Florida Medicaid ABA Quick Reference 2026
What it is and what it is for
The Florida Medicaid behavior analysis rules a BCBA or agency checks most, condensed from AHCA's coverage policy (December 2024) and fee schedule (October 1, 2024): who qualifies and who refers, which credential can provide each service, the assessment and authorization timelines, the 15-minute unit rule, assessment unit limits, what is not covered and how managed care has worked since February 2025.
Key facts
Who qualifies and who refers
- Florida Medicaid recipients under 21 who need medically necessary behavior analysis for behavior that impairs a major life activity, such as safety, communication, self-stimulating behavior or self-care.1
- The referral comes from an independent physician or a qualified practitioner and includes a physician’s order and a comprehensive diagnostic evaluation (CDE).1
- Eligibility is verified each time a service is given.1
Who provides what
| Service | Lead Analyst | BCaBA | RBT |
|---|---|---|---|
| Treatment by protocol | Yes | Yes | Yes |
| Treatment with protocol modification | Yes | Yes | No |
| Group treatment, up to 6 participants | Yes | Yes | By protocol only |
| Family treatment guidance (caregiver training) | Yes | Yes | No |
The Lead Analyst is a BCBA, an FL-CBA or a practitioner fully licensed under Chapters 490 or 491, F.S. BCaBAs work under a BCBA and RBTs under a BCBA or BCaBA. The Lead Analyst may train parents or guardians by telemedicine for up to 2 hours a week.1
Assessment and authorization timeline
| When | What |
|---|---|
| Before any intervention | Behavior assessment with the Vineland-3 (every child) and the BASC-3 PRQ (ages 2 to 18) |
| Each authorization | Behavior plan for up to 6 months |
| At least every 6 months | Reassessment and updated behavior plan |
| Every 12 months | Core instruments again |
| Fee-for-service | QIO authorization before services start and at least every 180 days |
Units and billing
- Services are billed in 15-minute units. After dividing the minutes by 15, a remainder of 8 minutes or more counts as one unit.1
- Fee schedule limits: 24 units of 97151 and 8 of 97152 per behavior assessment, 18 of 97151 TS per behavior reassessment, and 16 of 0362T for an initial assessment or reassessment, when prior authorized as medically necessary.2
- A supervisor may be paid for observing a supervisee implementing the plan, and the supervisee is not paid for that same time.1
Not covered
- Seclusion or manual, mechanical or chemical restraint to control behavior1
- Acting as a 1:1 aide, companion, chaperone or shadow, in any setting1
- Caregiver or childcare services, and travel time1
- Services by more than one behavior analysis provider at once, unless medically necessary, prior authorized and in the approved plan1
Managed care since February 2025
Children enrolled in an SMMC health plan have their ABA services paid through that plan; children not enrolled stay in fee-for-service. To be paid for a plan member, you must be contracted with that plan. Plans must honor ongoing treatment authorized before a child’s enrollment for up to 90 days.3
What may change
In 2026, Section 40 of House Bill 5003-E created an ABA Task Force at AHCA to study, among other topics, service-authorization limits and potential caps on service duration. Its recommendations are due by December 31, 2026.4 This quick reference reflects the versions AHCA lists on October 15, 2026.
Frequently asked questions
How many hours of ABA does Florida Medicaid cover?
Up to 40 hours a week of behavior analysis intervention, as the prior-authorized behavior plan sets. For recipients under 21, services beyond the policy or the fee schedule may be approved if they are medically necessary.
How are 15-minute units counted in Florida Medicaid?
Divide the total minutes by 15. The remaining minutes count as one more unit only if they are 8 or more; under 8, they are not billable.
Does my SMMC plan follow the same rules?
Managed care plans must cover behavior analysis as the policy describes and may not set stricter coverage limits than Florida Medicaid's, unless their AHCA contract says otherwise. Each plan runs its own authorization process, and you must be contracted with the child's plan to be paid.
Sources
- Florida Medicaid Behavior Analysis Services Coverage Policy. Agency for Health Care Administration (AHCA), December 2024, Rule 59G-4.125, F.A.C.
- Behavior Analysis Fee Schedule. Agency for Health Care Administration (AHCA), October 1, 2024.
- SMMC New Program Highlight: Behavior Analysis Services. Agency for Health Care Administration (AHCA), October 18, 2024.
- Applied Behavior Analysis Task Force. Agency for Health Care Administration (AHCA), accessed October 15, 2026.
Educational tool. It does not replace clinical judgment, legal advice or your payer’s rules. Always check the current version of each source.