Why the Autism Waiver Disappeared in Many States, and What Replaced It
Some parents still go looking for a program that closed years ago. The name lives on in old forum threads, outdated pamphlets, and advice passed between families. Meanwhile, the funding for ABA therapy services moved somewhere else entirely.
An autism waiver is a Medicaid home and community-based services (HCBS) program a state designs specifically for autistic children, usually to pay for behavioral therapy outside standard Medicaid rules. Many states retired theirs after federal regulators clarified in 2014 that Medicaid must already cover medically necessary autism treatment for children under 21. The short answer: most autism waiver programs were discontinued because ABA therapy moved into regular Medicaid through a benefit called EPSDT, and broader disability waivers now handle extras like respite care.
What an Autism Waiver Was, and Why Families Relied on It
Standard Medicaid follows strict federal rules. Waivers let states bend those rules for a defined group. An autism waiver typically did three things:
- Paid for intensive behavioral therapy that the state plan did not list
- Targeted a narrow group, often by age and level of need
- Capped enrollment, which created waitlists
Colorado's version shows how narrow these programs could be. According to federal waiver records, it covered behavioral therapy and treatment evaluations for autistic children ages 0 to 5 who met an institutional (ICF/IID) level of care. It was terminated on July 1, 2018.
These programs did real good while they lasted. A 2017 Health Affairs study led by Douglas Leslie of Penn State College of Medicine, with researchers from RAND and the University of Pennsylvania, found that raising waiver cost limits and enrollment limits significantly reduced the odds that a parent had to stop working. The effect varied by household income.
Researchers have also tracked how state Medicaid programs serving autistic people changed between 2004 and 2015, sorting them into autism-only, autism or intellectual disability, and intellectual disability-only groups. The trend matters for families today, because paying for care still depends on who covers ABA therapy in your specific state.
The 2014 Ruling That Reshaped the Autism Waiver Landscape
On July 7, 2014, Cindy Mann, then Director of the Center for Medicaid and CHIP Services, issued federal CMS guidance titled Clarification of Medicaid Coverage of Services to Children with Autism. It laid out every legal route states could use to fund autism services: the state plan under section 1905(a), 1915(i) state plan HCBS, 1915(c) waivers, and 1115 demonstrations.
The bulletin did not create a new benefit. It clarified an existing one. Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit already required states to cover medically necessary treatment for enrolled children under 21.
That clarification had direct consequences. Utah's Medicaid agency told state lawmakers in a Utah legislative report that CMS no longer permitted ABA as a waiver benefit, since the service had to be available through EPSDT.
Here is why states wound down their autism-specific waivers:
- Duplication. Paying for ABA through a waiver overlapped with a benefit Medicaid already owed children.
- Reach. Waivers could limit slots and ages. EPSDT applies to every eligible child under 21 when treatment is medically necessary.
- Simplicity. One coverage pathway is easier to administer than two running side by side.
Does Medicaid Cover ABA Therapy Now? How EPSDT Took Over
Yes, in the states Inclusive ABA serves, Medicaid covers medically necessary ABA through the state plan rather than an autism waiver. The details differ by state.
Nevada built its coverage in public. The Nevada Medicaid summary confirms ABA became a covered benefit on January 1, 2016, for children under 21 with an autism diagnosis. The state now goes further: the Nevada Health Authority covers ABA for recipients of all ages, including those with fetal alcohol spectrum disorder. Families comparing Medicaid with private plans should also know about the Nevada insurance cap and when it may not apply. Local details are on our page for ABA therapy in Nevada.
Ohio now has formal Ohio Medicaid rules spelling out ABA coverage, documentation expectations, limitations, and reimbursement, along with who qualifies as a rendering provider.
Nebraska families work under the same federal EPSDT requirement. Our breakdown of Nebraska reimbursement options covers how Medicaid fits alongside other funding.
Federal support keeps expanding too. In August 2026, CMS added a new federal ABA toolkit for state Medicaid and CHIP programs to its autism services resources.
Covered ABA can happen in more than one setting, including in-home ABA sessions, as long as the treatment plan supports it and authorization is in place.
