Physician-led, unlike the other four Standard Plans
Carolina Complete is the only NC Medicaid Standard Plan with direct North Carolina physician involvement in how it's run.
Carolina Complete Health ABA therapy coverage in North Carolina
Your Carolina Complete Health coverage, explained
Insurance jargon should never stand between your child and excellent ABA therapy. That's why we handle your coverage, your authorization, and every step in between, so all you have to focus on is your child.
Does Carolina Complete Health cover ABA therapy?
Yes, and it's the only physician-led plan of its kind in North Carolina
Carolina Complete Health is one of five NC Medicaid Standard Plans, and the only one jointly operated by a physician organization, Centene Corporation and the North Carolina Medical Society and Community Care of North Carolina run it together. Carolina Complete covers ABA therapy for eligible children under 21 through the federal EPSDT benefit.
What makes Carolina Complete's coverage work
The specifics that matter
Most families pay nothing out of pocket
NC Medicaid Standard Plans generally don't charge copays for behavioral health services for children under 21.
A real range for weekly hours
Most children receive between 10 and 40 hours of ABA per week, based on age, severity, and their treatment plan, with no hard cap under EPSDT.
Reauthorization roughly every 6 months
How the process works with Carolina Complete Health
From your first call to your first session
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Step 1: Schedule a free consultation
Call (888) 690-0663. We listen and learn what your family needs before anything else happens.
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Step 2: We verify your benefits
We confirm your coverage directly with Carolina Complete Health.
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Step 3: We submit your prior authorization
This includes a DSM-5 diagnosis with ICD-10 code F84.0, a referral or order from a qualified clinician, a BCBA-led treatment plan, and standardized assessments like the Vineland-3.
- 04
Step 4: Therapy begins
Your child starts sessions at home, at school, or wherever makes the most sense.
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Step 5: We manage your reauthorization
Roughly every 6 months.
Why families choose Apex ABA for their Carolina Complete Health coverage
What your coverage is actually paying for
Carolina Complete Health covers ABA therapy because it works, but it's worth knowing exactly what that coverage buys your child.
Communication
Finding words and the confidence to use them. Asking for help. Expressing needs.
Independence
Doing more, needing less help, one skill at a time.
Social Connection
Playing alongside others, then with them.
Self-Regulation
Fewer meltdowns. More tools to handle the hard moments.
Daily Routines
Mornings, mealtimes, transitions, smoother than you thought possible.
Family Life
Less crisis management. More time to just be family.
How your Carolina Complete Health coverage plays out at Apex
Coverage is one thing. What happens with it is another.
Plenty of families with good coverage still end up on the sidelines. Having Carolina Complete doesn't guarantee that experience is any different. How your provider uses it does.
At Apex, you're in the room
Not sidelined while decisions get made about your child. Not waiting to hear about it after the fact.
Small caseloads mean your authorization actually gets used well
We limit our caseloads on purpose. That means your BCBA knows your child, remembers what happened last week, and adjusts before your next reauthorization.
Your Carolina Complete benefits cover therapy where your child actually lives
In-home therapy during real family moments. School-based therapy during class, recess, lunch.
You see exactly how your coverage is being spent
Weekly check-ins with your BCBA. Live coaching during real moments. Written strategies you can use between sessions.
“My son's communication skills have really improved since he started with Apex. He used to have a hard time telling us what he wanted, but now he's able to communicate much better. We're so happy with the progress being made.”
— Ashton C., North Carolina
ABA therapy services covered by Carolina Complete Health
What your coverage can include
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In-Home ABA Therapy — real family moments: breakfast, getting ready, bedtime
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School-Based ABA Therapy — support during class, recess, and lunch
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Parent Training and Support — tools for the hours we're not there
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Daycare ABA Therapy — support at your child's daycare or early learning center
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Weekend ABA Therapy — because progress doesn't take Saturdays off
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Early Intervention ABA Therapy — for toddlers and preschoolers, when it matters most
Carolina Complete Health coverage across North Carolina
Where we serve Carolina Complete families
Carolina Complete Health is a statewide NC Medicaid Standard Plan, and our North Carolina office is based at 525 N Tryon Street in Charlotte.
Reach out anywhere in North Carolina, we'll confirm your enrollment and coverage.
Carolina Complete Health ABA therapy FAQs
What you're probably wondering
It's the only one of the five with direct physician involvement in how it's operated, jointly run by Centene and North Carolina physician organizations.
A DSM-5 autism diagnosis with ICD-10 code F84.0, a referral or order from a qualified clinician, a BCBA-led treatment plan, and standardized assessment results.
Most children receive 10 to 40 hours a week, depending on age, severity, and their treatment plan. There's no hard cap under EPSDT.
Most families pay $0 for medically necessary ABA therapy.
We help you appeal with additional documentation from your child's evaluation and our clinical team.
More coverage options in North Carolina
Don't have Carolina Complete Health?
We also work with Blue Cross Blue Shield, Healthy Blue, Trillium Health Resources, AmeriHealth Caritas, Vaya Health, Partners Health Management, WellCare, and Optum.
Blue Cross Blue Shield 
Healthy Blue 
Trillium Health Resources 
AmeriHealth Caritas 
Vaya Health 
Partners Health Management 
WellCare 
Optum 
Let's find out exactly what your Carolina Complete Health plan covers.
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