Sunny Skies ABA accepts Alliance Health Tailored Plan across Cumberland, Durham, Johnston, Mecklenburg, Orange, and Wake counties. Free benefits verification in 24 hours.
Alliance Health is one of four NC Medicaid Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plan operators in North Carolina. Tailored Plans launched July 1, 2024, and are designed specifically for Medicaid members with significant behavioral health, I/DD, or traumatic brain injury (TBI) needs — including most children with autism whose treatment intensity goes beyond what a Standard Plan typically supports.
For Tailored Plan members, Alliance integrates physical health, behavioral health, pharmacy, I/DD services, and long-term services and supports under one plan with one care team. ABA therapy is a covered service for eligible children under 21 with autism, supported by the federal EPSDT benefit. There is no hard cap on weekly hours — coverage flows from documented medical necessity, the BCBA's clinical recommendation, and ongoing progress data.
Sunny Skies ABA is in-network with Alliance Health and serves families across all counties Alliance covers: Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange, and Wake. Our intake team has direct working relationships with Alliance care managers and handles every authorization and reauthorization on your behalf.
Once medical necessity is documented and prior authorization is approved, Alliance Health typically covers the full range of ABA services for eligible children:
Because Alliance is a Tailored Plan, your child likely has additional benefits beyond ABA — including potential Innovations Waiver services, behavioral health residential treatment, or other I/DD supports — that we coordinate alongside ABA when appropriate.
To qualify for ABA therapy through Alliance Health, your child must meet these criteria. Our intake team prepares and submits every document on your behalf.
Your child must be enrolled in Alliance Health — either through the Tailored Plan, Alliance's Medicaid Direct services, or Alliance's state-funded services for non-Medicaid eligible members. Enrollment in Alliance is tied to your home county. We can confirm your enrollment status during verification.
Alliance Health requires a current DSM-5 diagnosis of Autism Spectrum Disorder with ICD-10 code F84.0 from a licensed psychologist, psychiatrist, developmental pediatrician, neurologist, MD, or DO. If your child does not yet have a formal diagnosis, we refer you to trusted diagnosticians in your area.
Most Alliance Health pathways require a referral from your child's primary care provider before ABA begins. Your care manager can also assist with this step. The referral is included in the authorization packet we submit.
Alliance Health requires prior authorization before ABA services start. We submit a complete clinical packet — diagnosis, assessments, BCBA-developed treatment plan, and authorization forms. Reauthorization is required approximately every six months and is also handled by our team.
Free, no-obligation verification in 24 hours.
Complete our online benefits verification form with a photo of your Alliance Health member card and your child's information. Call (919) 502-1112 or email info@sunnyskiesaba.com.
Within 24 hours our intake team confirms Alliance enrollment, county eligibility, prior authorization history, and exactly what's needed to start your child's authorization.
We email a written summary of your Alliance coverage and book a free consultation to discuss next steps and begin the BCBA assessment.
Sunny Skies ABA accepts every Alliance Health benefit pathway:
Medicaid managed care for members with significant BH or I/DD needs. ABA covered for under-21 members.
For members not yet transitioned to the Tailored Plan but receiving Alliance-coordinated services.
For NC residents without Medicaid who still meet clinical eligibility for behavioral health services.
For members with additional I/DD waiver services we coordinate alongside ABA.
Alliance Health's Tailored Plan covers seven NC counties. Within these counties, Sunny Skies ABA serves the following cities:
Alliance also covers Harnett, Johnston, and Orange counties. If your home county is served by Alliance but not listed above, contact us to confirm service availability.
Tailored Plan families navigate complex care needs and deserve a provider who can keep up with them. That's what Sunny Skies delivers:
Free benefits verification in 24 hours. No commitment.
Verify Your Alliance Benefits Now
