Insurance coverage for ABA therapy has been shifting all year, and this week the spotlight landed on a group of families who often get left out of the conversation: military families. A bipartisan pair of senators is now publicly pressing the Pentagon to fix how TRICARE covers ABA — and the fight offers a useful window into how insurers of every kind decide what autism care actually “counts.”
The TRICARE fight, explained
Since 2021, TRICARE — the health plan covering roughly 2 million military dependents — has covered ABA only through something called the Comprehensive Autism Care Demonstration, a temporary pilot rather than a standard, permanent benefit. In practice, that’s meant extra paperwork most civilian families never see: mandatory reassessments every two years, required parenting-stress questionnaires, and restrictions on where therapy can happen.
Last September, the National Academies of Sciences, Engineering, and Medicine — an independent scientific body Congress asked to evaluate the program — published a 336-page report on it. Their conclusion was blunt: ABA is a clinically effective, evidence-based treatment, and the demonstration’s rules were making it harder, not safer, for military kids to get care. The report recommended TRICARE end the “demonstration” label for good, drop the redundant testing requirements, let providers choose their own clinical assessment tools, and allow therapy in schools and community settings — the way most private insurers already do.
Nearly a year later, little has changed, which is what prompted Sens. Eric Schmitt (R-Mo.) and Kirsten Gillibrand (D-N.Y.) to send a joint letter to the Department of War in late June. Their letter followed NBC News reporting on a military family’s monthslong struggle just to get their son’s therapy approved — the kind of story that will sound familiar to a lot of parents, uniform or not. “Twelve years of a demonstration should be sufficient to determine the effectiveness of a medical treatment,” the senators wrote, calling on the department to finally make ABA a basic TRICARE benefit.
Why this matters even if you’re not a military family
TRICARE’s slow rollout is an unusually visible example of a pattern that plays out quietly across private insurance too. Every state now has some form of autism insurance mandate for private health plans, and most require coverage of ABA, speech therapy, occupational therapy, and evaluations when they’re medically necessary. But those state mandates have a major loophole: self-funded employer health plans, which cover a large share of privately insured workers, are regulated federally under ERISA and aren’t required to follow state autism mandates at all. Two families in the same state, working for different-sized employers, can end up with very different coverage for the exact same diagnosis.
That’s really the throughline connecting TRICARE to everyone else: coverage for ABA still depends heavily on which plan you happen to have, not just on what your child clinically needs. Advocates like Mariel Fernandez at the Council of Autism Service Providers describe the TRICARE push as “an incredible first step, but it is just a first step” toward closing gaps like these system-wide.
What parents can do with this
If your family has TRICARE, it’s worth knowing the NASEM recommendations exist, since they’re the strongest evidence-based case yet for reform — keep an eye on whether the Department of War responds, and don’t hesitate to ask your care navigator directly about upcoming changes to reassessment timelines.
If you have private insurance, ask your HR or benefits office one specific question: is our health plan self-funded? If it is, your state’s autism insurance mandate may not apply, and it’s worth reading your plan’s ABA-specific coverage language closely rather than assuming state law protects you.
Either way, ask your BCBA (Board Certified Behavior Analyst) how your child’s treatment plan is billed and whether the codes used are ones your specific plan reliably covers — mismatched billing codes are a common, fixable reason claims get denied.
None of these systems move quickly, and that’s frustrating when you’re the one navigating a maze of forms while your child is waiting for care. But the pressure campaigns happening right now — from senators, researchers, and advocacy groups alike — are aimed at making coverage less dependent on luck. We’ll keep tracking where this goes.
As always, if you have questions about your own child’s plan or benefits, that’s exactly what your care team is here for. We’re glad to talk it through with you, no appointment necessary.
Sources
- Schmitt, Gillibrand Call on DoW to Provide Essential Autism Care for Military Families — Office of Sen. Eric Schmitt
- This autism therapy is covered by many insurers. Why does the military’s plan restrict it? — NBC News
- TRICARE Report Validates Making ABA Benefits Permanent for Military Families — Behavioral Health Business
- Autism Insurance Coverage (2026): What’s Covered & What to Ask — Special Needs USA
