---
title: "Humana ABA coverage: which Humana is this?"
url: "https://carelu.com/payers/humana"
markdown_url: "https://carelu.com/payers/humana.md"
state: US (national)
payer: Humana
kind: Commercial insurance
description: Humana finished exiting employer group commercial medical coverage in 2025. A Humana card on a child today usually means Medicaid (Healthy Horizons), Medicare Advantage, or TRICARE East via Humana Military. How intake should route a bare Humana card.
last_reviewed: September 2026
---

# Humana ABA coverage: which Humana is this?

_Payer Guide · Humana · Last updated September 2026 · 6 primary sources_

> Humana finished leaving employer group medical in 2025 — route a bare "Humana" card to Medicaid, Medicare Advantage or TRICARE East first.

A card that just says "Humana" no longer means what it used to. On Feb. 23, 2023, Humana announced it was leaving the Employer Group Commercial Medical Products business, "which includes all fully insured, self-funded and Federal Employee Health Benefit medical plans," phased over 18 to 24 months. Its FY2025 10-K confirms that "during 2025, we finalized our exit." So the first intake question on a Humana card is which Humana plan this is, not what Humana covers.

What remains, per the 10-K: Medicare (individual and group Medicare Advantage, stand-alone drug plans, Medicare Supplement); Medicaid through state-based contracts; the military business, chiefly the TRICARE East Region contract; and specialty dental, vision, life and disability benefits. Each line handles ABA differently. This guide is the router for them.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Depends on the Humana line — Healthy Horizons Medicaid plans set PA by state; ABA codes are not on Humana's Medicare Advantage/D-SNP PA list (eff. 7/1/2026); TRICARE East runs through Humana Military [5][4]
  - Ask the plan: Identify the line of business from the card, then use the matching guide: the state Healthy Horizons guide, the TRICARE East (Humana Military) guide, or, for Medicare Advantage, Humana provider services via Availity to confirm ABA is a covered benefit at all.
- **Prior auth for treatment** _(plan-dependent)_: Depends on the Humana line — state-specific for Healthy Horizons Medicaid; not on the Medicare Advantage/D-SNP PA list; TRICARE East under Humana Military [5][4]
  - Ask the plan: Route by line of business first; the state Healthy Horizons PA list or the TRICARE East guide carries the operative rule.
- **Autism diagnosis required?** _(plan-dependent)_: Line-of-business dependent — Humana's medical coverage policy library carries ABA policies only for Medicaid (Oklahoma, South Carolina, Louisiana); no national or Medicare Advantage ABA policy is published [3]
  - Ask the plan: The state Healthy Horizons guide for a Medicaid member; for any other Humana line, ask Humana provider services which criteria govern ABA on that plan.

## At a glance

- **Employer group medical:** Gone — exit announced Feb. 2023, finalized during 2025 (fully insured, self-funded and FEHB)
- **Remaining lines:** Medicare Advantage, Medicare Supplement/PDP, Medicaid (state contracts), TRICARE East, specialty
- **Medicaid states (10-K):** FL, KY, IL, IN, LA, OH, OK, SC, VA, WI
- **Medicare Advantage PA list:** No ABA codes (eff. 7/1/2026, rev. 9/1/2026)
- **ABA medical policy:** Medicaid only (OK, SC, LA); no national or MA ABA policy
- **TRICARE East:** Humana Military, T-5 contract since 1/1/2025 — use the TRICARE East guide

## Who a "Humana commercial" card actually belongs to now

In Humana's FY2025 10-K, the medical membership table has columns for individual and group Medicare Advantage, stand-alone PDP, Medicare Supplement, state-based contracts and military services. There is no commercial medical column. The only employer products Humana still lists are specialty ones: "dental, vision, life and disability to employer groups." A family that says their child has Humana through a parent's employer is therefore describing one of three things: a specialty card (dental or vision, which carries no ABA benefit), a group Medicare Advantage retiree card, or a card from a plan the employer has since moved to another carrier. Ask for the family's current medical card before running anything. [1][2][6]

Claims from the wind-down years can still come up. On Humana's last commercial list, ABA codes 97151–97158, 0362T and 0373T (with H0031, H0032, H2012, H2019 and 90889) were "removed from the preauthorization list eff. Aug. 9, 2024." Humana's provider site posts no commercial prior-authorization list after July 2024. [1][2][6]

## Route by line of business

Medicaid (Humana Healthy Horizons) is the most likely match for a child. The 10-K names Medicaid contracts in "Florida, Kentucky, Illinois, Indiana, Louisiana, Ohio, Oklahoma, South Carolina, Virginia and Wisconsin." Each is a state contract with its own ABA policy and PA list, so never read one state's rules across to another. This directory has Healthy Horizons guides for Florida, Ohio, Oklahoma and Virginia. Humana's medical coverage policy library carries its own ABA policies for Oklahoma, South Carolina and Louisiana Medicaid. [1][3][7]

TRICARE East is a different payer. Humana Military administers the T-5 East Region contract, which "commenced on January 1, 2025 and comprises 24 states, and Washington D.C." ABA there runs under the TRICARE Autism Care Demonstration, so use the TRICARE East (Humana Military) guide, not this one. [1][3][7]

Medicare Advantage covers people 65 and over and "some disabled persons under the age of 65," so it is rare on a child. Humana's coverage policy library lists no Medicare Advantage ABA policy. [1][3][7]

## Medicare Advantage and D-SNP: what the PA list says

Humana's Medicare Advantage and D-SNP prior authorization list (effective July 1, 2026, revised Sept. 1, 2026) has a behavioral health category with two entries: partial hospitalization and transcranial magnetic stimulation. No ABA code (97151–97158, 0362T, 0373T) appears on it. That tells you ABA is not on the PA list. It does not tell you ABA is a covered Medicare Advantage benefit. The list itself says "certain services may not be covered under the member's plan" and points to an Advance Coverage Determination for services whose coverage is uncertain. It also notes that, from Jan. 1, 2026, CMS requires prior authorization decisions within 7 days for certain medical items and services. [5]

## How Humana works state by state

The clinical policy above is national, but three state-level layers change what a family's card actually buys: the state autism mandate (what fully-insured plans must cover), the carrier's state Medicaid plans (which follow the state Medicaid rules, not this commercial policy), and plan funding type (self-funded ERISA plans can carve benefits differently).

- **Georgia** (mandate: Ava’s Law (O.C.G.A. § 33-24-59.10)): fully-insured Humana plans issued in Georgia sit under the state mandate. State Medicaid baseline: [Georgia Medicaid guide](https://carelu.com/payers/georgia-medicaid).
- **North Carolina** (mandate: N.C.G.S. § 58-3-192 (autism coverage)): fully-insured Humana plans issued in North Carolina sit under the state mandate. State Medicaid baseline: [North Carolina Medicaid guide](https://carelu.com/payers/north-carolina-medicaid).
- **Indiana** (mandate: Indiana autism insurance mandate (IC 27-8-14.2)): fully-insured Humana plans issued in Indiana sit under the state mandate. State Medicaid baseline: [Indiana Medicaid (IHCP) guide](https://carelu.com/payers/indiana-medicaid).
- **Virginia** (mandate: Virginia autism insurance mandate (§ 38.2-3418.17)): fully-insured Humana plans issued in Virginia sit under the state mandate. For Medicaid members, Humana operates [Humana Healthy Horizons in Virginia](https://carelu.com/payers/humana-healthy-horizons-virginia) (each covered by its own guide). State Medicaid baseline: [Virginia Medicaid (DMAS) guide](https://carelu.com/payers/virginia-medicaid).
- **Tennessee** (mandate: Tenn. Code Ann. § 56-7-2367 (neurological parity)): fully-insured Humana plans issued in Tennessee sit under the state mandate. State Medicaid baseline: [TennCare (Tennessee Medicaid) guide](https://carelu.com/payers/tenncare-tennessee-medicaid).
- **Ohio** (mandate: Ohio autism insurance mandate (R.C. 3923.84)): fully-insured Humana plans issued in Ohio sit under the state mandate. For Medicaid members, Humana operates [Humana Healthy Horizons in Ohio](https://carelu.com/payers/humana-healthy-horizons-ohio) (each covered by its own guide). State Medicaid baseline: [Ohio Medicaid guide](https://carelu.com/payers/ohio-medicaid).
- **New Jersey** (mandate: P.L. 2009, c.115 (N.J.S.A. 17:48-6ii et al.)): fully-insured Humana plans issued in New Jersey sit under the state mandate. State Medicaid baseline: [NJ FamilyCare (New Jersey Medicaid) guide](https://carelu.com/payers/new-jersey-medicaid).
- **Maryland** (mandate: Habilitative services mandate (Md. Ins. § 15-835 + COMAR 31.10.39.03)): fully-insured Humana plans issued in Maryland sit under the state mandate. State Medicaid baseline: [Maryland Medicaid (Medical Assistance) guide](https://carelu.com/payers/maryland-medicaid).
- **Colorado** (mandate: Colorado autism insurance mandate (C.R.S. § 10-16-104(1.4))): fully-insured Humana plans issued in Colorado sit under the state mandate. State Medicaid baseline: [Health First Colorado (Colorado Medicaid) guide](https://carelu.com/payers/colorado-medicaid).
- **Utah** (mandate: Utah autism insurance mandate (Utah Code § 31A-22-642; caps removed 2020)): fully-insured Humana plans issued in Utah sit under the state mandate. State Medicaid baseline: [Utah Medicaid guide](https://carelu.com/payers/utah-medicaid).
- **Arizona** (mandate: Steven’s Law (A.R.S. § 20-826.04; dollar caps repealed by SB 1590, 2025)): fully-insured Humana plans issued in Arizona sit under the state mandate. State Medicaid baseline: [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).
- **New York** (mandate: NY autism mandate (Ins. Law §§ 3216(i)(25), 3221(l)(17), 4303(ee))): fully-insured Humana plans issued in New York sit under the state mandate. State Medicaid baseline: [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).
- **New Mexico** (mandate: New Mexico autism insurance mandate (NMSA 1978 § 59A-22-49)): fully-insured Humana plans issued in New Mexico sit under the state mandate. State Medicaid baseline: [New Mexico Medicaid (Turquoise Care) guide](https://carelu.com/payers/new-mexico-medicaid).
- **Missouri** (mandate: Missouri autism insurance mandate (RSMo § 376.1224)): fully-insured Humana plans issued in Missouri sit under the state mandate. State Medicaid baseline: [MO HealthNet (Missouri Medicaid) guide](https://carelu.com/payers/missouri-medicaid).
- **Texas** (mandate: Texas autism mandate (Tex. Ins. Code § 1355.015)): fully-insured Humana plans issued in Texas sit under the state mandate. State Medicaid baseline: [Texas Medicaid (THSteps-CCP) guide](https://carelu.com/payers/texas-medicaid).
- **Massachusetts** (mandate: ARICA — Ch. 207, Acts of 2010 (M.G.L. c. 175 § 47AA et al.)): fully-insured Humana plans issued in Massachusetts sit under the state mandate. State Medicaid baseline: [MassHealth (Massachusetts Medicaid) guide](https://carelu.com/payers/masshealth-massachusetts-medicaid).
- **Florida** (mandate: Steven A. Geller Autism Coverage Act (§ 627.6686, Fla. Stat.)): fully-insured Humana plans issued in Florida sit under the state mandate. For Medicaid members, Humana operates [Humana Healthy Horizons in Florida](https://carelu.com/payers/humana-healthy-horizons-florida) (each covered by its own guide). State Medicaid baseline: [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).
- **Kansas** (mandate: Kansas autism insurance mandate (K.S.A. 40-2,194)): fully-insured Humana plans issued in Kansas sit under the state mandate. State Medicaid baseline: [KanCare (Kansas Medicaid) guide](https://carelu.com/payers/kansas-medicaid).
- **Nebraska** (mandate: Neb. Rev. Stat. § 44-7,106 (autism coverage, 25 hr/wk cap)): fully-insured Humana plans issued in Nebraska sit under the state mandate. State Medicaid baseline: [Nebraska Medicaid (Heritage Health) guide](https://carelu.com/payers/nebraska-medicaid).
- **Idaho** (mandate: No autism statute — DOI Bulletin 18-02 (habilitative-parity floor, plan years from 2019)): fully-insured Humana plans issued in Idaho sit under the state mandate. State Medicaid baseline: [Idaho Medicaid guide](https://carelu.com/payers/idaho-medicaid).
- **Iowa** (mandate: Iowa autism mandates (Iowa Code §§ 514C.31, 514C.28; caps and age limits removed by H.F. 330 from 1/1/2026)): fully-insured Humana plans issued in Iowa sit under the state mandate. State Medicaid baseline: [Iowa Medicaid (IA Health Link) guide](https://carelu.com/payers/iowa-medicaid).
- **Oklahoma** (mandate: Nick’s Law (36 O.S. § 6060.21; age and hour caps removed 2022)): fully-insured Humana plans issued in Oklahoma sit under the state mandate. For Medicaid members, Humana operates [Humana Healthy Horizons in Oklahoma](https://carelu.com/payers/humana-healthy-horizons-oklahoma) (each covered by its own guide). State Medicaid baseline: [Oklahoma Medicaid (SoonerCare / SoonerSelect) - Oklahoma Health Care Authority guide](https://carelu.com/payers/oklahoma-medicaid).
- **Michigan** (mandate: Michigan autism mandate (MCL 500.3406s, 550.1416e; through age 18, $50K/$40K/$30K caps allowed)): fully-insured Humana plans issued in Michigan sit under the state mandate. State Medicaid baseline: [Michigan Medicaid guide](https://carelu.com/payers/michigan-medicaid).
- **Hawaii** (mandate: Luke’s Law (HRS § 431:10A-133; under 14, $25,000/yr ABA cap)): fully-insured Humana plans issued in Hawaii sit under the state mandate. State Medicaid baseline: [Hawaii Medicaid (Med-QUEST / QUEST Integration) guide](https://carelu.com/payers/hawaii-medicaid).
- **California** (mandate: SB 946 autism mandate (H&S § 1374.73, Ins. Code § 10144.51; no age or dollar caps)): fully-insured Humana plans issued in California sit under the state mandate. State Medicaid baseline: [Medi-Cal (California Medicaid) guide](https://carelu.com/payers/medi-cal-california-medicaid).
- **Pennsylvania** (mandate: Act 62 of 2008 (40 P.S. § 764h; under 21, CPI-adjusted cap $51,908 for 2026)): fully-insured Humana plans issued in Pennsylvania sit under the state mandate. State Medicaid baseline: [Pennsylvania Medicaid (Medical Assistance) guide](https://carelu.com/payers/pennsylvania-medicaid).
- **New Hampshire** (mandate: RSA 417-E:2 autism coverage (HB 569, 2010; no age or dollar caps in current text)): fully-insured Humana plans issued in New Hampshire sit under the state mandate. State Medicaid baseline: [New Hampshire Medicaid guide](https://carelu.com/payers/new-hampshire-medicaid).

## Intake gates

The questions that decide whether a family can start with Humana, and what they have to bring.

- **Age limit** _(plan-dependent)_: Depends on the line. Healthy Horizons Medicaid follows the state's program. TRICARE follows the Autism Care Demonstration. Medicare Advantage covers people 65 and over and "some disabled persons under the age of 65," so it is rarely a child's plan. There is no national Humana age rule. [1][3]
  - Ask the plan: Route by line of business, then read the age rule in the state Healthy Horizons guide or the TRICARE East guide.
- **Referral required?** _(plan-dependent)_: Depends on the line. On Medicare Advantage HMO and PPO plans "the full list of prior authorization requirements applies," but no ABA code is on that list (eff. 7/1/2026). Medicaid referral and PA rules are state-specific, and TRICARE East follows TRICARE's rules through Humana Military. [5]
  - Ask the plan: Route by line of business; the state Healthy Horizons guide or the TRICARE East guide carries the referral rule.
- **Prior-auth decision time** _(plan-dependent)_: Depends on the line. For Medicare Advantage, Humana's PA list notes that "effective Jan. 1, 2026, CMS requires prior authorization decisions within 7 days for certain medical items/services requests." Medicaid decision clocks are set by each state contract, and TRICARE by its own rules. [5]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East) for the decision clock that applies.
- **Other insurance (who pays first)** _(plan-dependent)_: Depends on which Humana line is involved. Two federal rules decide most cases. A Healthy Horizons Medicaid plan pays after any other coverage: where third-party liability is established, the state "must reject the claim and return it to the provider." TRICARE, including TRICARE East via Humana Military, is intended to "be the secondary payer to all health benefit, insurance and third-party payer plans." Get the other plan's card before billing Humana. [8][9]
  - Ask the plan: Benefits verification on each plan the child holds; confirm which is primary before the first claim.
- **Diagnosis recency** _(ask the plan)_: No national Humana rule. Recency requirements are set by the state Medicaid ABA policy or by TRICARE. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Who may diagnose** _(ask the plan)_: No national Humana rule. Who may diagnose is set by the state Medicaid ABA policy or by TRICARE's ASD-diagnosing-provider rules. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Diagnostic tools required** _(ask the plan)_: No national Humana rule. Required instruments are set by the state Medicaid ABA policy or by TRICARE. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Telehealth** _(ask the plan)_: No national Humana rule. Telehealth ABA follows the state Medicaid program or TRICARE. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).

## Delivery and billing rules

Coverage decides whether Humana pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision** _(ask the plan)_: Humana publishes no national ABA supervision rule. Its coverage-policy library has ABA policies only for Oklahoma, South Carolina and Louisiana Medicaid, and those are state policies that must not be read across. Supervision rules come from the line of business: the state Healthy Horizons policy, or TRICARE for Humana Military. [3]
  - Ask the plan: Route to the state Healthy Horizons guide or the TRICARE East guide once the line of business is known.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: No national Humana rule. Whether 97153 and 97155 may overlap is set by the state Medicaid program for Healthy Horizons members, or by TRICARE for Humana Military. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Daily limits / MUEs** _(ask the plan)_: No national Humana rule. Unit ceilings come from the state Medicaid fee schedule and PA for Healthy Horizons members, or from TRICARE for Humana Military. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Session-note signature** _(ask the plan)_: No national Humana rule. Documentation standards follow the state Medicaid program or TRICARE. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Place of service** _(ask the plan)_: No national Humana rule. Payable settings follow the state Medicaid program or TRICARE. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).
- **Bill as provider** _(ask the plan)_: No national Humana rule. Rendering-versus-billing NPI conventions follow the state Medicaid program or TRICARE. [3]
  - Ask the plan: The line-of-business guide (state Healthy Horizons or TRICARE East).

## What intake should collect for Humana

- **The product name on the card, verbatim:** "Healthy Horizons" means a state Medicaid plan, a Medicare Advantage product name means Medicare, and a TRICARE marking means Humana Military. The bare word "Humana" is not enough to route.
- **State of residence:** Decides which Healthy Horizons contract and policy apply. Humana's Medicaid ABA rules are state-specific.
- **Whether the card is medical or specialty:** Humana still sells dental, vision, life and disability to employers. A specialty card carries no ABA benefit.
- **Where the coverage came from:** If the family says an employer, ask for the current medical card. Humana finished leaving employer group medical coverage in 2025.
- **Member ID and date of birth:** Needed for eligibility on whichever line the card turns out to be.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does Humana cover ABA therapy?

It depends on which Humana plan the child is on. Humana finished leaving employer group medical coverage in 2025. Its remaining lines are Medicaid (Healthy Horizons, state by state), Medicare Advantage, and TRICARE East via Humana Military, and each handles ABA under its own rules. Identify the line first.

### Can my child still have Humana through a parent's employer?

Not as a medical plan. Humana announced in Feb. 2023 that it was leaving all employer group commercial medical products (fully insured, self-funded and FEHB) and finalized the exit during 2025. Humana still sells dental, vision, life and disability to employers, so an employer-issued Humana card today is most likely a specialty card with no ABA benefit. Ask for the family's current medical card.

### Is Humana Healthy Horizons the same as Humana?

Healthy Horizons is Humana's Medicaid product, contracted state by state (FL, KY, IL, IN, LA, OH, OK, SC, VA and WI per Humana's 2025 10-K). Each state has its own ABA policy and PA list. Use the state Healthy Horizons guide, not this national one.

## Primary sources

1. [Humana Inc. — Form 10-K for fiscal year 2025 (SEC EDGAR)](https://www.sec.gov/Archives/edgar/data/49071/000004907126000009/hum-20251231.htm)
2. [Humana — Humana to Exit Employer Group Commercial Medical Products Business (Feb. 23, 2023)](https://humana.gcs-web.com/news-releases/news-release-details/humana-exit-employer-group-commercial-medical-products-business)
3. [Humana — Medical Coverage Policies library, keyword search "behavior" (read 2026-09-27)](https://mcp.humana.com/tad/tad_new/Search.aspx?criteria=behavior&searchtype=freetext&policyType=medical)
4. [Humana — Prior authorization lists (provider page)](https://provider.humana.com/coverage-claims/prior-authorizations/prior-authorization-lists)
5. [Humana — Medicare Advantage and D-SNP Prior Authorization and Notification List (eff. 7/1/2026, rev. 9/1/2026) (PDF)](https://assets.humana.com/is/content/humana/FINAL_Medicare%20and%20DSNP%20Prior%20Authorization%20and%20Notification%20List%20-%207-1-2026pdf)
6. [Humana — Commercial Summary of Medical Preauthorization and Notification List Changes (last updated Nov. 5, 2024) (PDF)](https://assets.humana.com/is/content/humana/Commercial%20SOCpdf)
7. [Humana Military — Applied Behavior Analysis (ABA) provider FAQ (PDF)](https://assets.humana.com/is/content/humana/aba-provider-faqpdf-1)
8. [42 CFR § 433.139 — Medicaid payment of claims involving third party liability](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
9. [32 CFR § 199.8 — TRICARE double coverage](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/part-199/section-199.8)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.