MaineCare Section 28 ABA Therapy: What You Need to Know

What Is MaineCare Section 28 for ABA Therapy?

MaineCare Section 28 is a home- and community-based waiver program that provides funding for applied behavior analysis (ABA) therapy to children with autism spectrum disorder (ASD) in Maine. Unlike standard MaineCare coverage, this waiver allows for intensive, early intervention services delivered in natural settings like home, school, or community. The goal is to help children develop essential skills and reduce behaviors that interfere with learning and daily life.

How Section 28 Differs From Regular MaineCare

Standard MaineCare covers some behavioral health services, but Section 28 specifically targets ABA therapy for children with severe autism-related needs. It includes a higher level of service intensity, such as up to 30 hours per week of therapy for some children, along with supervision by a BCBA and staff training. This waiver is part of MaineCare's commitment to supporting families facing significant challenges.

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Who Is Eligible for Section 28 ABA Services?

Eligibility for MaineCare Section 28 requires that the child: be under 21 years old; have a medical diagnosis of ASD from a qualified professional (such as a developmental pediatrician); be enrolled in MaineCare; and require an institutional level of care due to autism-related behavioral needs. The level of care determination is made by MaineCare through an assessment process. Children who are not yet MaineCare members may apply, and income limits apply for some categories (e.g., children in foster care or those receiving SSI may qualify automatically).

The Application Process Step by Step

To start, contact MaineCare's Member Services or your local Department of Health and Human Services (DHHS) office. Ask for a Section 28 waiver application. You'll need to provide the child's ASD diagnosis, a recent evaluation (e.g., from a psychologist or developmental clinic), and a completed level of care form. Once approved, you can contract with a Section 28-enrolled provider. Be aware that processing can take several weeks, so starting early is important.

What Services Does Section 28 ABA Cover?

Covered services include functional behavior assessments (FBAs), ABA treatment plans, direct one-on-one therapy (often called behavioral health professional or BHP services), caregiver training, and case supervision by a BCBA. MaineCare requires that all therapy be overseen by a BCBA, with direct staff delivering therapy under supervision. Services must be medically necessary and focus on socially significant behaviors.

Treatment Settings and Hours

Section 28 allows therapy in the home, school, community, or a combination. Typical intensities range from 10 to 30 hours weekly, depending on age and severity. The treatment plan is developed by the BCBA and reviewed by MaineCare regularly. Flexibility is key-some families use it for school-based supports or evening sessions.

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How to Find a Section 28-Approved ABA Provider

Not all ABA providers accept MaineCare Section 28. Approved agencies must be enrolled with MaineCare and meet staffing ratios (e.g., having a BCBA on staff). Many BCBA-led clinics in Maine like those in Portland, Bangor, or Lewiston participate, but availability varies. Our free matching service can help you find vetted, Section 28-accepting providers in your area, saving you time and stress.

What to Look for in a Provider

Look for a BCBA who has experience with the Section 28 waiver, a team that offers flexible hours, and cultural competence. Ask about supervision schedules, caregiver training, and how they handle school collaboration. Quality providers will offer an initial consultation at no cost to explain their approach. Our service helps you compare options and connect with providers who have openings.

Costs and Insurance: What Families Pay

For eligible families, MaineCare Section 28 covers 100% of approved ABA therapy costs, including assessment, treatment, and supervision. There are no copays, deductibles, or premiums for covered services. However, families must recertify annually and report any changes in income or household size that could affect MaineCare eligibility. Providers handle billing directly with MaineCare, so families typically have no out-of-pocket expenses beyond any unrelated fees (like some school services).

Common Mistakes to Avoid

One major error is assuming your child qualifies without a formal level of care determination-this must be done by MaineCare. Another is waiting too long: Section 28 can have waiting lists in high-demand regions, so applying early is wise. Also, do not switch providers without checking if the new one is MaineCare-enrolled. Finally, miss out on caregiver training-it's a covered service that empowers you to support your child's progress. Our matching service can help you avoid these pitfalls by connecting you with experts who know the system.

Next Steps: How to Get Started

Begin by gathering your child's autism diagnosis and MaineCare information. Contact MaineCare to start the Section 28 application. While waiting, research providers via our free matching service-we'll help you find BCBA-led clinics that accept MaineCare. You can also join local parent groups (e.g., the Autism Society of Maine) for support. Remember, you are not alone; many families navigate this successfully every day.