, the mandate requires that annual therapy hour caps be removed entirely. This ensures that treatment decisions are driven by the medical necessity of the child rather than arbitrary thresholds.
- Medical Necessity: Coverage is required for medically necessary Applied Behavior Analysis (ABA) for children diagnosed with autism spectrum disorder.
While the mandate establishes these baseline requirements for state-regulated plans, it is important to note that exact coverage details can still vary between specific insurance policies. Brighter Care ABA provides assistance with insurance verification to help families understand the specific provisions of their plan.
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