ABA Therapy Through Partnership HealthPlan of California: A Guide for North Bay and Solano Families

Partnership HealthPlan of California is not an insurance company you shop for. It is a County Organized Health System (COHS) — a nonprofit, public-private plan created by counties to run Medi-Cal locally. In a COHS county, Medi-Cal members are generally enrolled with Partnership rather than choosing among competing plans, which is why almost every North Bay family we talk to has the same plan name on the card.

Partnership began in Solano County in 1994 as the Solano Health Partnership. It added Napa in 1998, Yolo in 2001, Sonoma in 2009, and Marin and Mendocino in 2011, and has kept expanding north and east since. It now covers 24 counties:

• North Bay and Solano: Marin, Solano, Napa, Sonoma, Yolo, Lake, Mendocino
• Everywhere else: Humboldt, Del Norte, Trinity, Siskiyou, Modoc, Lassen, Shasta, Tehama, Glenn, Colusa, Plumas, Sierra, Butte, Sutter, Yuba, Nevada, and Placer

Partnership does not have a separate autism program. ABA is delivered under the Medi-Cal benefit called Behavioral Health Treatment, which every Medi-Cal managed care plan in California must cover for members under 21. The engine underneath it is the federal EPSDT rule, which requires Medicaid to cover any medically necessary service for a child.

Partnership's published BHT policy says your child qualifies when they:

1. Are under 21 and enrolled in Partnership Medi-Cal.
2. Have a recommendation from a licensed physician, surgeon, or psychologist that BHT is medically necessary — regardless of diagnosis.
3. Are medically stable and do not need 24-hour hospital or facility-level monitoring.
4. Appear to have persistent, developmentally inappropriate behavior.

What is actually covered

Authorizing BHT approves a package your provider delivers and documents: a functional behavior assessment by a Board Certified Behavior Analyst (BCBA), a written treatment plan with measurable goals, one-on-one sessions with a behavior technician, BCBA supervision, parent training, and progress data. Services are designed to be delivered primarily in the home and other community settings — exactly the model Behavia runs.

Two details in the policy matter to parents. Blanket caps on the number of hours are prohibited, so hours come from clinical need rather than a plan-wide limit. And services can only be reduced or ended on a finding that they are no longer medically necessary — not because an authorization period ran out.

Look at your child's health plan card — not the white and blue state Medi-Cal Benefits Identification Card, but the plan card. The plan name printed on it is the plan that authorizes ABA, and it is the most useful fact you can bring to a first phone call.

The Kaiser wrinkle

Most Medi-Cal families in these counties are with Partnership, but not all. Kaiser Permanente participates in Medi-Cal in Marin, Napa, Solano, and Sonoma, and since Kaiser moved to a direct contract with the state in 2024, some families in Partnership counties are enrolled in Kaiser's Medi-Cal plan instead. Enrollment rules and arrangements change, so the card in your hand is more reliable than anything you read online — including this page.

Either way is workable. Behavia accepts Medi-Cal through Partnership HealthPlan and also works with Kaiser Permanente families. If the card is ambiguous, call the member services number on it and ask which plan authorizes Behavioral Health Treatment for your child.

This step is easier than most families expect. You do not need a specialist, a developmental pediatrician, or a completed autism evaluation to open the door. Partnership requires a recommendation from a licensed physician, surgeon, or psychologist that BHT is medically necessary — usually your child's pediatrician, at a regular visit.

• Your pediatrician or family doctor. The most common route. Ask for a recommendation for Behavioral Health Treatment and use the words “medically necessary” — that is the standard the plan applies.
• A licensed psychologist. If your child has already been evaluated, the evaluating psychologist can make the recommendation.
• Partnership itself. Member services and the behavioral health line can tell you what your plan needs and which providers are contracted near you.

From there the paperwork is the provider's job. Your ABA provider submits a Treatment Authorization Request (TAR) to Partnership with the diagnosis or behavioral concerns, history, and the BCBA's functional behavior assessment and recommended hours. You sign a Release of Information so the provider, the plan, and the regional center can share records; it lasts one calendar year and you can revoke it any time.

If you are also pursuing a formal diagnosis — worth doing for school services — our guide on getting an autism evaluation in California walks through the four routes.

Many North Bay families hear about ABA from a regional center service coordinator, so the roles are worth separating clearly. In our area:

• Golden Gate Regional Center (GGRC) serves Marin County, along with San Francisco and San Mateo.
• North Bay Regional Center (NBRC) serves Solano, Napa, and Sonoma counties, with offices in Napa and Sonoma County.

For children under three, the regional center runs Early Start, California's early intervention program, and you can self-refer — no doctor's referral needed. It runs alongside, not instead of, a Partnership BHT request.

For funding, the order is clear. Regional centers are payers of last resort, and Partnership's own policy states that the plan has primary responsibility for all medically necessary BHT services. If a regional center or school district provides some behavioral support that does not meet your child's full medical need, Partnership must authorize the remainder, and it must coordinate so services are complementary rather than duplicated.

Here is the whole path in order. Some steps overlap, and your provider carries most of the weight after step three.

