For most families in Miami-Dade, the slowest step between "I'm worried" and "therapy has started" is not the therapy provider and not the insurance company. It is the evaluation. This guide explains what you need, who can provide it, and how to avoid the longest lines.
What you need
Florida Medicaid plans (Molina, Sunshine Health, the CMS Health Plan and others) authorize ABA based on a comprehensive diagnostic evaluation by a licensed practitioner, plus a referral from your child's doctor. Private plans usually want the same evaluation. A screening questionnaire from the pediatrician is not enough; a school evaluation is helpful but generally not accepted on its own.
A comprehensive evaluation typically includes a developmental history interview with you, direct observation and standardized testing of your child (an ADOS-2 or similar instrument is common), review of any prior reports, and a written report with a diagnosis and recommendations. Ask for the full written report; plans want the document, not a one-page summary.
Who does evaluations in Miami-Dade
Evaluations are performed by developmental-behavioral pediatricians, child psychologists, pediatric neurologists and child psychiatrists. In Miami-Dade the main sources are:
- Hospital-affiliated developmental centers at the large children's hospitals and university programs. Thorough, well-recognized by insurers, and often the longest waits.
- Community developmental pediatric practices. Shorter waits, usually a few weeks to a couple of months.
- Licensed psychologists in private practice who specialize in autism assessment. Often the fastest route; some accept Medicaid, many are private-pay with a superbill.
- Early Steps (for children under 3) provides developmental evaluations that establish eligibility for its services, which is not the same as a diagnostic evaluation but is a useful first step and free.
- Miami-Dade County Public Schools evaluates for educational eligibility. This is free and valuable for school services, but most insurance plans do not accept it for ABA authorization.
Why waits vary so much
Hospital programs see the most complex cases and take every referral, so they carry the longest queues, sometimes six months or more. Smaller practices and private psychologists have shorter lists but may not take every plan. Waits also change month to month as providers open and close their books. The families who start fastest are the ones who call three places, not one.
Paying for it
- Medicaid plans: The evaluation is covered when performed by an in-network provider. Ask the practice to confirm they are in network with your specific plan before booking.
- Private insurance: Usually covered with a referral; check whether the evaluator is in network and what your cost-share is.
- Private pay: Some psychologists offer evaluations for a flat fee with the shortest waits. If you go this route, confirm in writing that the report will meet your insurance plan's requirements for ABA authorization before paying.
What to do while you wait
- Ask your pediatrician for the ABA referral now, so it is ready the day the report arrives.
- If your child is under 3, refer to Early Steps; it does not need a diagnosis.
- Contact an ABA provider and share the evaluation date. We can verify your plan, explain the authorization steps, and hold a place so the assessment happens the week the report comes in.
- Keep a short log of concerns with dates and examples. Evaluators use it, and so does the BCBA.
How we help
Beaton Care Services keeps a current list of evaluators in Miami-Dade with typical waits and which plans they accept. A bilingual BCBA will share it in a 15-minute call and tell you exactly what your plan needs, at no cost and with no diagnosis required to talk.