Autism in Texas: ECI, the ARD Table and Who Pays

Texas does not run autism services out of one office. The state writes the rules; the help arrives from a local contractor — a community agency covering your ZIP code for early intervention, your independent school district for special education, your Medicaid plan or insurer for therapy, and a local intellectual and developmental disability authority for longer-term supports. Two of those systems keep time in opposite ways, which is the thing to grasp first: a school evaluation is measured in school days and can be lost by waiting for someone to offer it, while the Medicaid waiver interest lists are measured in years and are worth joining the week you first hear the word autism.

Who can make the diagnosis here

Most families arrive through a routine checkup. The Centers for Disease Control and Prevention states that the American Academy of Pediatrics recommends developmental screening at 9, 18 and 30 months, and screening specifically for autism at 18 and 24 months. In Texas those two autism screenings are not only advice: the Department of Insurance rule at 28 TAC §21.4403(e) requires a health benefit plan subject to the state mandate to “provide coverage for screening a child for autism spectrum disorder at the ages of 18 months and 24 months.”

A screening result is not a diagnosis, and Texas is explicit about the difference. The Texas Medicaid Children’s Services Handbook (September 2026) states that “a comprehensive diagnostic evaluation is required to diagnose ASD,” and that the diagnosis “may be made by any one of the following providers or utilizing an interdisciplinary diagnostic team approach”: a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an interdisciplinary team qualified by licensure to use the diagnostic tools. The evaluation must set out DSM criteria and symptom severity level and use “a reliable, valid, standardized diagnostic assessment tool or combination of tools” — and screening tools such as the M-CHAT-R/F “may not replace the use of validated diagnostic assessment tools.”

Birth to three: ECI, and the 45-day plan

Early Childhood Intervention is Texas’s IDEA Part C program, run by the Health and Human Services Commission through local contractors. HHS states that a child qualifies “if he/she is under 36 months old, resides in Texas and meets one of ECI’s eligibility types”: a medically diagnosed condition likely to cause developmental delay, “a developmental delay of 25 percent in one or more areas of development, or a 33 percent if the delay occurs only in the area of communication,” or identification “as deaf or hard of hearing or as blind or visually impaired, as defined by the Texas Education Agency.”

You do not need to wait for a doctor to act. HHS says “a referral to ECI can be based on professional judgment or a family’s concern,” and that “a medical diagnosis or a confirmed developmental delay is not needed to refer.” That page also carries the ECI Program Search, which finds your local program by ZIP code; or call the HHS Office of the Ombudsman at 1-877-787-8999 and choose Option 3.

The ECI Parent Handbook carries the deadline that matters: “The IFSP must be written within 45 days of your referral to ECI.” Date your referral and keep a note of it. Texas asks families to contribute to costs but cannot charge you out of services: “families are expected to share in the cost of services; however, no family is turned away because of an inability to pay.”

Transition is a formal step, not a birthday. “All children must leave ECI by their third birthday,” and planning “begins after your child is two.” At least 90 days before that birthday, “your service coordinator will offer to set up transition meetings with the programs or community services you are considering.” And if you decline school services at three, “you can contact the local school district at any time and ask that your child be evaluated for eligibility for special education.”

School age: the ARD committee and the autism supplement

Texas does not say “IEP team.” It says ARD committee — Admission, Review, and Dismissal. The document is still an IEP, and three school-day counts govern how you reach the table. The Texas Education Agency’s statement for student handbooks sets them out: if a parent makes a written request for an initial evaluation “to the director of special education services or to an administrative employee,” the district or charter school “must respond no later than 15 school days after receiving the request.” If it agrees to evaluate, “it must complete the student’s evaluation and evaluation report no later than 45 school days following the date it receives a parent’s written consent.” You must get a copy of the report “no later than five school days prior to the initial admission, review and determination (ARD) committee meeting.”

Autism is one of the eligibility categories Texas schools use. TEA’s autism page notes that IDEA defines it as “a developmental disability significantly affecting verbal communication, nonverbal communication, and social interaction,” and reports that “in the 2025-2026 school year, 160,218 Texas students received special education services due to the disability condition of autism.”

