A person who is the caregiver, guardian or parent of a child with autism may wonder, “Is ABA therapy expensive?” This answer is important because the financial responsibilities of caring for a child with disabilities can often put a family into a dire situation. Families are often faced with the impossible decisions of getting the child the services they need in order to be able to live as independently as possible during adulthood or putting food on the table and clothes on the backs of everyone in the household.
Hourly Cost of ABA Therapy
ABA therapy, or applied behavioral analysis therapy, is one medically-proven approach to help people with autism learn to navigate the world. In fact, it’s viewed by many as the gold standard approach. ABA works by incentivizing children to perform desired behaviors instead of harmful ones. However, this therapy works best when done very early. According to the Institute of Child Health and Human Development, it takes four times as long for a fourth-grader to benefit from ABA as it does for a kindergartener to benefit. This is because younger children’s brains have more plasticity, which means they can learn new skills much more easily.
It’s important to note that ABA therapy is much different than what most people think of when they picture therapy. An autistic child won’t simply visit a therapist’s office once a week. ABA is an intensive and gradual process. However, the exact number of hours per week a child needs will depend on several factors. One is the child’s level of functioning. Children with lower-functioning autism tend to need help in more areas of their lives, and they may also have more trouble with managing emotions. These children are likely to need more therapy. Higher-functioning children may need fewer hours per week, and some very high-functioning children may not need this type of therapy at all.
For children who need it, though, ABA usually lasts 25 to 40 hours per week. In some cases, higher-functioning children who just need a little behavioral help do well with just four to six hours of therapy per week. In order to find out how much therapy a child needs, the family will need to set up an evaluation with a qualified professional.
Before starting with a treatment plan, the therapist will meet with an autistic child and their family. After assessing the child, the therapist will make a treatment plan. Since the goal of ABA therapy is to teach the child skills they will use throughout life, ABA isn’t designed to last forever. In most cases, the therapy gradually lessens until the child no longer needs it.
For parents just learning about ABA therapy, cost is very likely to be a concern. And because intensive ABA therapy lasts for so many hours, the first thing many people ask about is the hourly rate.
The average hourly cost of ABA therapy is $120 as of January 2020. For most families, this is expensive. Considering the average hourly wage for workers in the United States was $27.16 as of August 2018, this is nearly four times the average hourly earnings of an American worker. Of course, the price will vary some depending on the cost of living, but ABA therapy is typically fairly expensive.
Even for families who are fairly well-off, ABA therapy cost may be troublesome. It is also worth considering that when a household includes a child with a disability, the household income typically decreases. If two parents had worked outside of the home for paid employment, the birth of a child with a disability or the diagnosis of a disability in a child could necessitate that one parent work part-time or not at all in order to help with the child’s care. If both parents continue to work, they may need to hire in-home babysitters or caretakers who are capable of working with autistic children. This may also prove to be expensive.
When considering the hourly rate for ABA, it’s important to keep a couple of things in mind. The first is that many kinds of insurance will cover at least some of the cost. The second is the fact that investing in ABA now may save the family a significant amount of money down the line. The goal of ABA is to improve a child’s functioning, and some children may eventually be able to take care of themselves as adults. For children who cannot do this, it may be necessary to pay for long-term care. Ultimately, the cost of not doing ABA may end up outweighing the cost of ABA.
Range of Yearly Expenses for ABA Therapy
A typical family of a child with autism will spend at least $17,000 per year on ABA therapy. Most households spend much more, with some families spending more than $40,000 per year on ABA therapy. The higher costs are related to the location where the services are provided and the number of therapy hours received by the child. A child who is severely impacted by autism may require more hours per week of ABA therapy by a highly-trained, doctoral-level psychologist rather than a master’s degree-level psychology apprentice or assistant. Some children may do better if the ABA therapist comes to their home, and this will typically cost more than an office visit would.
Because autism is a disorder on a spectrum, some children will need much more care than others. For instance, children with autism may need specialized daycare services, and these can cost as much as $11,000 per year. Teenagers or adults who can’t take care of themselves on their own may need to stay in longer-term care facilities with 24/7 nursing staff. These living arrangements often cost more than $40,000 per year. People who can live on their own but need some assistance may still need to pay around $3000 per year for in-home help.
How long a family will need to keep covering the costs of ABA therapy will depend on how the child responds to therapy. In most cases, ABA therapy will need to last one to three years, and it’s best to start when the child is younger — usually between the ages of two and six. However, some autistic adults need continued ABA therapy, especially when they have difficulty adjusting to life changes.
While family members may begin to see improvement relatively soon after the therapy starts, it’s important to consult with the child’s therapist to determine how long the therapy should continue. Repetition is a vital part of this therapy, and if the family discontinues it too soon, the child may not continue with the improved and modified behaviors.
