Serving Anoka, Hennepin, Ramsey, Washington, Scott & Dakota Counties
Insurance & Payment
Straightforward answers about coverage and cost
Guidance Center works with Minnesota Medical Assistance, MinnesotaCare, MA-TEFRA, and private insurance, so your family can focus on your child’s care, not the paperwork behind it.
Understanding EIDBI
Understanding EIDBI
EIDBI, or Early Intensive Developmental and Behavioral Intervention, is a Minnesota Health Care Program benefit, not a private insurance plan. It is designed to fund medically necessary therapy for children under 21 who have autism spectrum disorder or a related condition, and it covers far more than therapy sessions alone.
To qualify, your child generally needs a diagnosis of autism spectrum disorder or a related condition, a completed CMDE, and enrollment in Medical Assistance, MinnesotaCare, or MA through the TEFRA option. Many families qualify based on their child’s own eligibility, even when household income alone would not otherwise qualify them.
What the benefit funds
Coverage Options
Two paths to covering your child’s care
Most families use one of these two paths, and many use a combination of both.
Medical Assistance & EIDBI
Most of the families we serve access services through Minnesota’s EIDBI benefit, funded through Medical Assistance, MinnesotaCare, or MA-TEFRA. For eligible children, EIDBI-covered services typically come at little to no out-of-pocket cost.
Private Insurance & Self-Pay
If your family has private insurance, we help you understand your plan’s ABA and therapy benefits and coordinate coverage alongside Medical Assistance where applicable. Self-pay options are also available for families who prefer to pay directly.
How to Get Started
From your first call to your child’s first session
We handle as much of the coverage process as we can, so you can focus on your child.
01
Reach Out
Call or message our team and share your child’s basic information and current coverage.
02
We Verify Coverage
Our team checks your Medical Assistance, MinnesotaCare, or private insurance benefits on your behalf.
03
Complete a CMDE
If your child does not already have a valid CMDE, we help coordinate the evaluation that establishes medical necessity.
04
Begin Services
Once coverage and your Individual Treatment Plan are confirmed, we schedule your child’s first sessions.
Common Questions
Insurance and payment questions families ask us
Insurance and payment questions families ask us
No. EIDBI is a Minnesota Medical Assistance benefit, while private insurance is employer or marketplace coverage. Both can fund ABA therapy, but they follow different processes, and some families qualify for both at the same time.
Does my family’s income affect eligibility?
Not always. Through the MA-TEFRA option, a child can qualify for Medical Assistance based on their own income rather than the household’s, so income alone rarely rules a family out.
What does the EIDBI benefit actually pay for?
It covers the CMDE evaluation, the Individual Treatment Plan, therapy hours, and parent and caregiver training, so the cost of care is rarely limited to sessions alone.
How long does Medical Assistance enrollment take?
Enrollment is processed through your county or tribal financial worker and can take several weeks, so it helps to start that process as early as possible.
Can we use private insurance and Medical Assistance together?
Often, yes. Our team can help you understand how to coordinate both types of coverage so your child’s care is not delayed or duplicated.
What if we do not have Medical Assistance or private insurance yet?
Reach out to our team first. We can help point you toward enrollment resources and let you know what a self-pay option would look like in the meantime.
Still unsure what your coverage looks like?
Reach out and our team will help verify your benefits and walk you through what happens next, at no obligation.