1. 1

   Confirm coverage and note the plan

   Make sure your child's Medi-Cal is active and read the plan name on the card. If it says Kaiser rather than Partnership, see the section above.

2. 2

   Ask your pediatrician to recommend Behavioral Health Treatment

   A licensed physician, surgeon, or psychologist recommends BHT as medically necessary. No diagnosis is required. Ask for a copy for your records.

3. 3

   Choose a provider contracted with Partnership

   Partnership credentials licensed professionals and BACB-certified providers for autism services, so your provider must be contracted with the plan and actually staffed in your city. Behavia serves the North Bay and Solano County in-home — you can start online in about five minutes.

4. 4

   The BCBA assessment

   A BCBA meets your child, usually at home, and builds a functional behavior assessment plus a treatment plan with measurable goals, recommended hours, and parent-training targets.

5. 5

   Authorization

   Your provider submits the Treatment Authorization Request with the assessment and the physician recommendation, and Partnership reviews it against medical necessity criteria — including any follow-up questions from the plan.

6. 6

   Scheduling and the first sessions

   Once services are authorized, we match your family with a behavior technician whose availability overlaps yours. Share your real weekly availability rather than your ideal one. Our guide to the first month of in-home ABA covers what happens next.

The benefit is identical across Partnership's counties, but the practical texture is not. Distance to a clinic, your pediatrician's hospital system, and which district holds the IEP all change the conversation.

• San Rafael and Novato (Marin). Marin is Golden Gate Regional Center territory, not North Bay. Kaiser San Rafael Medical Center is many Marin families' medical home, so check the card carefully — a Kaiser pediatrician does not automatically mean a Kaiser Medi-Cal plan.
• Vallejo, Fairfield, and Vacaville (Solano). Solano is Partnership's original county and North Bay Regional Center holds the caseload. Kaiser Vallejo and Kaiser Vacaville Medical Centers are common referral sources, and Fairfield-Suisun and Vacaville Unified handle school-based supports. Solano families often drive a long way for clinic-based care — precisely the problem in-home ABA removes.
• Napa and Sonoma. Both are Partnership counties served by North Bay Regional Center. We are building capacity here and will tell you plainly what we can staff before you commit.

One thing holds everywhere: Medi-Cal does not pay for services delivered at school under your child's IEP, but Partnership's policy is explicit that it cannot assume a school district is covering a child's behavioral needs. If school services stop or fall short of medical necessity, the plan is still responsible.

There is no Partnership number to look up. Hours come from your BCBA's assessment, and the plan authorizes what is medically necessary for your child. The Behavior Analyst Certification Board's practice guidelines describe two broad models most plans recognize:

• Focused treatment targets a limited set of goals — communication, toileting, a specific challenging behavior — and commonly runs 10 to 25 hours per week.
• Comprehensive treatment works across many developmental domains at once and commonly runs 30 to 40 hours per week.

Partnership requires the treatment plan to be reviewed, revised, or modified no less than once every six months, and it must include exit criteria from the start. That six-month rhythm is also when hours are re-authorized, up or down, based on the data.

The honest caveat: authorized hours and delivered hours are different numbers. Sessions only happen when a technician is available and your child and a caregiver are consistently home. Families with wide, regular availability reach their authorized hours faster, which is why we ask about your schedule early. Our guide on preparing your home and schedule explains how to set that up.

Denials happen, and they are usually about documentation rather than a judgment on your child. The deadlines are real, so act on the notice rather than filing it away.

1. Read the Notice of Action. Partnership must tell you in writing what was denied or changed and why. The date on that notice starts the clock.
2. Appeal to Partnership within 60 days. Appeal by phone or in writing using the member services number on the card, and ask your provider for updated progress data and a letter of medical necessity. If you file quickly and services were already approved, ask for them to continue during the appeal.
3. Request a State Hearing up to 120 days after the appeal decision. After Partnership decides, you can ask the California Department of Social Services for a State Hearing.
4. Or ask for an Independent Medical Review. For medical necessity disputes you can request an IMR from the Department of Managed Health Care after the plan appeal. The State Hearing clock keeps running while you do, so watch both dates.

Disability Rights California publishes free, plain-language guides to Medi-Cal appeals, and the Medi-Cal Managed Care Ombudsman can step in when a plan is not following its own rules. Your ABA provider should be carrying most of this paperwork — you should never be doing it alone.

• Partnership HealthPlan of California — county service area, member services, and member handbooks
• Partnership policy MCUP3126: Behavioral Health Treatment for Members Under the Age of 21 — the eligibility, authorization, and treatment-plan rules quoted above
• DHCS: Behavioral Health Treatment and All Plan Letter 23-010, the statewide policy every Medi-Cal plan follows for BHT
• California DDS regional center listings — Golden Gate Regional Center (Marin) and North Bay Regional Center (Solano, Napa, Sonoma)
• Disability Rights California: Medi-Cal Managed Care Appeals and Grievances

Policies and phone numbers change — confirm any specific number or requirement here against your child's current card and Partnership's own materials. For a statewide view of the same benefit, see Does Medi-Cal Cover ABA Therapy in California and How to Get ABA Therapy Through Medi-Cal.