If your child has been diagnosed with autism and needs Applied Behaviour Analysis (ABA) therapy, you’re likely weighing how to pay for it. Between government programs, private insurance, and out-of-pocket costs, the funding landscape can feel overwhelming.
The good news: there are options, and understanding them early can help you get your child the support they need without delay.In Ontario, families typically access ABA therapy funding through two main routes: the Ontario Autism Program (OAP) or private insurance coverage.
Here’s what you need to know about both, and how to navigate the process with confidence.
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What Is the Ontario Autism Program (OAP)?
The Ontario Autism Program (OAP) is a government-funded program that helps families pay for core clinical services once their child has been diagnosed with autism spectrum disorder (ASD).
At Portia Learning Centre, we offer many of these services, including:
- ABA therapy
- Speech-language therapy
- Occupational therapy
- Mental health services and supports (for example, psychotherapy)
Important note: OAP funding does not cover psychological assessments or reassessments. Many families assume they can use their funding for a follow-up evaluation with a psychologist, but it is not an eligible expense under the program.
Once a child receives an autism diagnosis, families must register with the Ontario Autism Program. From there, they’re placed on a waitlist for core clinical services.
What are the OAP Wait Times and Interim Services?
The current wait time for OAP core clinical services is roughly five years. For most families, waiting that long isn’t realistic. Early intervention matters, especially for young children.
The Ontario Autism Program offers interim services to certain children who fall into specific categories:
- Foundational Services: Parent workshops offered through the Children’s Hospital of Eastern Ontario (CHEO) that provide education and strategies you can use at home.
- Caregiver-Mediated Programs: For children under 2 years old. A professional comes into the home to coach parents on strategies to use throughout the day.
- Entry to School Program: For children entering kindergarten or Grade 1 for the first time while on the OAP waitlist. It includes six months of group learning at a clinic, followed by six months of school-based consultation to help children build school-readiness and daily living skills.
If your child doesn’t fit one of these categories (for example, too old for caregiver-mediated support, but not yet entering school), you must seek out private funding. This is where private insurance plans become essential. (We’ll cover private insurance options a little later in this guide.)
How Does OAP Funding Work Once You’re Approved?
When your family reaches the top of the OAP waitlist, you’ll be contacted to schedule a Determination of Needs (DON) meeting. This is an intake assessment with a care coordinator that takes about four hours.
Important Note: The care coordinator does not assess your child directly.
Instead, they interview the caregiver(s) and, based on the responses, determine your child’s needs and the amount of funding your family will receive.
Families are placed into one of three funding categories:
- Children with higher support needs receive more funding
- Children with lower support needs receive less funding
- Children above a certain age range receive reduced funding regardless of needs, because they may already be accessing supports through the school system
Unfortunately, this interview-based approach can create challenges. Caregivers naturally want to speak positively about their children, which can unintentionally underrepresent the level of support a child actually needs. Language barriers or simply not knowing how to frame answers can also affect funding decisions.
Once approved, families receive their funding in lump-sum payments. You are responsible for:
- Spending the money on eligible services only
- Keeping detailed receipts
- Submitting invoices to OAP for reconciliation
- Managing funds to ensure they last for the designated period
Can I Use Private Insurance to Cover ABA Therapy?
For families on the OAP waitlist—or those who need services beyond what OAP covers—private ABA therapy insurance coverage can help bridge the gap. Many employer-based plans through companies like Canada Life, Sun Life, Manulife, Blue Cross, and GreenShield include coverage for psychological services, social work, or psychotherapy.
As of July 1, 2024, Registered Behaviour Analysts (RBAs) are now governed under the College of Psychologists and Behaviour Analysts of Ontario and recognized by the CRA as medical practitioners.
Here’s the challenge: This is relatively new, and many private health insurance plans haven’t updated their coverage lists to include RBAs yet.
What Parents Can Do to Advocate for Coverage
If you have private insurance, here are the steps to take:
- Get a prescription from your child’s doctor for ABA therapy services. This establishes medical necessity.
- Call your insurance provider to confirm coverage under categories like psychology, mental health, or psychotherapy.
- Ask if RBAs are included in your plan’s list of approved practitioners.
- If they’re not listed, advocate. Explain that your child has been prescribed ABA therapy by a Registered Behaviour Analyst, , and the College of Psychologists and Behaviour Analysts of Ontario now regulates this service. Provide your RBA’s registration number and name, and ask that they be added to the approved practitioner list.