Texas then adds something many states do not have. Under Commissioner’s Rule 19 TAC §89.1055, an ARD committee writing an IEP for a student with autism works through what schools call the autism supplement. TEA’s guidance states that “ARD committees must, at least annually, consider eleven strategies for students with autism,” and TEA’s autism page says they “must be considered and addressed, as practicable and as needed,” in the IEP. Not every strategy has to be adopted, but each has to be discussed on the record every year — eleven openings to raise something your child needs. Ask for the supplement form before the meeting.

Two state resources sit behind that table. SPEDTex, TEA’s special education information center for families, answers parent questions at 1-855-773-3839, including requesting an evaluation and “dispute resolution options.” And TEA runs Parent-Directed Special Education Services, “a one-time $1,500 grant for parents of students served by special education and who are enrolled in a Texas public school.” It opens in application windows, so check the current status with TEA or SPEDTex.

If a district will not move, two organizations can help. Partners Resource Network operates “the Texas statewide network of Parent Training and Information (PTI) Centers,” funded by the U.S. Department of Education and serving families of children aged 0–26; “all of our services are provided at no cost,” and its office is at 1-800-866-4726. Disability Rights Texas is “the protection and advocacy (P&A) agency for Texans with disabilities.”

Paying for therapy

Medicaid. The Children’s Services Handbook states that “autism services are a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Medicaid children or youth who are 20 years of age or younger and meet the criteria outlined in this section.” Applied behavior analysis is directed by a licensed behavior analyst, who may supervise assistant behavior analysts and behavior technicians, and the manual is blunt about what authorization turns on: “ABA services must be medically necessary to treat, correct, or ameliorate the individual’s condition. A diagnosis alone is not sufficient documentation to support the medical necessity of ABA.” It also limits restraint under this benefit to “emergency instances of threat of physical harm,” by trained staff only, stopping when the emergency ends — a fair paragraph to put to any clinic in writing before you enroll.

To start, HHSC’s family guide to Medicaid ABA says to call your child’s primary care provider, your health plan on the number on your ID card, or the Texas Medicaid & Healthcare Partnership Contact Center at 800-925-9126; licensed behavior analysts are listed in TMHP’s Online Provider Look-up at opl.tmhp.com.

Two other doors. STAR Kids is “a Texas Medicaid managed care program that provides free health coverage for children and young adults with disabilities” aged 20 or younger, and “all members in STAR Kids receive service coordination.” If you are not on Medicaid, the Children with Special Health Care Needs Services Program “helps people 20 and younger who have special health care needs,” for families at or below 200 percent of the federal poverty level; it keeps a waiting list when funding is short. The number is 800-222-3986.

Private insurance, and the tenth birthday. Texas’s autism mandate sits in Insurance Code Chapter 1355, Subchapter A, implemented by the Department of Insurance in 28 TAC Subchapter JJ. The rule requires a plan to cover an enrollee diagnosed with autism “from the date of diagnosis if the diagnosis was in place prior to the enrollee’s 10th birthday.” What must be covered is “all generally recognized services prescribed in relation to autism spectrum disorder by the enrollee’s primary care physician” — a list including evaluation and assessment, applied behavior analysis, behavior training and management, speech, occupational and physical therapy. From age 10 a cap is allowed: a plan “is not required to provide coverage… for an enrollee 10 years of age or older for applied behavior analysis in an amount that exceeds $36,000 per year.”

One provision is worth carrying to an appeal: a plan “may not deny coverage for services for autism spectrum disorder on the basis that a health care practitioner providing applied behavior analysis does not hold a license issued by an agency of this state,” so long as the practitioner meets one of the statutory alternatives. The subchapter applies to the plans specified in Insurance Code §1355.002 and expressly does not apply to several others, so ask your employer’s benefits team, in writing, whether your coverage is one the Texas mandate reaches. No reliable published Texas figure exists for private fees, so ask each provider for the session rate, the assessment cost, whether supervision and parent training are billed separately, and which plans they are in network with.

The interest lists: join now, use later

Texas funds its most substantial long-term supports through Medicaid waivers, and entry is by queue. For Home and Community-based Services and Texas Home Living, HHS states that “each local intellectual and developmental disability authority (LIDDA) is responsible for maintaining” the lists for its service area, and that “the person with the longest time on the interest list is served first.” For the Community Living Assistance and Support Services waiver, HHS says “to contact the CLASS interest list call 877-438-5658.” That same CSIL hotline number is the route onto the other HHSC waiver lists, the Medically Dependent Children Program among them. Because position is bought with time rather than need, call early and keep your contact details current for as long as it takes.

