Proposed changes for Medicaid coverage of ABA (Indiana)
If you are a parent of a child with Autism receiving ABA services in the state of Indiana, you have likely heard about the proposed changes in ABA coverage that are supposed to go into effect in April 2025. The following changes are being proposed and the public notice period is up on February 14, 2025:
Comprehensive ABA services in fee-for-service and managed care Medicaid will be limited to 30 hours per week for a duration of no longer than three (3) years as a lifetime maximum.
Following the maximum three (3) year duration, ABA recipients would be permitted to continue limited hour, behavior-specific, focused ABA, if medically necessary.
What does this mean for your child?
ABA care can be provided as “comprehensive” meaning that the individual receives 30-40 hours of weekly therapy. This is usually recommended when individuals have delays across multiple domains (ie language, socialization, etc.) as well as significant behavioral issues, especially those that pose a danger to self and others. Comprehensive therapy is often recommended in early intervention as research has demonstrated a link between hours provided and outcomes (more services has been shown to lead to better outcomes).
ABA care can also be provided for 10-25 hours per week. This is considered “focused” care. Focused care is usually appropriate for individuals that require services for a few specific targeted skills or targeted behaviors. In focused care, individuals typically receive other services outside of ABA (examples include special education, speech, music therapy, occupational therapy, day services, vocational rehabilitation, etc.). Focused care may also be provided as a client transitions out of ABA services into an educational placement, other day services, etc.
If your child has received 3 years or more of ABA at 30 hours of care or greater, then this proposal would require providers to reduce service hours as of April 2025 due to Medicaid not covering comprehensive care. ABA providers are always required to show medical necessity for ongoing services.
Medical necessity is a term that insurers use to determine whether services are covered under their policy. Your ABA team provides information about assessment results, symptoms, behaviors, progress, etc. every 6 months to your insurer in order to provide explanation of medical necessity and ongoing need for treatment.
If your child has received less than 3 years but is currently receiving more than 30 hours per week, their hours will likely be reduced to 30 hours maximum.
What can you do?
Write about your concerns: Written comments may be directed to FSSA, Office of Medicaid Policy and Planning, Attention: Madison MayGruthusen, 402 West Washington Street, Room W382, P.O. Box 7083, Indianapolis, IN 46207-7083 or by email to spacomment@fssa.in.gov. Correspondence should be identified in the following manner: COMMENT RE: ABA THERAPY COVERAGE. Written comments will be made available for public inspection at the address herein of the OMPP.
Contact your representatives: https://iga.in.gov/information/find-legislators
Have a back up plan and discuss it with your provider: Now is the time to begin looking at potential placements and options for your child if the proposed Medicaid plan changes are approved. Discuss with your current BCBA what your child’s transition plan looks like, where they are at in developing those skills, and what the longterm goals are for your child. Ask for current assessment results and discuss with your provider so that you understand your child’s needs. It will also be helpful to have your ABA provider attend meetings with you to talk to other programs in your community. Knowledge is power, and the more you know about your child’s progress, skills, and needs the better you can advocate for him or her moving forward.
