MDwise Insurance Coverage for ABA Therapy

Helping your child with autism spectrum disorder (ASD) thrive can feel like a constant quest. Applied behavior analysis (ABA) therapy can be a powerful tool in their journey, but navigating insurance coverage can add another layer of complexity.

MDwise, a healthcare provider offering plans specifically for Indiana residents, recognizes the importance of ABA therapy for children with ASD. They aim to simplify the process by offering coverage under certain conditions, potentially easing some of the burden on families. This guide will help you understand how MDwise can be a partner in your child's development.

Understanding MDwise

MDwise is a health insurance provider offering a range of plans to individuals and families in Indiana. MDwise is known for its Medicaid plans, including Hoosier Healthwise, the Healthy Indiana Plan (HIP), and Hoosier Care Connect. These plans aim to provide comprehensive healthcare coverage, including ABA therapy for children with autism.

Coverage for ABA Therapy

MDwise does cover ABA therapy, but the specifics depend on the plan you have. Here’s a breakdown:

Hoosier Healthwise:

  • Eligibility: Children under 21 with a formal diagnosis of ASD.
  • Coverage Limits: Up to 30 hours of therapy per week, with a maximum benefit of $120,000 per year​​.

Healthy Indiana Plan (HIP):

  • Eligibility: Individuals with ASD.
  • Coverage Limits: Limited to 60 hours of ABA therapy per year​​.

MDwise Marketplace Plans:

  • Coverage Specifics: Vary depending on the selected plan. It’s essential to review your plan documents to understand the exact coverage details​​.

Approval Process

Obtaining coverage for ABA therapy involves several steps:

  1. Prior Authorization

Before starting ABA therapy, you need prior authorization from MDwise. This involves submitting a detailed treatment plan, including diagnosis, treatment goals, and justification for the therapy’s medical necessity.

  1. Continued Authorization

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

Tips for Maximizing Your Coverage

Navigating insurance coverage can be complex, but these tips can help you make the most of your MDwise benefits:

Understand Your Policy

Familiarize yourself with your insurance policy, including deductibles, copayments, and coverage limits. Knowing these details will help you manage your financial responsibilities.

Stay In-Network

Using in-network providers can reduce out-of-pocket costs. Ensure your ABA therapy provider is contracted with MDwise.

Keep Detailed Records

Maintain comprehensive documentation of your child’s diagnosis, treatment plans, and progress reports. This information is crucial for obtaining and maintaining coverage.

Utilize the Appeals Process

If your coverage request is denied, use the appeals process provided by MDwise. Gather additional supporting documentation and follow the instructions for submitting an appeal​.

Conclusion

MDwise does provide coverage for ABA therapy, but the specifics depend on the plan you have. Understanding your coverage options, eligibility requirements, and the approval process is essential for maximizing your benefits. 

Don't let navigating insurance become a roadblock. With MDwise coverage and Step Ahead ABA's expertise, you can empower your child's journey towards a brighter future. Contact us to schedule a consultation and unlock your child's full potential.

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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.