A smaller, faster-moving option sits alongside them. The HHS Children’s Autism Program “provides focused Applied Behavior Analysis (ABA) services through local community agencies and organizations” to a Texas resident who “has a documented diagnosis on the autism spectrum made by a qualified professional” and “is 3 to 15 years old.” It is capped at 180 hours in 12 months and 720 over a lifetime, and attendance “for the child and the parents must be maintained at 85 percent of scheduled treatment.” Enroll by calling 2-1-1.

Checking who is treating your child

Texas licenses behavior analysts through the Department of Licensing and Regulation. TDLR states that people who use the title “licensed behavior analyst” or “licensed assistant behavior analyst,” and people “who engage in the practice of applied behavior analysis,” must hold the license unless exempt by law, and that a behavior analyst must hold current certification as a Board Certified Behavior Analyst or BCBA-Doctoral, or as a Qualified Behavior Analyst. The exemptions are the part to ask about — they cover students under supervision, paraprofessionals working under a licensed analyst’s direction, licensed psychologists working within their competence, and school employees providing ABA within their employment. So ask who will be in the room each session, whether they are licensed or working under an exemption, and who supervises them. Verify names on TDLR’s license search and on the BACB certificant registry.

Finding providers in your Texas city

StarzMeet lists private and non-profit providers across eight Texas cities, weighted very differently from one another.

If you know the service you need, the category pages are faster: ABA therapy, speech therapy, occupational therapy and diagnostic and assessment. The directory does not yet cover every Texas city; families in San Antonio, Fort Worth, El Paso and elsewhere should start with their local ECI program, their school district and their LIDDA.

Listing details come from providers and public information; confirm availability, fees and insurance directly with each provider.

Frequently asked questions

Our pediatrician suggested waiting. Can I refer to ECI myself?

Yes. HHS states that a referral “can be based on professional judgment or a family’s concern” and that “a medical diagnosis or a confirmed developmental delay is not needed to refer.” Use the ECI Program Search on the HHS referral page, or call the HHS Ombudsman at 1-877-787-8999 and choose Option 3. Once you refer, the IFSP must be written within 45 days.

My child turns three in two months and there is no IEP. What now?

Do two things at once. Ask your ECI service coordinator about the transition meetings offered at least 90 days before the third birthday, and separately put a written request for an evaluation to your district’s special education director or an administrative employee such as the campus principal. The district must respond within 15 school days, and if it evaluates, the report is due within 45 school days of your written consent.

Will Texas Medicaid pay for ABA?

It can. Autism services are a benefit of the Texas Health Steps-Comprehensive Care Program for children and youth 20 or younger who meet the criteria. You will need a comprehensive diagnostic evaluation from a qualifying provider, and the manual states that “a diagnosis alone is not sufficient documentation to support the medical necessity of ABA.” Start with your child’s primary care provider, your health plan, or TMHP at 800-925-9126.

Our child was diagnosed at 11. Does the state insurance mandate still apply?

The minimum coverage the Texas rule requires attaches to a diagnosis that “was in place prior to the enrollee’s 10th birthday,” and from age 10 a plan may cap applied behavior analysis at $36,000 a year. Plans may offer more than the minimum, so ask your insurer in writing what your policy covers, whether it is one of the plans the Texas mandate reaches, and for any denial in writing. Texas Medicaid’s autism benefit runs on its own rules to age 20.

Sources

• Texas HHS – ECI Information for Families, Make a Referral to ECI, the ECI Parent Handbook, STAR Kids, Texas Health Steps, CSHCN Services Program, the Children’s Autism Program, HCS and TxHmL Interest Lists and CLASS Interest List
• Texas Education Agency – Student Handbook Statement, Autism, PDSES, Autism Supplement Guidance and SPEDTex
• Texas Medicaid – Children’s Services Handbook, September 2026 and the HHSC family guide to Medicaid ABA services
• Texas Department of Insurance – 28 TAC Subchapter JJ, Autism Spectrum Disorder Coverage and its Autism Spectrum Disorder page
• TDLR – Behavior Analyst license requirements and license verification; BACB Certificant Registry
• CDC – Developmental Monitoring and Screening; Partners Resource Network; Disability Rights Texas

Banner: AI-generated illustration; the people shown are not real and are not the providers listed.