The CMS Health Plan is Florida Medicaid's plan for children with serious or chronic health conditions, run through Children's Medical Services. ABA is a covered benefit, but it is authorized in stages, and families lose weeks by not knowing what the next stage needs. This is the full sequence as it works for our families in Miami-Dade.
Step 1: Diagnosis and referral
ABA under the CMS Health Plan requires a qualifying diagnosis, most often autism spectrum disorder, documented in a comprehensive diagnostic evaluation by a licensed practitioner (a developmental pediatrician, psychologist, neurologist or psychiatrist). The plan also requires a referral or prescription for ABA from the child's physician.
What to gather:
- The full evaluation report, not just the summary letter.
- A signed referral for ABA from the pediatrician or specialist.
- Your child's plan ID card and the name of the care coordinator if one has been assigned.
If your child does not have an evaluation yet, this is the longest step. Waits at some Miami-Dade evaluators run months; others are weeks. Ask us which is which before you book.
Step 2: Choosing an in-network provider
The provider must be contracted with the plan's managed-care administrator. Beaton Care Services is contracted with the full Molina line, including the CMS Health Plan, and with Sunshine Health. Once you send us the documents from step 1, we verify eligibility with the plan the same day.
Step 3: The assessment
The plan authorizes a behavior assessment first, before treatment. A BCBA meets your child and family, reviews the evaluation, observes at home or school, and completes standardized measures of skills and behavior. This produces the treatment plan: goals, the recommended number of hours per week, settings (home, school, community), parent training, and how progress will be measured.
Typical time from authorization to a completed assessment report: two to three weeks.
Step 4: Treatment authorization
We submit the assessment and treatment plan to the plan for review. The plan's clinical reviewers check medical necessity and issue an authorization that specifies:
- The service codes approved (direct treatment by a technician, supervision by the BCBA, parent training).
- The number of units or hours per week.
- The authorization period, commonly six months.
Turnaround varies, but most decisions come back within about two weeks. If the plan approves fewer hours than recommended, the BCBA can request a peer-to-peer review or submit additional justification; we handle that.
Step 5: Sessions begin
With authorization in hand, we schedule a technician and start. Parent training is part of every plan from the first month.
Reauthorization
Before each authorization period ends, the BCBA writes a progress report with updated data and goals, and we submit it for the next period. Families do not need to do anything except attend the progress meeting. The important thing is that no gap opens between periods, which is why we start reauthorization about 45 days early.
Molina administers the CMS Health Plan (since October 1, 2026)
Since October 1, 2026 the CMS Health Plan is administered by Molina Healthcare instead of Sunshine Health. Children stayed on the CMS Health Plan; the company handling authorizations and claims changed. Authorizations approved before the switch are honored during a continuity-of-care period, and every new request or renewal goes to Molina. Beaton Care Services is contracted with Molina for the CMS Health Plan, so families with us did not change providers. We have a separate guide on what to check after the switch on this site.
How long the whole thing takes
From a completed evaluation to a first session, a family that has all documents ready and chooses an in-network provider with capacity typically starts within four to six weeks. Without an evaluation, add the evaluator's wait. The single fastest way to shorten the timeline is to send us what you have now, even if it is incomplete; we will tell you exactly what is missing.