26-196 Updated ABA Medical Necessity Criteria for Medi-Cal, Effective April 20, 2026
Date: 02/13/26
New criteria adopted to support consistent, needs‑based ABA care for Medi‑Cal patients under age 21
Effective April 20, 2026, the medical necessity criteria for Medi‑Cal patients will be updated with the adoption of clinical policy CA.CP.BH.104 Applied Behavior Analysis (ABA). This change supports more individualized, needs‑based care for patients under age 21 by promoting developmental, behavioral and functional improvements for them and their families.
This ABA medical necessity criteria set replaces the Council of Autism Service Providers (CASP) criteria for Medi‑Cal only. CASP criteria will continue to apply to Commercial Employer Group plans (HMO/POS, PPO) and Individual and Family Plans (Ambetter HMO and PPO).
How to access ABA policies
View the complete ABA clinical policies at the link below:
- Medical Policies
- CA.CP.BH.104 Applied Behavior Analysis (ABA)
- CA.CP.BH.105 Applied Behavior Analysis (ABA) Documentation Requirements
Resources
For additional information about Autism Spectrum Disorders and ABA, referrals, and prior authorization forms, refer to Autism Spectrum Disorders in the Medi-Cal Provider Operations Manual.
Need help? Contact us
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center at 800-675-6110. Behavioral health providers can call 844-966-0298.
This information applies to Participating Physician Groups (PPGs), Ancillary Providers and Behavioral Health Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.