Specific insurance plans—particularly certain Canada Life plans and government employee plans—have already started including RBAs in their coverage.
The more families call and advocate, the faster coverage will expand.
When a Multidisciplinary Team Approach Makes Sense
Some families choose to work with a multidisciplinary team that includes both an RBA and a psychologist—especially for complex needs that benefit from multiple perspectives.
Having a psychologist involved can help with insurance coverage for ABA therapy, since psychological services are already widely recognized. However, this does mean families end up paying for both professionals’ time, so it’s important to consider your insurance limits and what makes the most financial sense for your situation.
Can You Combine OAP and Private Insurance?
Yes, you can use both OAP funding and private insurance—just not for the same service.
Think of it like a co-pay situation: whatever OAP doesn’t cover, you can subsidize through your insurance plan or out-of-pocket payments.
Important Note: You cannot “double-dip” by claiming the same expense through both OAP and insurance. But if your child needs more therapy hours than OAP funding provides, or if there are services OAP doesn’t cover, many insurance companies can help fill those gaps.
Common Challenges Families Face (and How to Avoid Them)
Over the years, we’ve helped countless families manage OAP funding and understand the ins and outs of ABA therapy coverage. It can feel overwhelming at first, but a few practical steps can make things much smoother.
Here are some suggestions based on what we’ve learned—and if you have any questions, please reach out to the team at Portia Learning Centre. We’re happy to guide you through it.
- Understating needs at the DON meeting: As mentioned earlier, caregivers may unintentionally downplay their child’s support needs during the determination of needs interview. For example, if you are asked if you take your child to the park, you might naturally say “We go every day!” without mentioning that you have to hold their hand the entire time because they’re a flight risk.
We encourage you to highlight safety concerns, behavioural challenges, and the level of support your child truly requires.
- Managing OAP funds: Receiving a lump sum of $25,000 is both a relief and a significant administrative burden on top of everything else parents are juggling.
We suggest opening a separate bank account for OAP funds only so you can track spending outside of your personal expenses. Additionally, keep all receipts organized and submit invoices promptly for reconciliation.
- Insurance audits: Audits do happen, particularly for higher-cost claims. Keep detailed records of all services, dates, and costs.
At Portia Learning Centre, we provide timely, transparent, accurate invoicing that aligns with services rendered.
- Advocating too late: Don’t wait until you’re already overwhelmed to start asking questions. Push early for RBA coverage with your insurer and prepare thoroughly for the DON meeting.
Get Autism Funding Process Support From Portia Learning Centre
Portia Learning Centre has helped families navigate Ontario’s autism funding landscape and insurance coverage for ABA therapy since 2006. Over nearly 20 years, funding structures have changed repeatedly; we’ve guided families through each iteration.
Here’s how we can help you:
- OAP navigation: Our client services team can help you prepare for your DON meeting. We know the questions to expect and help you accurately represent your child’s needs. (For active clients, we can take part in the meeting—at your request—and serve as an advocate.)
- Insurance guidance: We help families understand private ABA coverage, advocate for RBA inclusion, and assemble the right team based on your situation and resources.
- Fund management support: Once you receive OAP funding, we clarify eligible expenses, help you organize finances, and show you how to reconcile spending with the OAP. Our accounting team works to prevent overspending and missing documentation.
- Ethical, transparent billing: Invoices are detailed and accurate. If your child misses a session, we adjust billing or schedule a make-up. We keep meticulous records so OAP or insurer audits have no surprises.
- Experienced clinical team: Our administrative and clinical teams have decades of combined experience. We understand system nuances and have helped hundreds of families access the funding they’re entitled to.
Once you’re part of the Portia family, we’ve got your back!
Whether you need help understanding ABA therapy costs, your insurance benefits, or preparing for a government meeting, we’re here to guide you through it all.
Explore Your Financial Options
Paying for ABA therapy in Ontario is complex. With long OAP wait times, evolving therapy insurance coverage, and the administrative tasks of managing funds, it’s easy to feel overwhelmed.
You’re not alone. With the right guidance and preparation, you can avoid unnecessary delays and financial stress.Ready to explore your options and get your child started with ABA therapy?Book a free screening with Portia Learning Centre. We’ll help you understand funding choices and build a plan that works for your family.