Hoosier Health card Insurance Coverage for ABA Therapy

Is your child diagnosed with autism spectrum disorder (ASD)? Determining the best course of treatment can feel overwhelming. But there is hope — Hoosier Health Card Insurance can be a powerful ally in providing coverage for applied behavior analysis (ABA) therapy, a treatment proven to significantly improve the lives of children with ASD. 

This guide will be your roadmap to navigating Hoosier Health Card Insurance, explaining coverage, eligibility, and the entire process — clearly and simply.

Understanding Hoosier Health Card 

Hoosier Health Card is part of Indiana’s Medicaid program designed to provide comprehensive health coverage for low-income individuals, including children, pregnant women, and families. It includes various plans like Hoosier Healthwise, Hoosier Care Connect, and the Healthy Indiana Plan (HIP).

ABA Therapy Coverage

ABA therapy is a well-regarded treatment for children with ASD, focusing on improving social, communication, and learning skills. Here's how Hoosier Health Card covers ABA therapy:

Eligibility Requirements

Diagnosis: A formal diagnosis of ASD by a qualified healthcare provider is required.

Age Limit: Coverage generally extends to individuals under 21 years old.

Coverage Limits

Plan Variations: Coverage details, including the number of therapy hours and annual caps, can vary. For example, HIP Plus offers more extensive benefits than HIP Basic. Some plans might cover up to 60 hours of ABA therapy annually, but specifics should be verified with your plan.

Approval Process:

Prior Authorization: Before starting ABA therapy, prior authorization is needed. This involves submitting a comprehensive treatment plan, including the diagnosis, treatment goals, and justification for medical necessity.

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

Provider Requirements

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

Additional Services Covered

Besides ABA therapy, Hoosier Health Card offers various other services beneficial for children with special healthcare needs, such as:

Behavioral Health Services

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

Speech and Occupational Therapy

These therapies enhance communication and motor skills.

Medical Equipment

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

Tips for Navigating Hoosier Health Card Insurance

Here are some tips to help you maximize your benefits:

Stay Informed

Regularly check the Hoosier Healthwise website and consult healthcare providers for updates on coverage and benefits.

Maintain Detailed Records

Keep thorough documentation of your child’s diagnosis, treatment plans, and communications with healthcare providers.

Advocate for Your Child

Proactively seek necessary services and reach out to healthcare professionals or autism support organizations if you face challenges with coverage.

While navigating insurance policies can be complex, understanding your options empowers you to advocate for your child's well-being. Hoosier Health Card offers a valuable resource for ABA therapy, a life-changing intervention for children with ASD.

Contact Step Ahead ABA today and let's discuss how we can guide your child towards a brighter future. Together, we can make a significant difference.

Most major insurances accepted

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We accept Medicaid & all major insurances
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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.