Healthy Indiana plan Insurance Coverage for ABA Therapy

Navigating the right healthcare coverage can be daunting for families with children diagnosed with autism spectrum disorder (ASD). However, it's a vital step to ensure their loved one thrives. 

Families in Indiana may consider the Healthy Indiana Plan (HIP), the state’s Medicaid program for low-income adults. HIP provides access to necessary healthcare services, including applied behavior analysis (ABA) therapy. This guide delves into the specifics of HIP's coverage for ABA therapy, outlining eligibility criteria, coverage limits, the approval process, and additional relevant details to help families navigate the available benefits effectively.

What is the Healthy Indiana Plan (HIP)?

HIP is designed to offer comprehensive health coverage to low-income adults aged 19-64 in Indiana. It includes various plans such as HIP Plus, HIP Basic, and HIP Maternity, each offering different levels of benefits. 

The program covers a broad spectrum of health services, including hospital care, preventive services, and behavioral health treatments, which are crucial for managing chronic conditions and ensuring overall well-being.

Coverage for ABA Therapy

ABA therapy is a widely recognized and effective treatment for children with ASD. The Healthy Indiana Plan provides coverage for ABA therapy, although the specifics can vary depending on the plan and individual circumstances. Here are the key aspects of HIP's coverage for ABA therapy:

Eligibility Requirements

  • ABA therapy is covered for children diagnosed with ASD.
  • Coverage generally extends to individuals under the age of 21.
  • The child must have a formal diagnosis of ASD from a qualified healthcare provider.

Coverage Limits

The extent of coverage, including the number of therapy hours and the annual cap, varies by plan. For example, some plans may offer up to 60 hours of ABA therapy per year, while others might offer more extensive coverage.

HIP Plus members typically have more comprehensive benefits compared to HIP Basic members. HIP Plus covers more services and has fewer out-of-pocket costs.

Approval Process

Prior Authorization

Before starting ABA therapy, families must obtain prior authorization. This process involves submitting a comprehensive treatment plan that includes the diagnosis, specific treatment goals, and a justification for the therapy’s medical necessity. This ensures that the therapy is necessary and appropriate for the child’s condition.

Continued Authorization

Ongoing therapy requires periodic reviews to maintain authorization. These reviews ensure that the therapy remains effective and that the child is making progress towards the outlined goals. Providers must submit updated treatment plans and progress reports regularly.

Provider Requirements

Families must use state-approved providers to receive coverage for ABA therapy. These providers are typically Board Certified Behavior Analysts (BCBAs) or professionals with specialized training in ABA. Using approved providers ensures that the therapy meets state standards for quality and effectiveness.

Additional Services Covered by HIP

Besides ABA therapy, HIP offers a variety of services beneficial for children with special healthcare needs. These services help address the diverse needs of children with ASD and other conditions:

Behavioral Health Services

These services include counseling and psychiatric care, supporting the mental health and emotional well-being of children and their families.

Speech and Occupational Therapy

Essential for improving communication and motor skills. These therapies help children develop crucial skills for daily living and social interactions.

Medical Equipment

Coverage for necessary devices like communication aids and other assistive technologies. These tools can enhance a child's ability to communicate and participate in everyday activities.

Tips for Navigating HIP

Maximizing the benefits provided by HIP can be complex. Here are some tips to help you:

Stay Informed

Regularly visit the HIP website and consult with your healthcare provider for updates on coverage and benefits. Keeping informed about any changes in the program can help you make the best decisions for your child’s care.

Maintain Detailed Records

Keep thorough documentation of your child’s diagnosis, treatment plans, and communications with healthcare providers and Medicaid offices. Detailed records can streamline the authorization process and ensure continuity of care.

Advocate for Your Child

Proactively seek the services your child needs. If you encounter challenges with coverage, reach out to healthcare professionals or organizations specializing in autism support. Advocacy can help you navigate the system more effectively and secure the necessary services for your child.

By understanding HIP's coverage for ABA therapy and effectively navigating the program’s requirements, families in Indiana can ensure their children receive the necessary support and care to thrive.

For comprehensive ABA therapy services and expert guidance, contact Step Ahead ABA’s representative. Let us help you ensure your child's development and well-being are prioritized.

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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

Put your child on the path to progress.