Florida's autism insurance mandate: what group health plans must cover for ABA

Florida’s autism coverage rules sit in two sections of the insurance code, together called the Steven A. Geller Autism Coverage Act: s. 627.6686 for insurers and s. 641.31098 for HMOs¹².

• Covered: group health insurance policies and group benefit plans from insurers licensed in Florida, including the state group insurance program, and group HMO contracts¹².
• Excluded by the text: plans in the individual market, individually underwritten plans and plans provided to a small employer¹².
• The regulator’s reading: Florida’s Department of Financial Services (DFS) says the statutes apply to Florida-regulated, fully insured large group insurance and HMO plans, including the state employee plan³.

DFS adds that most large group plans must also follow the federal mental health parity law (MHPAEA), and that neither the ACA nor that law explicitly mandates ABA the way Florida law does for large groups³. Coverage also varies with the type of policy and its original issue date³.

The law protects an eligible individual, defined as “an individual under 18 years of age or an individual 18 years of age or older who is in high school who has been diagnosed as having a developmental disability at 8 years of age or younger”¹. The sentence does not make clear whether that diagnosis age applies to children under 18 or only to those 18 and older, so confirm with the plan before counting on coverage for a child diagnosed after age 8.

• Conditions. Treatment of autism spectrum disorder and Down syndrome¹. The statute defines autism through three disorders as defined in the most recent edition of the DSM: autistic disorder, Asperger’s syndrome and pervasive developmental disorder not otherwise specified¹. DFS notes that an ASD diagnosis now includes those conditions³.
• Services. Well-baby and well-child screening for autism, plus speech, occupational and physical therapy and ABA¹.
• Timing. Plans issued or renewed on or after April 1, 2009¹. Down syndrome was added by chapter 2016-222, the last law to amend both sections⁴¹².

• Under s. 627.6686, the required coverage is limited to $36,000 a year and may not exceed $200,000 in total lifetime benefits. The HMO section uses the same amounts¹².
• Both sections adjust “the maximum benefit under paragraph (4)(b)” every January 1 by the medical component of the Consumer Price Index for All Urban Consumers¹². That paragraph holds both amounts. We found no Florida document that publishes the adjusted figure for 2026, so ask the plan which maximum it applies this year.
• DFS describes the amounts as minimum benefits, and the statute says it does not limit benefits a plan otherwise offers³¹.
• Dollar limits, deductibles and coinsurance may not be less favorable than those for physical illnesses, except as the section itself provides¹.
• A plan may not deny this coverage because the services are habilitative¹.

• Providers. ABA must be provided by a person certified under s. 393.17 or licensed under chapter 490 or 491¹. Section 393.17 requires the state agency to recognize behavior analyst certification awarded by a nonprofit that meets national credentialing standards⁵. For what that means in practice, see Florida’s rules on BCBA licensure. The statute does not mention technicians, so ask each plan how it covers RBT services delivered under supervision.
• Prescription. Coverage is limited to treatment prescribed by the treating physician in accordance with a treatment plan¹.
• Plan contents. A diagnosis, the proposed treatment by type, its frequency and duration, the anticipated outcomes stated as goals, how often the plan will be updated, and the treating physician’s signature¹.
• Plan rules still apply. The insurer may use coordination of benefits, network requirements, limits on services by family or household members, utilization review and medical necessity review¹.

A plan also may not deny, terminate or restrict coverage because a person has a developmental disability diagnosis¹.

When a child has both, Florida law makes Medicaid the payor of last resort, and other sources of payment come first⁸.

The text above is the 2026 edition of both statutes, and the last amendment was chapter 2016-222¹²⁴. The maximum benefit changes every January 1¹². For how Medicaid authorizations work, see ABA prior authorization in 2026.

This explains the statute; it is not legal or insurance advice. Coverage depends on the plan document, so confirm with the plan, DFS or an attorney, especially for self-insured plans³.