An FAQ on autism and the care journey
August 28, 2026 | 4 minute read time
The FAQ below is designed to help you understand autism and how Aetna®, a CVS Health® company, is working toward a more holistic system of support.
You can also learn more about how CVS Health is taking a coordinated approach to autism care here: Understanding autism today – and how care is evolving.
1. What is autism?
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition. Most recent estimates indicate that more than three percent of the population in the United States has an ASD diagnosis. It can impact a person’s way of communicating, learning and interacting with their environment and the people around them. Autism is an individualized experience, impacting each person differently.
The number of kids being identified as Autistic has increased since the early 1990s due to several factors, including more access to screening. As diagnosis rates continue to rise, we are seeing more demand for treatment and increasing costs. That's why we're looking to improve the end-to-end experience and make it easier for members and families to navigate to, and access, high‑quality, personalized support while also safeguarding the system from practices that undermine trust.
2. What are common characteristics of autism and how is autism diagnosed?
Some of the most common characteristics of autism include differences in how a person communicates and interacts socially as well as behaves. For example, some Autistic individuals may communicate through alternative means such as gestures, signs or pictures while others may communicate through spoken language. Some individuals may have topics they enjoy intensely, and others may be more particular about how they want their routines to go. The important thing to know is that autism presents differently across everyone.
There is no single medical test such as a blood test or MRI to detect autism. Instead, a specialist with expert knowledge in autism such as a psychiatrist, psychologist, neurologist or developmental pediatrician gathers information about a person's development and behavior from their caregivers and through direct assessments.
The diagnosing provider spends time with the individual or family to talk with them about the diagnosis and recommendations for treatment.
3. What therapies, accommodations or supports are commonly recommended for people with autism?
There is no single path for autism care. Each Autistic individual has their own set of strengths and challenges and can benefit from varying therapies and support.
This may include speech or occupational therapy, behavioral support, written instructions or flexible schedules at school or work, care navigators, job coaching, in‑home assistance or other options. Applied Behavior Analysis (ABA) is a common evidence-based therapy that helps children learn new skills and social interactions.
Because autism care often includes many different services and supports, navigating options can feel overwhelming. Aetna is working to make it easier by simplifying the autism journey with personalized navigation and proactive outreach so people better understand their choices, get access to specialized provider organizations and find the care and support that best fits their needs.
4. What is Aetna doing to support members with autism?
Aetna is focused on driving a meaningfully different experience for members and caregivers along the autism care journey: one that is easier to navigate through a single point of contact and more supportive for members and their families. We recognize that autism affects each person differently, and that individuals with autism are also more likely to experience related health issues like anxiety, depression, obesity, gastrointestinal challenges and sleep disorders.
Our approach is designed to reflect individual needs and goals. We're improving how members find and access care by offering clearer guidance, partnering with providers who have a record of high-quality care and helping connect members to them, and supporting families along the way so they don’t have to manage the journey alone.
5. What solutions has Aetna built to support members with autism?
Today, Aetna offers one of the most robust autism support models with a dedicated ASD support team available to all members as well as an advanced neurodiversity navigation program, available to select Aetna Commercial customers, that provides a simpler support journey for people with autism and other neurodivergent conditions. The program helps Autistic members and/or their families, to:
- Understand their options
- Find the right providers
- Get support across the whole care journey
It includes one-on-one coaching, training and digital tools that guide people step-by-step. The program also provides support for people without an official diagnosis, making it easier to receive early care.
In addition, Aetna is continuing to invest in a better experience for members and caregivers where care is guided, individualized and built around specific needs. Our future model will be focused on improving access to diagnosis and personalized care, simplifying navigation and reducing the burden on individuals and families over time.
6. How is Aetna addressing fraud, waste and abuse in the industry?
The rising demand for ABA unfortunately has created conditions for a small group of bad actors to engage in fraud, waste and abuse (FWA). This can include providers delivering ineffective interventions, overwhelmed providers reusing generic intervention plans or limiting their direct observation of the patient, or children staying in services longer than is clinically appropriate and away from school, family and other support. Addressing this is about protecting quality care during a critical development window for children, not just controlling costs.
At Aetna, we’re using advanced pattern identification to detect FWA in autism services. For example, our proactive analytic detection strategy uses algorithms and systems to sort through our claims and determine which ones may need closer review.
Aetna is also investing in smarter detection capabilities and provider engagement efforts designed to strengthen accountability while preserving access to quality care. For example, our clinicians are strengthening our clinical standards to ensure members have access to clinically appropriate and effective care. We are proactively and regularly engaging with providers to give feedback and discuss progress of Aetna members. We are also improving oversight and holding providers accountable.
And for our members, we’re working to meet their unique needs by empowering them with information at the right time in their autism journey to make informed decisions about their own or child's care.
Ultimately, we are helping to ensure that members receive the right care, at the right intensity, for the right duration — which ultimately supports better outcomes and family experience.
7. Where can I find resources and support for autism?
First, check your health plan. Many health plans, including Aetna, offer tools to help families find in-network autism specialists, locate services and connect with advocates.
Local community centers and schools may have tailored programs or resources. Clinical organizations and nonprofits may also provide further education or resources for individuals with autism.
If you’re a provider looking for coverage information, Aetna relies on evidence-based guidelines as outlined in our Clinical Policy Bulletins.
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Avisos legales
“Aetna” es el nombre comercial que se utiliza en los productos y servicios ofrecidos por una o más de las compañías del grupo Aetna, entre las que se incluyen Aetna Life Insurance Company y sus filiales (denominadas “Aetna”).
Programs and services may not be available for all plans or in all locations.
Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.
The EAP is administered by Resources for Living, LLC. All EAP calls are confidential, except as required by law. EAP instructors, educators and participating providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Refer to Aetna.com for more information about Aetna® plans.