Navigating Kentucky’s Behavioral Therapy Payment Options

Spectrum Behavioral Services of Kentuckiana sees waiver clients through an agency in Louisville. I provide private-pay parent training and consultation on a very limited basis. I no longer accept insurance, which includes Medicaid and MCOs. To assist visitors to this page I will explain Kentucky’s pathways to behavior services, even if they don’t lead to me.

Read on for more information about paying for behavior therapy through:

  • Private pay
  • Medicaid waivers
  • Commercial and employer-funded insurance
  • Managed care organizations
  • Grants

Private Pay

Your preferred provider might be open to private pay, meaning direct compensation. Barriers to doing so include point-of-sale technology and the liabilities of dealing with personal checks and cash. If they do, this arrangement can get very expensive if attempting a larger, more comprehensive treatment package. Ask your provider about parent training and consultative models for more economic options.

Spectrum Behavioral accepts private pay but I no longer offer ongoing ABA therapy services. Instead, I provide short-term, private-pay consultations for families or providers seeking support with a specific behavioral need or goal. This focused approach allows us to work together purposefully and respectfully, without the demands of long-term service contracts.

Please feel free to get in touch if you’d like to explore whether a consultation could support you or the family you’re working with.

Make a referral to Spectrum Behavioral Services of Kentuckiana.

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Funding Overview

Medicaid Waivers like SCL and MPW connect consumers with Positive Behavior Specialists, who may or may not be Board Certified Behavior Analyst. In Kentucky, health insurance companies typically require licensure of their providers, and in this state licensure requires board certification. Health plans vary widely in their approval requirements, reimbursement strategies, ease of use, and network size. Commercial or Employer-funded plans vary most widely, these often cover Applied Behavior Analysis but only for autism. Managed Care Organizations administer medicaid benefits and their processes are more comparable to one another. “Straight Medicaid” bypasses the MCOs and bills the state directly, but requirements are similar to those of MCOs, in my experience. Paying “out of pocket” is an option for some, and providers might offer payment plans. Finally, grants and charity cover therapy in some cases.

Kentucky Medicaid Waivers

Supports for Community Living (SCL)

SCL is a home and community-based waiver program of the Kentucky Medicaid program developed as an alternative to institutional care for people with intellectual or developmental disabilities. The waiver allows individuals to remain in their homes with services and supports, including Positive Behavior Supports.

From the Division of Developmental and Intellectual Disabilities:

Positive Behavior Supports are used when there is a need to develop a plan which identifies prevention strategies to reduce significant challenging behaviors which interfere with activities of daily living, social interaction or work. The plan will instruct on replacement skills and new ways to respond to the challenging behaviors.

For more information, visit the Kentucky Cabinet for Health and Family Services page.

Michelle P. Waiver (MPW)

The Michelle P. Waiver came out of a lawsuit filed in 2002 regarding the 3,000 person long waitlist for SCL. MPW is open to children and parental income is not considered for eligibility. Though MPW was intended to resolve the wait for SCL, there is a significant waitlist for MPW, up to several years long. Seven Counties is the regional “Point of Entry” for individuals with Intellectual and Developmental Disabilities. The Family Supports team can assist with applications to both SCL and MPW. For more information, visit Seven Counties Developmental Disabilities Services. (502) 459-5292

Spectrum Behavioral Services is pleased to offer Positive Behavior Supports to both SCL and MPW participants through Sage Supports Services, as availability permits. In-school behavior support is not provided but I will happily provide a school excuse for medical services. For questions or to refer, contact the True North Counseling office.

Health Insurance

Commercial Health Insurance

Health insurance typically covers ABA only for beneficiaries with an autism diagnosis. Medicaid plans have been approving ABA for a larger number of diagnoses, including the ICD-10 F codes for intellectual disabilities. Administration of Medicaid benefits varies across MCOs (Agencies like Passport and Wellcare), so speak to a representative from your carrier.  All health plans will require a medical necessity and a qualifying diagnosis made by a qualified healthcare professional, this does not include educational diagnoses made by a school psychologist.

As mentioned above, Spectrum Behavioral Services of Kentuckiana no longer accepts insurance.

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Autism Mandates for ABA Coverage

Kentucky’s Autism Mandate requires group plans to cover Applied Behavior Analysis to treat autism. UofL’s Kentucky Autism Training Center explains the Autism Insurance Bill here. ABA is widely covered for this purpose in employer-sponsored plans but self-funded plans are excluded from the requirement. If you are trying to get ABA but are in a self-funded plan that does not have that benefit, the Autism Speaks insurance resources page includes a self-funded company toolkit.

Read more about insurance coverage for ABA in my post about diagnosis and eligibility. 

Managed Care Organizations

MCOs administer the same medicaid benefits so coverage will be comparable but networks will differ. These plans accept a slightly wider variety of diagnoses for ABA but still require medical necessity.

The current MCOs in Kentucky are:

  • Aetna Better Health of Kentucky
  • Humana Healthy Horizons in Kentucky
  • Molina Healthcare
  • UnitedHealthcare Community Plan
  • WellCare of Kentucky

Read more about Kentucky’s contracted MCOs here.

Charities and Grants

Grant opportunities are constantly changing, and eligibility requirements vary.