Hoosier care connect Insurance Coverage for ABA Therapy

Understanding insurance coverage for essential therapies like applied behavior analysis (ABA) can significantly impact the support available for children with autism spectrum disorder (ASD)

To help you navigate the process, this guide explains how Hoosier Care Connect, part of Indiana's Medicaid program, covers ABA therapy, including details on eligibility, coverage limits, and approval processes.

What is Hoosier Care Connect?

Hoosier Care Connect is a coordinated care program under Indiana Medicaid for individuals aged 65 and over, those with blindness, or those with disabilities who are not eligible for Medicare. This program provides comprehensive health coverage, including doctor visits, hospital care, preventive services, and mental health and substance abuse treatment​ 

Coverage for ABA Therapy

ABA Therapy is a proven method for helping children with ASD develop critical skills. Hoosier Care Connect offers coverage for ABA therapy under specific conditions:

Eligibility Requirements

  • Diagnosis: A formal diagnosis of ASD by a qualified healthcare provider is necessary to access ABA therapy.
  • Age Limit: Coverage generally extends to individuals under 21 years old, ensuring early and consistent intervention.

Coverage Limits

  • The extent of coverage can vary based on the specific details of the Hoosier Care Connect plan. It typically includes a set number of therapy hours per week, and some plans may offer up to 30 hours per week, with an annual cap that can reach up to $120,000​​.

Approval Process:

Prior Authorization: Prior authorization is required before starting ABA therapy. This involves submitting a detailed treatment plan, including diagnosis, treatment goals, and justification for medical necessity.

Continued Authorization: Ongoing therapy requires periodic reviews to maintain authorization, ensuring the therapy's effectiveness and monitoring the child's progress​​.

Provider Requirements:

Families must use state-approved providers, typically Board Certified Behavior Analysts (BCBAs) or professionals with specialized ABA training, to ensure high-quality, standardized care​.

Additional Services Covered

Hoosier Care Connect's comprehensive coverage includes various other services beneficial for children with special healthcare needs, such as:

Behavioral Health Services

Counseling and psychiatric care to support mental and emotional well-being.

Speech and Occupational Therapy

These therapies help improve communication and motor skills.

Medical Equipment

Necessary devices like communication aids and other assistive technologies are covered​.

How to Verify Coverage

To confirm your coverage for ABA therapy under Hoosier Care Connect, follow these steps:

Contact Member Services

Reach out to Hoosier Care Connect's member services for detailed information about your specific plan.

Review Policy Documents

Carefully review your insurance policy documents to understand the extent of coverage and any limitations.

Consult with Providers

Speak with approved ABA therapy providers to ensure they accept Hoosier Care Connect and understand the coverage process.

Navigating the Approval Process

Securing prior authorization for ABA therapy involves several steps:

Consultation 

Schedule a consultation with a qualified healthcare provider to diagnose ASD and recommend ABA therapy.

Documentation

Gather all necessary documentation, including the diagnosis, treatment plan, and medical necessity justification.

Submission

Submit the required documents to Hoosier Care Connect for prior authorization.

Follow-Up

Stay in contact with your provider and Hoosier Care Connect to ensure all paperwork is processed and approved.

Tips for Navigating Hoosier Care Connect

Maximizing the benefits provided by Hoosier Care Connect can be straightforward with the right approach. Here are some tips to help you:

Stay Informed

Regularly check the Hoosier Care Connect website and consult with healthcare providers for updates on coverage and benefits. Staying informed helps you make the best decisions for your child’s care.

Maintain Detailed Records 

Keep comprehensive documentation of your child’s diagnosis, treatment plans, and communications with healthcare providers. This can streamline the authorization process and ensure continuity of care.

Advocate for Your Child

Proactively seek necessary services and reach out to healthcare professionals or autism support organizations if you face challenges with coverage. Effective advocacy can help you secure necessary services for your child.

Conclusion

Understanding your Hoosier Care Connect coverage for ABA therapy is a big step forward. Now, let's translate that knowledge into action for your child. Contact Step Ahead ABA today – let's unlock your child's potential 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

Put your child on the path to progress.