Sunny Skies ABA is an enrolled NC Medicaid provider. ABA therapy is fully covered under EPSDT for children under 21 — verify benefits free in 24 hours.
NC Medicaid Direct is the state's traditional fee-for-service Medicaid program — the program for North Carolinians who are not enrolled in a Standard Plan, a Tailored Plan, or the EBCI Tribal Option. Many children with autism remain on NC Medicaid Direct during transitions, while awaiting Tailored Plan enrollment, or because their family's circumstances place them in the traditional program. For these families, the good news is that ABA therapy is one of the most strongly protected benefits in the entire Medicaid program.
Coverage flows through the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit — a mandate that requires state Medicaid programs to cover any medically necessary service for children and young adults under 21, regardless of whether it appears on a typical adult benefit list. NC Medicaid Direct applies EPSDT to ABA without a fixed annual dollar cap and without a hard limit on weekly hours. What matters is medical necessity, documented progress, and clinical recommendation from a Board Certified Behavior Analyst (BCBA).
Sunny Skies ABA is an enrolled NC Medicaid provider and works directly with the NC Department of Health and Human Services for authorization, billing, and care coordination. Families on NC Medicaid Direct generally pay $0 for medically necessary ABA — no copays, no deductibles, no surprise bills. Our intake team handles every form so you can focus on your child.
Because EPSDT requires NC Medicaid to cover medically necessary services in full, NC Medicaid Direct's ABA benefit is one of the most comprehensive in the state. Once medical necessity is established and authorization is approved, the following are covered:
NC Medicaid Direct also covers diagnostic evaluations, speech-language therapy, and occupational therapy as separate benefits. Many of our families combine ABA with these services for a full, integrated treatment plan.
To qualify for ABA therapy under NC Medicaid Direct, your child must meet specific clinical and documentation requirements. Our intake team helps families gather everything needed and submits the full package to NC Medicaid.
Your child must be actively enrolled in NC Medicaid Direct (the traditional fee-for-service program). If your child is enrolled in a Standard Plan or Tailored Plan instead, we accept those plans too — see our main insurance page for the full list. We can confirm enrollment status during free verification.
A current DSM-5 diagnosis of Autism Spectrum Disorder with an ICD-10 code in the F84.0–F84.9 range is required. The diagnosis must come from a licensed psychologist, psychiatrist, developmental pediatrician, or other qualified clinician. If your child does not yet have a formal diagnosis, we can refer you to trusted local diagnosticians who accept NC Medicaid.
NC Medicaid Direct requires evidence that ABA is medically necessary — meaning your child's autism is impacting daily functioning and ABA is the appropriate intervention. Our BCBAs administer the Vineland-3 along with functional behavior assessments and parent interviews to document medical necessity in a way that meets NC Medicaid standards.
NC Medicaid Direct requires prior authorization before ABA services begin. The clinical packet typically includes the diagnosis, assessment results, the BCBA's treatment plan, and standardized authorization forms. Sunny Skies ABA prepares and submits every document on your behalf, and we handle each reauthorization (usually every 6 months) for as long as your child is in treatment.
Free, no-obligation benefits verification in 24 hours. We confirm everything before therapy starts.
Complete our online benefits verification form with a photo of your NC Medicaid card and your child's basic information. You can also call (919) 502-1112 or email info@sunnyskiesaba.com.
Within 24 hours, our intake team confirms your child is enrolled in NC Medicaid Direct (versus a Standard or Tailored Plan), pulls any prior authorization history, and outlines what documentation we still need.
We email a written summary of your Medicaid coverage and book a free consultation to discuss next steps, meet your family, and start the BCBA assessment if you'd like to move forward.
Sunny Skies ABA accepts NC Medicaid Direct along with every Standard Plan and every Tailored Plan operating in North Carolina:
Traditional fee-for-service Medicaid. Full EPSDT ABA benefits with no fixed cap.
For children whose family income exceeds Medicaid limits. ABA covered with similar protections.
For enrolled members of the Eastern Band of Cherokee Indians.
AmeriHealth Caritas, Carolina Complete, Healthy Blue, UnitedHealthcare, WellCare.
Alliance Health, Partners Health, Trillium, Vaya Health — for members with significant BH or I/DD needs.
We support families moving between Medicaid Direct, Standard Plans, and Tailored Plans without service interruption.
We provide Medicaid-covered ABA therapy in homes, clinics, and community settings across these North Carolina cities:
Medicaid families deserve the same quality, attention, and clinical excellence as any other family. At Sunny Skies, that's exactly what they get:
Free benefits verification in 24 hours. No cost. No commitment.
Verify Your Medicaid Benefits Now
