MedicaidPrior AuthMedium impact
26-198 Updated ABA Medical Necessity Criteria for Medi-Cal, Effective April 20, 2026
Health Net·CA · Psychiatry·Prior Authorization
Effective date
Apr 20, 2026
We identified it
Jun 20, 2026
Summary
Effective April 20, 2026, Medi-Cal will adopt new medical necessity criteria for Applied Behavior Analysis (ABA) services for patients under age 21, replacing the previous Council of Autism Service Providers criteria. This change promotes more individualized, needs-based ABA care and requires providers to follow the new clinical policy CA.CP.BH.104.
Action Required
Before April 20, 2026: Behavioral health providers must review and implement the new ABA medical necessity criteria under clinical policy CA.CP.BH.104 for all Medi-Cal patients under age 21. Access the complete ABA clinical policies at the provided link and update prior authorization processes accordingly. Contact CalViva Health at 888-893-1569 for questions or Behavioral Health providers can call 844-966-0298.