Insurance Resource Center for Autism and Behavioral Health

27/08/2026

ASK THE INSURANCE GURU:

"Hi Guru,

I am hearing that MassHealth members will soon be asked to renew their coverage every six months. Does this apply to my child who has MassHealth CommonHealth with a verified disability?

Just curious…"

Hi Just curious,

Thank you for your email. In the One Big Beautiful Bill Act (OB3) it is going to require certain MassHealth members to renew their eligibility every six months. This requirement will largely impact adults without young children or a disability who are 19 through 64 years of age. Which means, your child with MassHealth CommonHealth who has a verified disability will not be asked to renew every six months. For more information about the upcoming changes - https://www.mass.gov/info-details/masshealth-federal-updates-and-impact

My tips for annual renewals remain the same. I encourage you to keep your contact information (address and phone) updated with MassHealth so that you are sure to get all correspondence. Open all of your mail. Renewals typically come in a large blue envelope, but sometimes, if MassHealth is just requesting proof of something, like income, that notice will come in a nondescript white envelope. Open all of your mail and respond in a timely fashion.

If you have further questions, you can always reach out to the Insurance Resource Center for Autism and Behavioral Health at 774-455-4056, [email protected].

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

21/08/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My son has MassHealth and started therapy over the summer. It has been really helpful for him, but now that school is starting, I’m worried about how I’ll get him to his appointments. Between his school schedule, my work and everything else, it may be difficult for me to drive him to every appointment. Does MassHealth offer transportation help for therapy appointments?"

Dear Mom,

Yes. If your child has MassHealth Standard, Common Health or CarePlus and transportation to medically necessary services is a barrier, you may be able to arrange transportation through the PT-1 transportation program. This benefit is used to request non-emergency transportation for eligible MassHealth members who need help getting to covered medical services with a MassHealth contracted provider.

Here’s how the process works: An eligible provider, usually the child’s primary care provider, completes a letter of medical necessity for transportation. See the medical necessity form for a list of eligible provider types here: https://www.mass.gov/doc/masshealth-medical-necessity-form-for-nonemergency-ambulancewheelchair-van-transportation-mnr-nat/download The medical necessity letter goes to the provider who is providing the service that requires transportation—in this case, your child’s therapy provider. The provider requesting transportation submits the letter and the online authorization request to the Massachusetts Behavioral Health Partnership (MBHP) through their online portal https://masshealth.ehs.state.ma.us/CWP/Default

If the request is approved, MassHealth will assign you a transportation broker who can arrange your rides. When transportation is set up for the first time, you should receive a welcome letter with the broker’s contact information. MassHealth also provides an informative brochure with helpful information about transportation services, which you can find here: https://www.mass.gov/doc/masshealth-transportation-consumer-brochure-pdf/download

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

13/08/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My child needs an AAC device to help with communication. Will MassHealth cover the cost?

Monica"

Dear Monica,

Yes, MassHealth will cover the cost of the device and accompanying software. Your child must be enrolled in either MassHealth Standard or Common Health. The first step is to get a referral for a speech evaluation from your child’s primary care doctor. An evaluation is performed by a Speech-Language Pathologist, including a trial of the device. A treatment plan will be written based on the results. You can use an SLP from your child’s school district to conduct the evaluation, but only a credentialed MassHealth SLP can submit for the authorization! You will then obtain a prescription for the device from the primary care clinician. A child must have a diagnosis of autism and a diagnosis of a severe communication disorder.

The MassHealth Speech-Language Pathologist will use the prescription and diagnosis to request prior authorization from MassHealth, and if approved, MassHealth will buy the device. The device will then be mailed to the Speech-Language Pathologist. MassHealth also covers medically necessary applications (apps) and accessories if submitted with the authorization.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

07/08/2026

This week’s Guru post!

ASK THE INSURANCE GURU:

"Dear Guru:

I read that children with autism have a much higher risk of drowning and I’m very worried for my son. Do you have any advice or resources about how I can keep him safe?

Worried Mom"

Dear Worried Mom

Thank you for reaching out. It is a very sad fact that drowning is the leading cause of death for children with ASD. I applaud you for proactively seeking out advice and resources. Our colleagues at the Massachusetts Department of Developmental Services recently published an excellent guide to Autism, Wandering and Water Safety, https://www.mass.gov/autism-wandering-and-water-safety which includes information for caregivers and others, as well as financial and other resources. I would recommend reviewing the guide and sharing it with your family members and other people who work with your son. I would also encourage you to look through the extensive list of resources that are included in the guide. Hopefully you will be able to access some of these and they can help increase your son’s safety and hopefully, your peace of mind.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

06/08/2026

ASK THE INSURANCE GURU:

"Dear Guru:

I read that children with autism have a much higher risk of drowning and I’m very worried for my son. Do you have any advice or resources about how I can keep him safe?

