Horizon NJ Health is the largest NJ FamilyCare (Medicaid) plan in the state. Members under 21 with an autism diagnosis are entitled to medically necessary ABA at $0 cost under the federal EPSDT benefit. The path: diagnosis, BCBA treatment plan, plan authorization, start.
What Horizon NJ Health covers
Under EPSDT, NJ FamilyCare plans must cover services that are medically necessary to correct or improve a child's condition, and for autism that includes applied behavior analysis. There are no copays for covered children's services: no deductible, no coinsurance, $0.
The process for families
- 1. Autism diagnosis: a comprehensive evaluation documenting an autism spectrum diagnosis (we can point you to evaluators who take Horizon NJ Health).
- 2. Benefits check: we confirm eligibility and any plan-specific requirements, free.
- 3. BCBA assessment and plan: our BCBA assesses your child and writes the treatment plan the plan reviews.
- 4. Authorization: we submit for prior authorization and track it to approval.
- 5. In-home therapy begins on the approved schedule, with periodic reauthorizations handled by us.
Things NJ FamilyCare families should know
- Keep your renewal current; FamilyCare eligibility redeterminations can interrupt services if paperwork lapses.
- If your card says a different MCO (Aetna Better Health, Fidelis Care, UnitedHealthcare Community Plan), the ABA benefit works the same way through that plan; see the NJ FamilyCare guide.
- School services and insurance ABA are separate systems; your child can have both.
Not sure what your plan covers? Send us your insurance card and we will verify ABA benefits for free, usually within a day or two: start here.
Horizon NJ Health is Medicaid, so ABA runs through the Children's System of Care
Horizon NJ Health is a NJ FamilyCare managed care plan, not a commercial Horizon product, and that changes the route entirely. ABA for children under 21 is covered under EPSDT, and access is arranged through PerformCare, the gateway to New Jersey's Children's System of Care, rather than by calling the plan's medical management line.
The practical difference for families is money and sequence. There is no deductible and no copay for ABA under 21. In exchange, the intake sequence is stricter: a diagnostic evaluation, a PerformCare case, then authorized services.
Families sometimes wait on a Horizon authorization that was never going to arrive because the request belonged with PerformCare. If you have been waiting more than a few weeks with no movement, that is usually why. Send us what you have and we will find where it stalled.
Frequently asked questions
Does Horizon NJ Health cover ABA therapy?
How much does ABA cost with Horizon NJ Health?
How long does Horizon NJ Health authorization take?
Can we get in-home ABA with Horizon NJ Health?
Start ABA therapy in New Jersey — no waitlist
We'll verify your insurance for free and map out your child's next steps. Most families start within weeks.
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Insurance details change and vary by plan. This page is general information, not insurance or medical advice. Plan names are trademarks of their owners; Liftoff ABA is an independent provider. We verify your exact benefits for free.