Financial Considerations -
Paying for Autism Evaluations, Services, and SupportsBefore You Begin
An autism diagnosis does not automatically qualify a child for every program. Insurance coverage, household income, the child’s support needs, age, and other rules may affect eligibility. Z Path Autism provides a starting point—not financial, tax, legal, medical, or benefits advice. Certain programs noted below are specific to Wake County and/or North Carolina.
Which situation describes your family?
If Your Child Does Not Have Health Coverage
NC Medicaid
NC Medicaid is public health coverage for eligible North Carolina residents, including children, some adults, pregnant people, older adults, and people with disabilities. Eligibility depends on the program’s rules—not simply on having an autism diagnosis.
You can apply for a child even if the adults in the household are not applying or do not qualify.
How to Apply for NC MedicaidNC Medicaid 1915(i) Services
1915(i) provides home- and community-based services for eligible Medicaid members with qualifying behavioral health, intellectual disability, developmental disability, or traumatic brain injury needs.
Why explore it: There is no statewide waiting list. For an eligible child, services may include Community Living and Supports, respite, Community Transition, and supported employment. A child waiting for the Innovations Waiver may receive 1915(i) without losing a place on the Registry of Unmet Needs.
Health Insurance Marketplace
The federal Marketplace sells private health plans. Depending on household income, a family may qualify for help paying premiums or other costs. Enrollment is generally available during Open Enrollment or after certain life events, such as losing other coverage, moving, marriage, divorce, birth, or adoption.
Visit HealthCare.govJob-Based Coverage
Ask your employer—or a spouse’s employer—whether your child can be added as a dependent to the employer-sponsored health insurance plan. A new job, loss of other coverage, birth, adoption, marriage, or divorce may allow enrollment outside the employer’s normal annual enrollment period.
If Your Child Has Health Insurance
Ask whether the service is covered
- Autism or developmental evaluations
- Speech, occupational, physical, or feeding therapy
- Applied Behavior Analysis (ABA)
- Behavioral health care and counseling
- Specialists, prescriptions, and medical equipment
Ask what you must pay
- Deductible: the amount you generally pay before the plan begins sharing certain costs
- Copay: a fixed amount for a visit or service
- Coinsurance: a percentage of the allowed cost
- Out-of-pocket maximum: the annual limit on covered in-network cost sharing
Ask what approval is required
- Does the provider need to be in network?
- Is a referral required?
- Is prior authorization required?
- Are there visit limits?
- What happens if the request is denied?
Health Savings Account (HSA)
An HSA is an account that lets an eligible person set aside money for qualified medical expenses. The money can be contributed before federal income tax or deducted under applicable tax rules, and qualified withdrawals are generally tax-free.
Who has access?
You generally must be enrolled in an HSA-eligible health plan and cannot have disqualifying additional coverage. Many—but not all—high-deductible health plans qualify. Check the plan documents or ask the insurer or employer whether the plan is specifically HSA eligible.
Where does it come from?
An employer may offer an HSA with an eligible health plan, sometimes with employer contributions. An eligible person may also be able to open an HSA through a bank or other HSA provider.
What happens to unused money?
The account belongs to the individual. Unused funds remain in the account, roll over from year to year, and stay with the person after changing jobs or health plans.
Flexible Spending Accounts (FSAs)
An FSA is an employer-sponsored benefit that lets an employee use pre-tax money for certain expenses. You cannot usually open an FSA independently. Not every employer offers one, and the employer’s plan sets the enrollment and reimbursement rules.
Healthcare FSA
A healthcare FSA reimburses eligible medical expenses for the employee and eligible family members. It may help with qualified evaluations, therapy, copays, prescriptions, and medical supplies.
Who may have access? Employees whose employer offers a healthcare FSA and who enroll during the permitted enrollment period.
Dependent-Care FSA
A dependent-care FSA is different. It generally helps pay eligible childcare or adult dependent-care expenses that allow the employee—and, when applicable, a spouse—to work or look for work. It is not a general medical or therapy account.
Who may have access? Employees whose employer offers the benefit and whose care arrangement meets the plan and tax rules.
What happens to unused money?
FSAs generally have a “use-it-or-lose-it” rule. Some employer plans allow a limited carryover or grace period, but they are not required to offer both. Check the deadline before electing an amount or making a large purchase.
WCPSS Contracted Transportation Stipend
Some students with disabilities are assigned specialized transportation through a contracted van or other transportation provider. If WCPSS assigns the student a contracted transportation seat but does not have a permanent driver available, the district may offer the family a temporary payment to transport the student.
How much is it?
The current WCPSS notice describes $25 for each eligible school day, up to $500 per month. Only one payment is available per day, even when the parent makes multiple trips.
Who may qualify?
A family whose student is currently assigned a seat on contracted vendor transportation and is waiting for a permanent driver. It is not a general mileage benefit for every family that drives to school.
Who does not automatically qualify?
Students assigned to a regular yellow bus, students whose school assignment requires parent transportation, and families who simply prefer to drive should not assume they qualify.
- 1Contact your child’s case manager or school administrator and ask whether the student is assigned contracted transportation and qualifies for the stipend.
