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Is ABA Therapy Covered By Insurance In Indiana?

Find out if Applied Behavior Analysis is covered by insurance in Indiana.

steven zauderer
Steven Zauderer
September 15, 2023
min read

Is ABA Therapy Covered By Insurance In Indiana?

In the state of Indiana, there's an autism mandate that stipulates specific health insurers give coverage to people with autism.

The mandate also requires individuals and group policies to give coverage for treating developmental disorders for people that aren't insured.

These are disorders classified as brain and neurological disorders, one of them being Autism Spectrum Disorder. The coverage that's needed may or may not have deductibles, monetary limits, or co-pay provisions that one seeking help wouldn't want.

Services that are related to speech and language aren't directly listed in the same statute, so health insurers in the state could have more discretion over funding costs associated with therapy sessions related to someone's talking abilities.

Some with autism have difficulty talking or could be entirely nonverbal, a serious consideration for the caretakers of anyone with such symptoms.

In this situation, coverage might be capped to treatment that's given by someone's doctor, so long as it's based on the initial treatment plan.

Applied Behavior Analysis is a therapy made to assist kids with autism. It helps them gain knowledge in novel skills and boost wanted behaviors. Most insurance companies will cover ABA therapy. However, the amount of coverage can vary greatly based on the state and the type of insurance plan provided.

According to Indiana state law, ABA is listed as a medical necessity for an autism diagnosis and its treatment. As a result, ABA is covered by most medical insurance plans doing business in the state.

Still, not every insurance company is the same. It's imperative that parents thoroughly look at their chosen plan to see the kind of coverage that's offered for ABA treatment.

This can be done by contacting the customer service number shown on an insurance card or by searching for the insurer's website. When on the website, a detailed listing of the plan and all it covers will be presented.

Kids with autism might be covered by an insurance plan that's employer-based as well, though this isn't set in stone. Again, parents must check with their health insurance provider to make sure they'll pay for the ABA treatment, and if necessary, other therapies.

Furthermore, ABA therapy is listed in the Essential Health Benefits deal with the Affordable Care Act, something that every health insurance plan given in Indiana must legally cover. This goes for private and public healthcare plans.

Parents and guardians of kids with autism can also buy the ACA plan through Indiana's Marketplace for federal health insurance.

Is ABA Therapy Covered By Medicaid In Indiana?

Children in Indiana that are diagnosed with autism could be eligible for Medicaid. Medicaid is a government health insurance program providing cheap or free medical treatment, particularly for anyone with a limited amount of income.

Medicaid eligibility in Indiana is provided for children that have a disability that falls within the standards listed by the Social security Administration. An official autism diagnosis immediately gives a child qualification for coverage with Medicaid.

There exists no cap for someone to meet the standard for Medicaid coverage. Every child with autism is eligible, no matter how much their family makes. Every child with the disorder can go to ABA therapy with Medicaid paying for it on the condition of stipulations.

Kids that get ABA therapy with Medicaid have to enroll in a Medicaid program with an autism diagnosis done by a professional, namely a psychologist with the right credentials needed for making an accurate diagnosis.

Since ABA is classified as a benefit covered by Medicaid, no alternative healthcare insurance is required for a child to get treated.

One issue that could occur deals with some ABA centers not accepting Medicaid as payment. For kids on the spectrum, this can be difficult as it could prevent them from getting the full care that they need.

For families that can't find an ABA center willing to take Medicaid, the following should be done:

  • Find an ABA center that does take Medicaid - This might be easier said than done, particularly for people living in areas outside of Indiana's largest cities.
  • Alternative funding options - Parents can look for funding through scholarships, grants, and loans.
  • Use both - This option involves using a private insurer and Medicaid to buy therapy.
  • Crowdfunding - This is another option, though it might not generate much income unless traction is created through online exposure.

Will Insurance Cover ABA For ADHD In Indiana?

The majority of insurance providers in Indiana will cover ABA for ASD and nothing else.

However, some providers might be willing to cover ABA therapy for a child with ADHD if their visit is recommended by a psychologist or physician. The health insurance provider might ask that parents provide a letter written by their child's doctor showing why ABA is needed for their symptoms.

Insurance Providers That Cover Applied Behavior Analysis In Indiana

Here are some healthcare providers known to cover ABA therapy in the state:

  • Medicaid - Available in all 50 states, including Indiana.
  • Cigna - Have ABA coverage plans incumbent upon paperwork showing an official diagnosis made by a doctor.
  • Blue Cross Shield - Various plans for ABA coverage. Most plans are subject to proof of diagnosis being administered.
  • Kaiser Permanente - One of the first providers to cover ABA therapy. Not available in every state.
steven zauderer

CEO of CrossRiverTherapy - a national ABA therapy company based in the USA.

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