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Autism Spectrum Disorder (ASD) is a developmental disorder that affects approximately 1 in 44 families. There are many different treatment options available for children with ASD. Some of these treatments can be very costly. 

In this article, we will discuss some of the ABA therapy payment options available in Indiana for families who have a child with autism.

Insurance Coverage

Applied Behavior Analysis (ABA) is a type of therapy that helps children with autism learn new skills and improve behaviors. Many insurance companies cover ABA therapy, but coverage can vary depending on your state and type of insurance. 

Under the state of Indiana’s rules, ABA is considered a medically necessary service for diagnosing and treating ASD. This means that ABA is a covered service under many health insurance plans in the state. 

However, each insurance company is different, so it’s essential to check with your specific plan to see what coverage they offer for ABA services by calling the customer service number on your insurance card or looking up your plan’s benefits online.

Your child with autism may be covered if you have employer-based insurance, but it’s not guaranteed. You should check with your insurance carrier to ensure they cover ABA and other therapies for autism. 

Applied Behavioral Analysis is included in the “Essential Health Benefits” package under the Affordable Care Act, which means that all health insurance plans offered in Indiana must cover it. This includes both public and private health plans.

Parents of children with ASD can purchase this Affordable Care Act Plan from Indiana’s federal health insurance marketplace. 

Now that we’ve exhausted our look at ways to find funding through insurance policies let’s take a look at the support that Medicaid offers children with autism.

Medicaid

In Indiana, children with autism may be eligible for Medicaid coverage. Medicaid is a government health insurance program that provides free or low-cost medical care for people with limited incomes. 

To be eligible for Medicaid in Indiana, a child must have a disability that meets the criteria set forth by the Social Security Administration (SSA). A diagnosis of autism spectrum disorder (ASD) automatically qualifies a child for Medicaid coverage.

There is no income limit to qualify for Medicaid coverage in Indiana, so all children with ASD are eligible regardless of their family’s income. All children with autism are eligible for ABA therapy through Medicaid, but there are requirements.

Children who receive ABA therapy through Medicaid must be enrolled in the Medicaid program and have a diagnosis of ASD from a qualified professional. 

ABA therapy is considered a covered benefit under Medicaid, so there is no need to purchase a separate insurance policy to receive this treatment.

A problem may arise for families of children with autism because, unfortunately, not all ABA providers accept Medicaid as payment. This situation is challenging for children with autism who rely on Medicaid for their health insurance coverage.

There are several options available for families in this situation:

  • One option is to find an ABA provider who does accept Medicaid
  • Next, parents of children with autism can seek out funding from other sources, such as grants or scholarships 
  • