YouthCare is the statewide HealthChoice Illinois plan for youth in the care of the Illinois Department of Children and Family Services and for former youth in care (adopted, in kinship care, or returned home). HFS says it is operated by Meridian. It covers ABA: its September 2026 provider manual lists Adaptive Behavior Treatment in its behavioral health authorization table, and its policy page lists the same Centene ABA policies Meridian uses.
HFS’s January 2026 map lists YouthCare as a statewide plan serving “Illinois Department of Children & Family Services (DCFS) Youth In Care (YIC) and Former Youth In Care (FYIC) Enrollees only,” and HFS describes it as “operated by Meridian Health.” Its September 2026 manual mirrors Meridian’s behavioral health table: “Adaptive Behavior Treatment – initial assessment” sits under “Notification required within 24 hours (Effective 1/1/26, notification is required within 24 hours of initiation of services. Concurrent review may begin after the 24-hour notification period),” and “Adaptive Behavior Treatment” under “Prior authorization required.” PA “should be requested at least 14 calendar days before the requested service delivery date”; standard decisions are made “within five (5) days,” urgent within 48 hours of complete information, and provider and member are notified within one business day of the decision.[14][15][6][7][2][16][17][18][19][20]
Illinois Public Act 104-0028 (HB 3019) changed behavioral health utilization management from January 1, 2026, and each HealthChoice Illinois plan has read it differently for ABA. Molina says ABA “services are no longer eligible for prior authorization and require concurrent review only” (no authorization for the initial assessment or the first 48 units of therapy a calendar year). Aetna Better Health approves 97151/97152 without medical-necessity review if notified within one business day, then runs concurrent review. Blue Cross Community Health Plans and YouthCare ask for notification within 24 hours of starting ABA services or the initial assessment. Meridian requires notice within 24 hours of 97151/97152 from May 1, 2026 and keeps prior authorization on treatment. CountyCare removed PA from 97151/97152 only. The Act itself added subsection (w) to 215 ILCS 5/370c: from January 1, 2026 “No policy shall require prior authorization for outpatient or partial hospitalization services for treatment of mental, emotional, or nervous disorders or conditions,” such coverage “may be subject to concurrent and retrospective review,” and “A Medicaid managed care organization may set a deadline of 24 hours after the initiation of treatment” for notification (one more business day if it cannot accept the notice). It also lets HFS “adopt rules to implement the applicable provisions” for managed care organizations “and the medical assistance fee-for-service program” (new 305 ILCS 5/5-5.28). The statute does not name ABA, which is why the plans differ; this guide reports each plan’s own written rule.[14][15][6][7][2][16][17][18][19][20]
YouthCare’s clinical and payment policy page lists Centene’s CP.BH.104 (Applied Behavior Analysis) and CP.BH.105 (ABA Documentation Requirements). CP.BH.104 wants a CDE from the past three years to start treatment (or a diagnostic interview within 12 months if it is three to five years old), at least two diagnostic tools including one primary clinician tool (STAT, ADI-R, CARS/CARS-2, GARS-3, ADOS/ADOS-2), hours up to six a day and 30 a week unless justified and under 20 a week for a child in school full-time, and protocol modification of at least two hours a week or 10% of direct hours. For a child in foster care, collect who holds consent and who participates in caregiver training early: CP.BH.104 expects documented caregiver involvement and a plan for barriers to family engagement.[3][4]
YouthCare applies Centene’s CP.BH.104 and CP.BH.105. CP.BH.104’s continuation criteria spell out what a reauthorization must show: an updated behavior assessment and an updated treatment plan “at least every six months (or as clinically appropriate, or as state mandated)”; the percentage of scheduled sessions completed and caregiver participation (attendance below 80% of authorized hours needs a written justification); “Documented progress toward goals since the last authorization,” including “Updated data collected during previous treatment authorization, corresponding to all treatment settings”; behavior-reduction progress “noted in a clear and legible graphic display, including: clear labels on each axis with indicators of treatment changes and environmental variables,” baseline data and progress over time; and skill-acquisition “baseline data and updated progress data for each treatment goal.” CP.BH.105 asks continuation records for “Data and graph representation of mastery of skills noted in the treatment plan” and changes in standardized assessment scores. So yes: graphs are required at reauthorization.[3][4][5][2][1]
Claims: YouthCare’s September 2026 manual says “The standard submission for professional and institutional Medicaid claims for both in-network and out-of-network providers is 180 days from the date of service to submit an initial claim,” with exceptions for retroactive eligibility (180 days from notice of the change) and third-party liability delays. Illinois law sets the payment clock for every HealthChoice Illinois plan: under 305 ILCS 5/5-30.1(g), “The MCO shall pay a claim within 30 days of receiving a claim that contains all the essential information needed to adjudicate the claim,” must notify the billing party within 30 days when it cannot adjudicate a claim, and owes a late-payment penalty at least equal to the Insurance Code’s timely-payment interest, calculated and paid within 30 days after the claim is paid, without the provider having to ask for it. No plan document we read publishes a weekly submission cutoff or check-run day; ask the plan’s provider services for its payment cycle.[3][4][5][2][1]
The questions that decide whether a family can start with YouthCare (HealthChoice Illinois for DCFS youth), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. HFS covers ABS for children 0 through 20, and YouthCare’s manual describes the plan as serving “current and former youth in care aged birth through 21”; it publishes no different ABA age limit.[21][2]
CP.BH.104: CDE in the past three years to start (or an interview within 12 months if three to five years old); within five years to continue.[4][3]
CP.BH.104: a licensed physician, psychologist, or other licensed professional with specialized ASD training, or a provider authorized under state law to diagnose autism.[4][3]
CP.BH.104: at least two tools, one a primary clinician tool (STAT, ADI-R, CARS/CARS-2, GARS-3, ADOS/ADOS-2).[4][3]
YouthCare publishes no separate referral rule; HFS’s ABS benefit requires a physician order and referral, valid one year.[2][8]
CP.BH.104 allows telehealth as a modality; for billing, HFS’s fee schedule governs. HFS’s ABS fee schedule (updated 05/14/2026) marks four codes for remote delivery: 97151 (assessment), 97155 (protocol modification), 97156 (family guidance) and 97157 (multiple-family group). The footnote reads: “Only use the GT or 93 modifier when providing allowable service remotely as a distant site telehealth service along with Place of Service (POS) 02 or 10, as applicable, on the specific service line of the claim.” 97152, 97153, 97154, 97158, 0362T and 0373T carry no telehealth modifier, so technician-delivered treatment is billed as in-person.[4][10]
Standard requests decided “within five (5) days”; urgent within 48 hours of complete information; notice within one business day of the decision. Request PA at least 14 calendar days before services.[2]
Coverage decides whether YouthCare (HealthChoice Illinois for DCFS youth) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
CP.BH.104 (listed on YouthCare’s policy page): protocol modification “for at least two hours per week or 10% of the direct service hours provided, whichever is greater” (one to two hours a week acceptable under 10 hours). HFS: RBTs “must receive supervision from a BCBA.”[3][4][9]
CP.BH.104: up to six hours a day and 30 a week unless documentation justifies more; under 20 a week for full-time students. HFS fee schedule daily maximums also apply.[4][10]
CP.BH.105 (listed on YouthCare’s policy page): each note carries the “Rendering clinician/technician’s name, credentials, and dated signature,” start and end times, pauses, location, code, participants and a summary.[3][5]
CP.BH.104: home, clinic, school or community, in person or by telehealth. HFS limits remote billing to 97151, 97155, 97156 and 97157.[4][10]
Yes. YouthCare uses Centene’s CP.BH.104 and CP.BH.105, which ask for behavior-reduction progress in a labelled graphic display, baseline and updated data for each goal, and data and graphs of skill mastery, with the assessment and plan updated at least every six months.
Yes. Its September 2026 manual lists Adaptive Behavior Treatment in its behavioral health authorization rules, under HFS’s ABS benefit for children under 21.
Only DCFS youth in care and former youth in care, statewide, per HFS’s managed care map.
No PA, but notify YouthCare within 24 hours of the initial assessment. Treatment needs prior authorization.
Meridian operates YouthCare and the two share Centene’s ABA policies, but YouthCare is a separate plan with its own manual and member ID.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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.
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