Sunny Skies ABA accepts Carolina Complete Health statewide. ABA fully covered for children under 21 under EPSDT — verify benefits free in 24 hours.
Carolina Complete Health is North Carolina's only physician-led NC Medicaid Standard Plan — a joint venture between Centene Corporation and the North Carolina Medical Society's Community Care of North Carolina. The plan launched as part of NC Medicaid's managed care transition and now serves Medicaid members statewide as one of five Standard Plan options.
For families with children diagnosed with autism, Carolina Complete Health covers Applied Behavior Analysis therapy as a behavioral health benefit. Coverage flows through the federal EPSDT benefit, which protects medically necessary services for Medicaid-enrolled children and young adults under 21. That means there is no hard dollar cap and no fixed weekly hour limit — coverage is driven by what the BCBA documents as medically necessary, supported by ongoing progress data.
Sunny Skies ABA is in-network with Carolina Complete Health. Our intake team is experienced with the Carolina Complete authorization process and submits the full clinical packet on your behalf. Families generally pay $0 out-of-pocket for medically necessary ABA services.
Once medical necessity is established and prior authorization is approved, Carolina Complete typically covers:
Carolina Complete also covers diagnostic evaluations, speech therapy, occupational therapy, and primary care — services that often work together with ABA in a comprehensive care plan.
To qualify for ABA therapy under Carolina Complete Health, your child must meet these requirements:
Your child must be actively enrolled in Carolina Complete Health. If your enrollment is in a different Standard Plan, see our main insurance page — we accept all five.
Carolina Complete requires a current DSM-5 diagnosis of Autism Spectrum Disorder with ICD-10 code F84.0 from a licensed psychologist, psychiatrist, developmental pediatrician, or other qualified clinician. We refer you to local diagnosticians if needed.
Our BCBAs administer Vineland-3 along with functional behavior assessment and parent interviews to document that ABA is medically necessary for your child specifically.
Carolina Complete Health requires prior authorization before ABA begins. We submit the complete clinical packet through Carolina Complete's provider portal. Reauthorization is required approximately every six months.
Free, no-obligation verification in 24 hours.
Complete our online benefits verification form with a photo of your Carolina Complete member card and your child's information. Call (919) 502-1112 or email info@sunnyskiesaba.com.
Within 24 hours our intake team confirms active enrollment, prior authorization history, and the documentation needed to start your child's authorization.
We email a written summary of your Carolina Complete coverage and book a free consultation to discuss next steps and begin the BCBA assessment.
Sunny Skies ABA accepts every Carolina Complete benefit pathway:
The primary Medicaid Standard Plan. ABA covered for under-21 members.
For children whose family income exceeds Medicaid limits.
We support families moving from Medicaid Direct or another Standard Plan.
For families with Carolina Complete as primary or secondary alongside commercial coverage.
We provide Carolina Complete-covered ABA therapy in homes, clinics, and community settings across these North Carolina cities:
Carolina Complete Health families deserve the same level of clinical excellence as any other family. That's what we deliver:
Free benefits verification in 24 hours. No commitment.
Verify Your Carolina Complete Benefits Now
