Hoosier Healthwise Insurance Coverage for ABA Therapy

When navigating healthcare options for children with autism in Indiana, understanding the coverage provided by Hoosier Healthwise can significantly impact your child's treatment plan. 

This article provides a detailed look at Hoosier Healthwise's coverage for Applied Behavior Analysis (ABA) therapy, including eligibility, coverage limits, and the approval process. Learn how Step Ahead ABA can support your family through this journey.

What is Hoosier Healthwise?

Hoosier Healthwise is Indiana’s Medicaid program designed to provide comprehensive healthcare for children, pregnant women, and other eligible individuals. It covers a wide range of medical services, including doctor visits, hospital care, prescription medications, and mental health services.

Coverage for ABA Therapy

ABA therapy, an evidence-based treatment for children with Autism Spectrum Disorder (ASD), is covered under Hoosier Healthwise. The program recognizes the importance of ABA therapy in helping children with autism develop essential skills and improve their quality of life. Here’s what you need to know:

Eligibility Requirements:

  • ABA therapy is available to children diagnosed with ASD.
  • Coverage typically extends until the child turns 21.
  • The therapy must be deemed medically necessary by a qualified healthcare provider.

Coverage Limits:

  • The specific limits on the number of therapy hours can vary. Generally, the guidelines suggest that ABA therapy should not exceed 40 hours per week, which aligns with clinical recommendations for intensive behavioral intervention.
  • There may be annual or lifetime caps on the amount of ABA therapy covered, depending on the specific health plan under Hoosier Healthwise.

Approval Process:

  • Prior Authorization: Families must obtain prior authorization from Hoosier Healthwise. This process involves a healthcare provider submitting a request that includes the child’s diagnosis, a treatment plan, and a justification for the medical necessity of ABA therapy.
  • Continued Authorization: Periodic reviews are required to continue receiving coverage. These reviews ensure that the therapy remains beneficial and that progress is being made according to the treatment goals.

Provider Requirements:

  • Families must work with approved providers who meet the state’s criteria for delivering ABA therapy. Approved providers are typically Board Certified Behavior Analysts (BCBAs) or other professionals with specialized training in ABA.

Additional Services Covered

In addition to ABA therapy, Hoosier Healthwise provides a comprehensive suite of services for children with special health care needs. These include:

  • Speech and Occupational Therapy: Essential for addressing communication and motor skills.
  • Mental Health Services: Including counseling and psychiatric care.
  • Medical Equipment: Such as communication devices and sensory aids.

Navigating Hoosier Healthwise

Understanding and navigating the coverage provided by Hoosier Healthwise can be complex. Here are some tips to help you make the most of your benefits:

Stay Informed

Regularly check the Hoosier Healthwise website and contact your healthcare provider for the latest information on coverage and benefits.

Documentation

Keep detailed records of your child’s diagnosis, treatment plans, and communications with healthcare providers and the Medicaid office. This can help streamline the approval and authorization process.

Advocate for Your Child

Don’t hesitate to advocate for the services your child needs. If you encounter any issues with coverage, seek assistance from healthcare professionals or organizations that specialize in supporting families with children who have special needs.

Conclusion

In conclusion, Hoosier Healthwise is there to provide coverage for ABA therapy, a crucial resource for children with autism in Indiana. Families simply need to meet eligibility requirements and navigate through the approval process. 

But that's not all – Hoosier Healthwise goes the extra mile by offering various additional services tailored to special health care needs. To make the most of these resources, it's important to stay informed, keep detailed records, and advocate for your child when necessary. By following these steps, families can ensure their child receives the comprehensive care and support they deserve from Hoosier Healthwise.

For more information on how Step Ahead ABA can support your family, visit Step Ahead ABA or contact us directly.

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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.