- 2Obtain the agreement and current instructions before relying on reimbursement.
- 3Submit the required monthly documentation and keep copies of attendance records, forms, insurance information, and correspondence.
- 4Follow up if payment is delayed. Eligibility rules, paperwork, payment amounts, and availability may change.
Transportation assistance: 919-805-3030, option 5
Special Education Family and Community Connections: 919-431-7334
Disability Support Programs
The programs in this section have separate application and eligibility rules. A family may explore them whether the child is privately insured, uninsured, or enrolled in Medicaid. Important note: Current Medicaid not required to apply for these programs!
NC Innovations Waiver
A Medicaid waiver for eligible people with intellectual or developmental disabilities who meet its level-of-care requirements. Families request placement on the Registry of Unmet Needs through their local Tailored Plan.
Why explore it: Apply early because the wait can be long.
While you wait: Ask your Tailored Care Manager whether your child may qualify for NC Medicaid 1915(i) services while remaining on the Registry of Unmet Needs.
How to ApplyCommunity Alternatives Program for Children (CAP/C)
A Medicaid home- and community-based program for eligible medically fragile children.
Why explore it: It may be relevant for a child with significant medical needs who requires extensive care and support at home.
Supplemental Security Income (SSI)
A federal monthly benefit for a child who meets Social Security’s disability rules and whose household meets applicable income and resource limits.
Why explore it: It may provide monthly financial support to an eligible family.
Grants, Scholarships and Reduced Pay for Specific Costs
This section is for families looking for help paying for something specific—such as therapy equipment, respite, camp, recreation, or another approved need. These organizations are not substitutes for insurance, and funding is not guaranteed.
First In Families of North Carolina
Works with eligible people with intellectual or developmental disabilities and their families. Local chapters may help families identify community resources or request assistance for specific needs, subject to local rules and available funds.
First In FamiliesAutism Society of North Carolina
Provides information, navigation, education, support, and services for autistic people and their families. Ask which current resources serve Wake County and whether any financial assistance is available for a particular program.
Autism Society of NCFamily Support Network of North Carolina
Connects families of children with disabilities or special healthcare needs with information and parent support. It can help a family identify who to contact, even when it does not directly pay an expense.
Family Support NetworkExceptional Children’s Assistance Center
Helps North Carolina families understand special education rights and services. It does not pay ordinary family expenses, but it can help parents understand which supports the public school may be responsible for providing.
ECACPlanning for Your Child’s Future
You do not need to complete long-term financial and legal planning immediately after a diagnosis. These tools become relevant when a family wants to save money for disability-related expenses or plan how assets will be managed in the future.
ABLE Account
A tax-advantaged savings account owned by an eligible person with a disability. Money may be used for qualified disability expenses. Eligibility, annual contributions, account limits, and effects on public benefits should be reviewed before opening or funding the account.
ABLE National Resource CenterSpecial Needs Trust
A legal trust designed to hold or manage assets for a person with a disability without giving the beneficiary direct control of the funds. The wrong trust language or funding decision can affect public benefits, so families should consult a qualified attorney.
Find Special Needs Planning InformationPotential Medical Expense Deduction
IRS Publication 502 explains which medical and dental expenses may be included when a taxpayer itemizes deductions.
Why explore it: Families with substantial unreimbursed medical, therapy, equipment, or qualifying transportation expenses may want to discuss the rules with a tax professional.
A Manageable First Week
Choose the pathway that matches your child’s current health coverage. Use the links to go directly to the programs and explanations referenced in each step.
If Your Child Does Not Have Health Insurance
- Review coverage options for an uninsured child, including NC Medicaid, the Health Insurance Marketplace, and employer-sponsored health insurance available through a parent or spouse.
- Apply for the most appropriate coverage. NC Medicaid applications are accepted year-round, while Marketplace and employer plans generally have enrollment periods or qualifying-event rules.
- Do not wait for Medicaid approval before exploring the NC Innovations Waiver, CAP/C, or SSI. Current Medicaid enrollment is not required to begin those processes.
- If a specific cost is creating an immediate problem, review grants, scholarships and reduced-payment options. Review the rules for a possible medical expense tax deduction.
- Save application confirmations, medical records, school records, bills, and correspondence in one folder.
If Your Child Has Health Insurance
Potential options for families that do not qualify for income-based Medicaid coverage.
- Review how to use your child’s existing health insurance, including provider-network rules, prior authorization, visit limits, and expected costs.
- Check whether you can use a Health Savings Account or an employer-provided Flexible Spending Account for eligible expenses.
- Apply early for the NC Innovations Waiver, which accepts applications regardless of income or current insurance. Families of medically fragile children can also explore CAP/C, which has its own medical and financial eligibility process.
- Review ABLE accounts and special needs trusts and the rules for a possible medical expense tax deduction.
- Ask providers about payment plans or sliding-scale fees and review grants, scholarships and reduced-payment options.
- Save every authorization, denial, Explanation of Benefits, invoice, and receipt.
Looking for help paying for K–12 education?
North Carolina has separate scholarship programs that may help some eligible families with private-school tuition and other approved educational expenses.
Explore Financial Assistance for Education →