HCBS Waiver Support Today: The CES Waiver Colorado Families Use
Waivers did not vanish. Their job changed. Today an HCBS waiver typically covers the supports that fall outside medical treatment.
Colorado's EPSDT rules state this directly: services Colorado offers through a waiver, such as respite, in-home support, and home modifications, are not EPSDT benefits. So therapy comes from one door, and daily-life supports come from another.
For many Colorado families, that second door is the Children's Extensive Support (CES) waiver. Under the published CES waiver criteria, a child must:
- Be under 18 and live in the family home
- Have a developmental disability, or a developmental delay if under age 5
- Need direct human intervention at least once every two hours during the day, plus overnight support on a weekly average
- Meet an institutional (ICF/IID) level of care and federal disability criteria
The waiver's brochure lists services such as respite care, parent education, assistive technology, home accessibility adaptations, and a community connector. CES members also keep all Health First Colorado benefits that are not duplicative. Our overview of Colorado ABA coverage and our page on ABA therapy in Colorado explain how these pieces work together locally.
Nevada uses a different model. Nevada's ATAP program is a temporary, state-run assistance program, not a Medicaid waiver. It acts as the payer of last resort, so Medicaid or private insurance must be used first.
A real-world scenario. Picture a mom in Fort Collins whose 4-year-old son was recently diagnosed. A relative tells her to apply for "the autism waiver." She calls and learns it closed in 2018. Here is the path that replaced it:
- Her son's Health First Colorado coverage becomes the funding source for ABA under EPSDT.
- An ABA provider completes the intake and requests prior authorization.
- Separately, she contacts her local Case Management Agency to ask about CES, since her son needs frequent support at night and she needs respite.
- She joins parent training sessions so the skills from therapy carry into bedtime and mealtimes.
Therapy started without waiting on a waiver slot. The waiver application runs on its own track. That split reflects how our clinical team approaches funding questions with families every week.
The autism waiver era ended for a practical reason. Federal law already guaranteed children the treatment those waivers were paying for. What remains is a two-part system: EPSDT for medically necessary ABA, and broader HCBS waivers for respite, equipment, and family support.
Not sure which part applies to your child? Connect with our team and we'll help you separate the therapy question from the waiver question, so neither one slows the other down.
Frequently Asked Questions
What is an autism waiver?
An autism waiver is a state Medicaid HCBS program designed specifically for autistic children, often to fund behavioral therapy. Many states discontinued theirs after 2014.
Does Medicaid cover ABA therapy?
Yes. Medicaid covers medically necessary ABA for eligible children under 21 through the EPSDT benefit.
Why did Colorado end the autism waiver?
Colorado terminated its autism-specific waiver on July 1, 2018, as ABA became available through regular Medicaid under EPSDT.
What is the CES waiver in Colorado?
The CES waiver is a Colorado HCBS program for children under 18 with developmental disabilities and high support needs. It covers services like respite, parent education, and home adaptations.
Do I need a Medicaid waiver for ABA therapy?
Usually not. Eligible children can receive medically necessary ABA through standard Medicaid without a waiver slot.
Is Nevada's ATAP a Medicaid waiver?
No. ATAP is a state-funded assistance program that pays only after Medicaid or insurance.
Sources:
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/CO
- https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1136
- https://pubmed.ncbi.nlm.nih.gov/34251042/
- https://www.medicaid.gov/federal-policy-guidance/downloads/cib-07-07-14.pdf
- https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/legislative%20reports/hhs%20services/AutismWaiver11-15.pdf
- https://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Pgms/CPT/ABAReports/ABA_Summary.pdf
- https://www.nevadamedicaid.nv.gov/programs/applied-behavior-analysis-aba/
- https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Stakeholders,%20Partners/LegalandContracts/Rules/DR-NonBIA/ERF188422.pdf
- https://www.medicaid.gov/medicaid/benefits/autism-services
- https://hcpf.colorado.gov/epsdt
- https://hcpf.colorado.gov/childrens-extensive-support-waiver-ces
- https://adsd.nv.gov/Programs/Autism/ATAP/ATAPIAPFAQ/
- https://hcpf.colorado.gov/sites/hcpf/files/Children%27s%20Extensive%20Support%20Waiver%20Brochure-v15.pdf
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