As of January 1, 2026, California health plans regulated by the state can no longer require a child who already has an autism or related diagnosis to undergo a new diagnostic evaluation just to keep receiving behavioral health treatment coverage — including ABA therapy. This protection applies to plans issued or renewed on or after that date.
If your child's insurer has requested a re-diagnosis as a condition of continuing services, that request may not be lawful under the new rule. Here's what changed and what to do if you're facing this situation.
What the law changed
Prior to this change, some California health plans required families to repeat the diagnostic process before authorizing continued ABA or behavioral health treatment — even when a diagnosis was already established and services were ongoing. For many families, this created delays, additional out-of-pocket costs, and disruptions in care.
The updated rule prohibits state-regulated health plans from imposing a re-diagnosis requirement as a condition of continuing coverage. A plan can still ask for updated treatment plans, progress documentation, and records supporting that services remain medically necessary — those requests are still permitted. What is no longer permitted is requiring a new formal diagnosis when one already exists.
This change was enacted through AB 951 and applies to state-regulated plans issued or renewed on or after January 1, 2026.
Who this applies to — and who it doesn't
This protection applies to state-regulated health insurance plans in California. It does not automatically apply to self-funded employer health plans, which are regulated under federal law rather than state law. If your coverage comes through an employer, check your Summary Plan Description to understand which rules apply to your plan.
If you're on Medi-Cal, coverage rules operate differently. For questions about ABA coverage under Medi-Cal, contacting your regional Medi-Cal managed care plan directly is the most reliable path to current information.
If your insurer is still asking for re-diagnosis
If your plan renewed on or after January 1, 2026, and your insurer is requiring a new autism evaluation as a condition of continuing ABA or behavioral health services, you have the right to push back. Start by requesting the denial or requirement in writing. A written explanation identifies exactly what the plan is claiming and gives you a basis for an appeal.
Organizations like Disability Rights California and the California Department of Managed Health Care's Help Center are resources for families navigating insurance disputes. If you believe your plan is violating state law, a complaint with the DMHC is one avenue — their process is designed for exactly these situations.