CareSource Insurance Coverage for ABA Therapy

Applied behavior analysis (ABA) therapy is a widely recognized treatment for individuals with autism spectrum disorder (ASD) and other developmental disabilities. This therapy focuses on improving specific behaviors such as social skills, communication, and adaptive learning skills.

If you are a CareSource insurance holder, understanding the details of your coverage for ABA therapy is essential. This guide provides a thorough look at how CareSource handles ABA therapy coverage, ensuring you have all the necessary information to make informed decisions.

Understanding CareSource

CareSource is a nonprofit health insurance provider that has been serving individuals and families since 1989. The company offers a variety of health plans, including Medicaid, Medicare Advantage, and Marketplace plans. CareSource is particularly notable for being one of the largest Medicaid managed care plans in the United States, operating in states such as Ohio, Indiana, Kentucky, West Virginia, and Georgia.

Coverage for ABA Therapy

Yes, CareSource covers ABA therapy, but the specifics of coverage can vary based on the type of plan you have and state regulations. Here’s a detailed overview:

Medicaid Plans

Coverage Details:

  • CareSource Medicaid plans typically cover ABA therapy as part of their behavioral health services. This includes the screening, diagnosis, and treatment of children with autism.
  • ABA therapy under Medicaid requires that services be provided by a licensed ABA therapist who is contracted with CareSource.

Requirements:

  • A referral from your child’s primary care physician is often required.
  • A formal diagnosis of ASD from a qualified healthcare professional is necessary.
  • A treatment plan must be created by a licensed ABA therapist and usually needs pre-authorization to ensure it meets CareSource’s coverage criteria.

Marketplace Plans

Coverage Details:

  • ABA therapy is considered an essential health benefit under CareSource Marketplace plans. This means the therapy is covered at the same level as other medical services, with no limits on the number of sessions.
  • Coverage encompasses various aspects of ABA therapy, aimed at enhancing behavioral, social, and learning skills.

Requirements:

  • You may need to meet your plan’s deductible before the insurance covers ABA therapy costs.
  • Review your specific plan details to understand the coverage scope and any out-of-pocket expenses.

Steps to Access ABA Therapy with CareSource

  1. Consultation and Referral:some text
    • Start by consulting with your child’s primary care physician. They can assess if ABA therapy is appropriate and provide the necessary referral.
  2. Finding a Provider:some text
    • Use the CareSource provider directory or contact customer service to find a licensed ABA therapist contracted with CareSource.
    • Ensure the provider meets CareSource’s coverage criteria.
  3. Understanding Your Plan:some text
    • Carefully review your specific plan details or contact CareSource directly to understand the coverage specifics, including deductibles, co-insurance, or any out-of-pocket costs.
    • Each plan may have different requirements and limitations, so being well-informed is crucial.

Financial Considerations

Even with insurance, ABA therapy can be expensive. Potential out-of-pocket costs, such as deductibles or co-insurance, may apply. However, many ABA therapy providers offer payment plans or financial assistance programs to help families manage these expenses.

Additional Support from CareSource

CareSource is committed to supporting families dealing with ASD beyond insurance coverage. They provide additional resources and assistance, such as access to a network of specialized care providers and educational materials to help navigate the challenges associated with ASD. This comprehensive support ensures that families receive the necessary help and guidance to maximize the benefits of ABA therapy.

Conclusion

CareSource offers substantial coverage for ABA therapy across its various plans, although specifics can vary. By understanding your plan and following the necessary steps for pre-authorization and referrals, you can ensure your child receives the essential treatment they need to enhance their development and quality of life.

Being informed and proactive enables you to take full advantage of the benefits offered by CareSource, supporting your child’s development through effective ABA therapy. Reach out to Step Ahead ABA to discuss your insurance coverage options together.

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ABA impact: Real life success stories

Get a glimpse at the impact of ABA on our client’s lives, with
these genuine success stories shared by our proud team.

*All names have been changed to ensure client confidentiality.

"All year, Sophia* has been working towards integrating into the gen-ed class at school and the hard work has paid off! Next week, after spring break, she will be fully integrating all day!
But that’s not all. Sophia’s school goes on regular trips to the swimming pool and we have been working hard on swimming independently in a community pool (as opposed to at water parks, where Sophie is more confident). Yesterday she swam in the pool independently for the first time while telling herself she could do it and earned a strawberry ice cream afterward to celebrate!"

RBT - Indiana

“I’ve been working with Mia* for a year and a half. Mia had a good start to many skills but her challenging behaviors were getting in the way of her ability to be successful in a daycare environment. She often became upset and refused to follow instructions, even for activities she enjoyed. She would spend a lot of her day having tantrums and resist doing things she was asked, which made it difficult for her to interact with other children or make progress academically. After eighteen months of hard work from her whole team at Step Ahead, she was able to decrease challenging behaviors to near zero levels, successfully transition into a Kindergarten setting and make friends without requiring prompting. Mia did so well that we were able to completely transition her out of our services and she is now an independently successful Kindergartener!”

Regional Director - Indiana

“Liam* has made so much progress in his communication! When I first started he was only using physical gestures to express his needs. He is now independently using 2+ word requests in every session! His parents have also reported that he is using verbal requests independently, outside of session as well. I am so proud of Liam and how much progress he has made!”

RBT - North Carolina

“I’ve been working on eating a wider variety of foods with my kiddo, Logan, tolerating new foods and being okay with alternatives if a preferred food is not available. In the past, his caregivers dealt with tantrums that were hours long and Logan would refuse to eat if a preferred food wasn't available. The other day, when Logan asked for fries, his caregiver did an AMAZING job confidently offering alternatives- "You can have salad or rice". Logan chose rice and ate all of what was served to him!
Recently, he’ll even prepare non-preferred food items that we’ve been working on, so when I arrive he can show them to me. He points to it and says "Eat! Good!" while giving me a thumbs up.”

Lead RBT - Nebraska

“We’ve been working with Ava* for 3 months now and at my parent meeting last week, Mom and Dad stated that they are so happy with our services and the progress Ava has made. When we first started, she had little functional communication skills and she now asks to be played with, requests to stop an activity, and asks for more time! Ava’s parents are so happy with her progress that they want her sibling to receive in-home therapy too.”

BCBA - Oklahoma

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