Cost Differences With Different Types of Therapists
Understandably, ABA therapy cost can vary considerably depending on a given therapist’s qualifications and experience level. When it comes to ABA therapy, the most expensive therapists are likely to be BCBA-Ds. This stands for board-certified behavior analyst with a doctorate. These therapists have earned a Ph.D. in the field. Many BCBA-Ds don’t do the hands-on therapy, although some do. Rather, they assess the child and design a therapy plan. If another therapist does the therapy itself, the BCBA-D will supervise. This way, doctoral-level therapists have the freedom to assess and design treatment plans for several autistic children instead of focusing most of their time on rehabilitating one.
Therapists don’t need a doctorate to work in the field, and many ABA therapists are BCBAs. This stands for board-certified behavior analyst. These therapists have earned a master’s degree in the field, and they also have completed a certain number of hours training in the field with a certified BCBA or BCBA-D. After completing their degrees and gaining some experience, BCBA candidates then must pass an exam to become certified. Like BCBA-Ds, BCBAs can assess children and develop therapy plans.
Some ABA therapists may have a certification as a board-certified assistant behavioral analyst (BCaBA). These therapists tend to charge less because the only degree requirement is a bachelor’s degree. However, they are supervised by a BCBA or BCBA-D. But regardless of the practitioner designing the plan, most people who do the therapy work with the child are registered behavior technicians (RBTs). Because of differences in degrees and experience level, every ABA practitioner has slightly different pricing. It’s always wise for parents to make sure they know how much each practitioner charges so they know how much they’ll owe upfront.
State Laws for Insurance Coverage of ABA Therapy
Each state has different laws about insurance coverage for ABA therapy. In 46 states, there are mandates for provision of ABA therapy for children with autism. The coverage level varies by the state and the child’s age. According to the National Conference of State Legislatures, Alabama provides a maximum coverage of $36,000 per year for ABA therapy. In Arizona, the benefit is $50,000 per year for children up to age nine and $25,000 per year for children ages nine to 16.
The laws surrounding ABA therapy can get somewhat complex. As of 2020, all states have a requirement for fully-funded health insurance plans to cover ABA treatment. Fully-insured plans are what most people think of when they think of employer-sponsored healthcare. The employer will pay a premium to the insurance company, and employees often pay a part of this premium. Employees are also responsible for copays and for meeting the plan deductible.
The requirement for coverage for ABA therapy does not extend to self-funded plans. Self-funded plans can also be obtained through an employer. With these plans, the employer runs its own healthcare plan to reduce premium cost. If you aren’t sure which type of plan you have, it’s a good idea to verify with your employer. Currently, about 45% of larger companies have healthcare plans that cover ABA therapy, and children on Medicaid qualify for the service as well.
Options for Families Paying Out-of-Pocket
If a family lives in a state where ABA therapy is not covered by insurance, or they use up their ABA insurance coverage, there are a few options for paying for the services. Families could use a Health Savings Account or Health Reimbursement Account to pay for these expenses and reduce their tax burden. Families paying cash might be able to negotiate lower fees. And some providers may offer financing options, too.
It can be overwhelming to figure out how to pay for ABA therapy, but there are also organizations that can help. Parents uncertain of where to find providers or how to pay for therapy should contact the Behavior Analysis Certification Board. This organization will be able to point families to ABA practitioners near them, and it also can sometimes help families find resources to help cover the costs. The autistic child’s pediatrician may also be a great resource. Chances are good that most pediatricians have treated children with autism, and they’re likely to be able to help parents navigate the often-confusing treatment landscape.
Several organizations that support autistic people and parents of children with autism also have resources to help with payment. Some have free guides to help families with financial planning, and many offer advice on obtaining disability benefits for an autistic child. Many of these organizations also can refer families to available grants and other forms of assistance.
Lastly, several states will allow parents to set up an ABLE account for their child. ABLE stands for Achieving a Better Life Experience. These accounts can help families save on taxes. And unlike traditional IRAs, ABLE accounts have no penalty for withdrawing money as long as it’s being withdrawn to help treat the child’s disability. ABLE accounts are also a great tool for future planning. For autistic children who will eventually live on their own, parents can set up accounts and make contributions.
Essentially, for uninsured families or families whose insurance does not cover ABA, trying to figure out how to pay for therapy can be confusing and discouraging. But there are a surprising number of free resources to help them make sure their child gets the therapy they need.
Knowing how much ABA therapy costs could help a family figure out how much of it they can afford to pay for out-of-pocket and whether or not they might qualify for programs or services that could offset the cost of the therapy. Knowing the hourly rate of ABA therapy could also help families determine how many hours of services their child can get per year under their current health insurance coverage. Knowing the answer to, “Is ABA therapy expensive?” helps families plan for the future.
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