Worried Mom"

Dear Worried Mom

Thank you for reaching out. It is a very sad fact that drowning is the leading cause of death for children with ASD. I applaud you for proactively seeking out advice and resources. Our colleagues at the Massachusetts Department of Developmental Services recently published an excellent guide to Autism, Wandering and Water Safety, https://www.mass.gov/autism-wandering-and-water-safety which includes information for caregivers and others, as well as financial and other resources. I would recommend reviewing the guide and sharing it with your family members and other people who work with your son. I would also encourage you to look through the extensive list of resources that are included in the guide. Hopefully you will be able to access some of these and they can help increase your son’s safety and hopefully, your peace of mind.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

30/07/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I have been having issues for many months finding an ABA provider to help my child. I recently found a provider who said that they have immediate availability. But they are not in network with my insurance and offered to obtain a “single case agreement” to cover the services outside of the network. However, I’m not sure if this is the right thing to do for my child. Is there anything I should know about getting services from an Out of Network Provider?

Thank you,"

In many cases, working with an Out of Network provider can be a great benefit to your child, especially when there is limited availability. However, you should understand that there may be certain risks you may be taking, as the provider may not be contractually obligated to follow all the rules of your health insurance provider, especially balance billing rules. As such, it is important that you understand the benefits your health plan has available to you and first inquire with your health plan to understand any potential risks or financial obligations you may have as a result.

You should be aware that there are some inherent risks when choosing to receive services from an Out of Network provider. Out of Network providers do not have to follow all of your health insurance companies’ policies / procedures, which can result in reduced protections for you and your family. In most cases, working with an out of network provider is perfectly fine, but sometimes there are increased risks in comparison to working with an In Network Provider. One of these risks is that an Out of Network provider may be able to balance bill for unpaid services, but In-Network Providers are not allowed to do this. So, working with Out of network Providers can create a financial risk and you’d want to understand this prior to starting services.

If you need assistance finding an In Network provider, I suggest that you call your health plan and ask for a care coordinator to help you find providers with availability in your area. Even if the provider has already provided supplied a list of in-network providers, a care coordinator can help identify an appropriate provider with availability. Additionally, you can contact the Insurance Resource Center for Autism and Behavioral Health, as we have some resources that may be of assistance to you. Our contact information is: PH: 774-455-4056, or you can email us at [email protected]

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

23/07/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My child has been receiving aba services for the past 3 years, and I received a message saying the provider will terminate services in the next two weeks due to payment issues that the provider is having with our health insurance plan.

Thank you for your help,"

Providers should generally give at least 30 days’ notice before terminating services, and work with you on a discharge/transition plan. There are some situations where a provider can terminate services sooner due to non-payment, but we would need more specifics to understand if that applies here.

I’d suggest you contact your health insurance company to request guidance on this issue as well as assistance with finding a new provider. Also, if you feel like your provider is treating you unfairly or unprofessionally, you can consider filing a complaint against the provider with state’s licensing board. To file a complaint please go to the following website: https://www.mass.gov/info-details/have-a-complaint-against-a-licensee

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

17/07/2026

16/07/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My child has been receiving aba services for several years, and I have been paying co-pays during this time. But I received a message that they are going to be terminating services due to payment issues with my health plan, and a large bill for unreimbursed services. Is there anything I can do?

Thank you for your help"

I am sorry to hear about this situation. It would be helpful to know more specifics, and I would suggest the first thing you do is get clarification about the charges you are being billed for. While you should ask the provider for an explanation as to why you are being billed, you should also get this information from the health plan. Is the provider looking for you to pay claims that the health plan is denying for some reason? Clarifying the situation will help determine your next steps, and the health plan should be able to advise if there are any “hold harmless” rules in place that might limit your liability. Again, specifics will help determine how you should proceed. If you are ultimately responsible for the balance and can’t pay it, you would see if the provider will work out a payment plan with you. But again, there may be more steps to pursue before you get to this point and you should request assistance from your health plan. And if it’s necessary to switch providers, the health plan may be able to help find another provider with more appropriate billing practices.

If you need any assistance resolving this issue, then please reach out to the Insurance Resource Center for Autism and Behavioral Health. Our contact information is: PH: 774-455-4056, or you can email [email protected]

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

09/07/2026

ASK THE INSURANCE GURU:

“Dear Guru,

I remember you saying that we could reach out to you if we come across acronyms and don’t know what they stand for. Can you please provide a list of acronyms that I might see now that I decided to apply for MassHealth.”

I am so glad you asked. There are a lot of acronyms related to MassHealth coverage, but I will pick a few of my favorites that you might see while you are applying for coverage. If there is a specific acronym not shown here that you come across, just shoot me a quick email and I will reply. When I say that there are a lot of acronyms that you might see, I am not exaggerating!

ARD (Authorized Representative Designation Form): This is a form that needs to be completed to speak to MassHealth about someone other than yourself or your minor child(ren). It designates the person chosen to act on someone’s behalf.

DES (Disability Evaluation Services): MassHealth has contracted with Disability Evaluation Services to assist with disability evaluations and verify disabilities.

ESI (Employer Sponsored Insurance): Health insurance through your employer. If you have access to ESI, MassHealth needs to know about it. ESI that meets certain requirements can make you eligible for an additional benefit called Premium Assistance.

MAGI (Modified Adjusted Gross Income): When you apply for MassHealth coverage, they will look at your Modified Adjusted Gross Income as reported on your taxes for eligibility/ premium purposes.

Reminders:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.