Insurance and funding, explained.
The plans we work with, what your coverage actually depends on, and how we help you check before you commit to anything.
One call
Usually enough to find out
We verify first
Before you commit to anything
Insurance plans we work with
- Medi-Cal, California Medicaid
- Contra Costa Health Plan
- Blue Shield of California
- Anthem Blue Cross
- Cigna
If your plan is not on that list, it is still worth asking. In some cases an insurer will approve a single case agreement, which allows an out-of-network provider to work with your family under your existing plan. These are approved at the insurer's discretion and are not guaranteed, but we are glad to look into whether one is possible for you.
- Being in network is not the same as being covered. Network status varies by plan and product and can change over time, and eligibility, benefits and medical necessity are determined by your individual plan. We will help you verify your coverage before you commit to anything.
- Being in network is not the same as being covered. Network status varies by plan and product and can change over time, and eligibility, benefits and medical necessity are determined by your individual plan. We will help you verify your coverage before you commit to anything.
Insurance plans we work with
- Medi-Cal, California Medicaid
- Contra Costa Health Plan
- Blue Shield of California
- Anthem Blue Cross
- Cigna
If your plan is not on that list, it is still worth asking. In some cases an insurer will approve a single case agreement, which allows an out-of-network provider to work with your family under your existing plan. These are approved at the insurer's discretion and are not guaranteed, but we are glad to look into whether one is possible for you.
- Being in network is not the same as being covered. Network status varies by plan and product and can change over time, and eligibility, benefits and medical necessity are determined by your individual plan. We will help you verify your coverage before you commit to anything.
- Being in network is not the same as being covered. Network status varies by plan and product and can change over time, and eligibility, benefits and medical necessity are determined by your individual plan. We will help you verify your coverage before you commit to anything.
What we work on together
Private insurance
California law requires many state-regulated plans to cover medically necessary behavioral health treatment for autism, with no age or dollar caps. Most private plans ask for a documented autism diagnosis and a treatment referral from a licensed physician or psychologist, plus prior authorization. What you receive depends on your plan type, medical necessity, and your provider's network status.
Medi-Cal
Medi-Cal behavioral health treatment may cover members under 21 with or without an autism diagnosis, when treatment is determined medically necessary by the appropriate licensed provider. Prior authorization is typically required, and eligibility is determined by Medi-Cal rather than by us. This can be a useful route for families still waiting on a full evaluation, and we are happy to talk you through it.
Regional Center of the East Bay
RCEB serves Alameda and Contra Costa counties and can fund or coordinate services for eligible children under the Lanterman Act. Eligibility is determined by the Regional Center rather than by us.
Early Start, for children under three
California's early intervention program is often the fastest way in, and a formal diagnosis is not always required to begin. If your child is under three, this is usually the first call to make.
Private pay and grants
Some families self-fund, temporarily or by choice. Non-profit organizations also offer grants toward services, and they are worth asking about. Private-pay services are not guaranteed to be reimbursed later.
A recent change worth knowing about
Under California Assembly Bill 951, signed in July 2025, state-regulated commercial health plans cannot require someone already diagnosed with autism or a pervasive developmental disorder to be re-diagnosed in order to maintain coverage for behavioral health treatment. Treatment also cannot be paused while any re-evaluation is carried out. It applies to plan contracts issued, amended or renewed on or after January 1, 2026, and it does not apply to Medi-Cal. Your own clinician can still recommend a re-evaluation if they judge it useful, and insurers may still carry out utilization review, which is a different process.
How to find out what you actually have
1
Look at your card
It usually tells you your plan type, which determines which rules apply to you.
2
Call member services
The number is on the back. Ask specifically about behavioral health treatment for autism spectrum disorder, and ask whether your plan is fully funded or self funded.
3
Ask your HR department
If your insurance comes through work, they can often answer faster than the insurer can.
Things that can change your coverage
- Losing health coverage, whether employer-based, individual or student
- Changing plan type, for example from an HMO to a PPO or EPO
- A new policy number or group number
- Losing eligibility for Medicare, Medi-Cal or another state program
- Losing eligibility for Medicare, Medi-Cal or another state program
- Turning 18 while enrolled in Medi-Cal or Medicaid
- Starting a new job or another household employment change
- Marriage or divorce, which can change which plan is primary
- A death in the family, which can also affect primary and secondary coverage
- Moving to a new ZIP code or county, since Medi-Cal coverage varies by location
- Income changes affecting Medi-Cal eligibility
- Reference content, not persuasion — worth a bookmark for later.
Benefits and eligibility are determined by the payer and may change due to life events, plan rules or state regulation.
Navigating this is exhausting. Your energy belongs with your family.
- Verifying your benefits before you commit
- Preparing documentation
- Explaining what your plan actually says, in language that was not written for insurers
- Pursuing a single case agreement where one is needed
If it turns out another provider is a better fit for your coverage, we will tell you that too.
Services we can help you find
Some support falls outside insurance, or outside what a child currently qualifies for. We can help with referrals and coordination for:
These are not currently delivered by Nurture Path. Where appropriate we assist families with referrals,coordination
and guidance in accessing community providers.
Services we can help you find
Some support falls outside insurance, or outside what a child currently qualifies for. We can help with referrals and coordination for:
These are not currently delivered by Nurture Path. Where appropriate we assist families with referrals,coordination
and guidance in accessing community providers.
Questions we get asked
Coverage for evaluations and therapy varies by plan and by provider. A plan may cover a service in principle but not with a provider who is out of network, and medical necessity criteria still apply. Your insurer's member services line can confirm what your specific plan covers.
Call the member services number on the back of your card and ask specifically about coverage for developmental or diagnostic evaluations, including any requirement for a referral or prior authorization.
When a child is covered by two plans, one is primary and pays first, and the second may cover part of what remains. Which is primary is determined by plan rules rather than by preference, and life events like marriage or divorce can change it.
Call us anyway. We can look at a single case agreement, talk through private pay and grant options, or point you toward another provider. We will give you an honest picture even when it does not end with us.
Not sure where you stand?
You do not need to have your questions organised.
Most people are not. One call is usually enough to find out
Most people who contact us open with I do not really know where to begin. That is a perfectly good place to begin.