In Washington, a child under 21 starts ABA therapy in four steps: an evaluation by a Center of Excellence (COE) provider, a written ABA order from that provider, an intake assessment by an ABA agency such as Evergreen Pathways, and insurance authorization. Services begin once the authorization is approved.
Step 1: an evaluation by a Center of Excellence
A Center of Excellence, or COE, is a clinician or clinic that Apple Health recognises to diagnose autism and other developmental disabilities and to order ABA. For children and young people 20 and younger, the Health Care Authority says the evaluation must come from an ABA COE provider. For adults 21 and older it must come from a neurologist, psychiatrist or psychologist.
If your child has Apple Health through a managed care plan (Molina, Coordinated Care, Community Health Plan of Washington, UnitedHealthcare or Wellpoint), call the plan and ask for an in-network COE and an ABA case manager. If your child has Apple Health without a plan, choose from the HCA's COE list. Private insurance usually follows a similar path; ask your plan what evaluation they accept.
Step 2: the diagnostic evaluation and ABA order
The COE provider completes a comprehensive diagnostic evaluation, recommends a treatment plan that may include speech, occupational therapy and other services, and orders ABA if it is appropriate. You receive a copy of the evaluation and the order. Keep both: your ABA provider needs them.
Step 3: choose an ABA provider and get on wait lists
The HCA's own advice is blunt: wait lists are common, so contact every ABA provider in your area that accepts your coverage and get on more than one list. Ask each provider where sessions happen (home, clinic, school, telehealth), which counties they cover, and whether they have openings for your child's age.
Evergreen Pathways provides in-home and community-based ABA for ages 2 to 22 in King, Pierce, Snohomish, Thurston and Kitsap counties and is listed in the HCA's fee-for-service ABA directory.
Step 4: assessment, treatment plan and authorization
Your ABA provider completes intake assessments, writes an individualised treatment plan and requests prior authorization from your plan. Sessions start when the authorization is approved. Plans re-authorize on a schedule, usually every six months, based on progress reports from the BCBA.
What to do while you wait
Seattle Children's publishes a family guide on what to do while waiting for an autism center appointment, including early support and school services. You can also ask your child's school district about an evaluation for special education services, which runs on a separate track from medical ABA.
Common questions
Do I need an autism diagnosis to get ABA in Washington?
For Apple Health, yes: WAC 182-531A-0400 requires documentation from a COE provider of an autism spectrum disorder or another developmental disability for which ABA is shown to help, plus evidence that the impairment affects daily life at home, school or in the community.
Can my pediatrician order ABA?
Only if the pediatrician is a recognised COE provider. Most families are referred by their pediatrician to a COE clinic or clinician for the evaluation and order.
How long does the whole process take?
It varies widely by region and by COE wait times. Getting on several ABA wait lists while you wait for the COE appointment is the most reliable way to shorten the total time.
- Washington Health Care Authority, Applied Behavior Analysis
- WAC 182-531A-0400, ABA client eligibility
- WAC 182-531A-0500, Stage one: COE evaluation and prescription
- HCA Centers of Excellence provider list for ABA (PDF)
- Seattle Children's, What to do while waiting for an autism center appointment (PDF)
This article is general information for families in Washington State, not medical advice or a promise of coverage or outcomes. Rules change; check the linked sources and your plan.
Talk to Evergreen Pathways
In-home ABA for ages 2 to 22 across King, Pierce, Snohomish, Thurston, Kitsap counties.
Call (206) 796-4797