My child was diagnosed with autism. What do we do next?

Ask the evaluator for the full written report, not only a summary letter. Insurance plans, the school and the regional center will each ask for it. It should name the diagnosis (autism spectrum disorder), say who evaluated your child and what tools they used, and describe your child’s strengths and needs.

Also ask whether the evaluator recommends behavioral treatment such as ABA, and get that in writing. California’s autism coverage law describes covered behavioral health treatment as prescribed by a licensed physician or developed by a licensed psychologist, so a prescription or recommendation from your pediatrician or evaluator is a normal part of the paperwork.

Keep every report in one folder, paper or digital. You will use it for years: for insurance, for the IEP, for any regional center application.

California’s early intervention program is called Early Start, for children from birth to age 3. The Department of Developmental Services (DDS) says anyone can make a referral, including parents and doctors, by contacting the local regional center or school district to ask for an evaluation. The state Early Start FAQ lists a toll-free Baby Line, 800-515-2229.

After a referral, the program has 45 calendar days to assign a service coordinator, get your consent, complete the evaluations and, for an eligible child, write an Individualized Family Service Plan. DDS states there is no charge for the evaluation, assessment or service coordination. Eligibility is based on developmental delay or risk, so a child can be referred before a diagnosis.

At age 3, the service coordinator helps you plan the move to preschool special education or other services. If your child is under 3, do this alongside your insurance steps below, not instead of them.

Children with a disability that affects learning are entitled to a free public education that fits their needs, delivered through an Individualized Education Program (IEP). The request starts with a letter to the school district, which should be dated and in writing, asking for an evaluation for special education and attaching the diagnostic report.

California law (Education Code section 56043) sets timelines: the district proposes an assessment plan within 15 days of a referral, you then have at least 15 days to consent, and the IEP meeting follows within 60 days of your consent, not counting school breaks longer than five days. Ask the district to confirm its dates in writing.

An IEP and ABA are different things. The IEP covers what the school provides at school; ABA from a health plan is a medical benefit delivered at a clinic. The state coverage law says a health plan’s autism benefit does not reduce a school district’s IEP obligations. Sharing the IEP with your ABA provider helps the two sets of goals fit together.

Regional centers are nonprofit agencies that the state contracts to coordinate services for people with developmental disabilities, under the Lanterman Act. There are 21 across California. After age 3, autism can qualify a child, when it causes a substantial disability; the DDS eligibility handout points to Welfare and Institutions Code section 4512 for the rules. Eligibility is decided by the regional center, not by this website.

The DDS regional center lookup assigns by county. Alameda County (Oakland, Berkeley, Alameda, San Leandro, Hayward, Fremont, Union City and neighbors) is served by the Regional Center of the East Bay, 500 Davis Street, Suite 100, San Leandro, 510-618-6100. It also serves Contra Costa County. Santa Clara County (San Jose, Santa Clara, Sunnyvale, Campbell, Cupertino, Los Gatos and neighbors) is served by San Andreas Regional Center, 6203 San Ignacio Avenue, Suite 200, San Jose, 408-374-9960. It also serves Monterey, San Benito and Santa Cruz counties.

Regional centers generally treat private health insurance as a first source of payment and fund what other sources do not (Welfare and Institutions Code section 4659). If you apply, ask your service coordinator how their services and your insurance fit together.

A note for families who already have a regional center funding hope: Rori Care does not accept Regional Center funding yet. If a regional center is your only way to pay for ABA, ask the center for its list of vendors for your area.

In California, state-regulated health plans must cover behavioral health treatment for autism, which includes ABA (Health and Safety Code section 1374.73 for health plans, Insurance Code section 10144.51 for insurers). Employer plans that are self-funded are generally governed by federal law instead, so ask your plan or your employer which type you have. The cost page linked below goes into deductibles, out-of-pocket limits and what to expect.

1. The family gets the diagnostic report and the recommendation for ABA.
2. The provider checks your benefits: plan type, network status, deductible, copay or coinsurance, and whether authorization is needed.
3. A Board Certified Behavior Analyst (BCBA) assesses your child and writes a treatment plan with goals and recommended hours.
4. The provider sends the plan to your insurer for authorization. The insurer decides how many hours it will approve, and that can be fewer than recommended.
5. Therapy begins. Under the state law the plan is reviewed at least every six months, so authorizations are renewed on a schedule.

Our guide on how to pay for ABA in California covers what you pay, prior authorization and private pay in more detail. The insurance page lists the plans Rori Care works with.

You are choosing a team you will see several times a week for a long stretch. These questions apply to us and to anyone else you talk to.

• Who writes my child's plan, and what credential do they hold? How often do they observe my child directly?
• Where does therapy happen: at a center, at home, or both? Do you do telehealth? (Rori Care is center-based only; we do not provide in-home or telehealth ABA.)
• How many hours do you recommend, and what is that based on? What happens if the insurer approves fewer?
• Which plans are you in-network with, and which funding sources do you not accept?
• How will I be trained to use the strategies at home? How often do we meet?
• How do you measure progress, and how often do I see the data?
• Who handles authorizations and renewals, and how will I know a renewal date is coming?
• What are your hours, and what does a typical weekly schedule look like?

Rori Care runs two centers: 3300 Webster St, Suite 210 in Oakland and 125 Ciro Ave, Suite 240 in San Jose. Therapy is center-based and led by BCBAs. We are in-network with Aetna, Anthem Blue Cross of California (through Carelon), Blue Shield of California, Kaiser Permanente through Catalight, UnitedHealthcare (including Optum, UMR and Surest), Cigna / Evernorth and TRICARE West. Exact coverage depends on your plan, and we verify it for free before your child starts.

We do not currently accept Regional Center funding or Medi-Cal. If those are your only options right now, we are not the right provider yet, and we would rather say that than waste your time. If you have a qualifying commercial plan, a free 30-minute consultation is the next step. If your child has not been evaluated yet, our page on autism diagnosis and evaluation describes the next step.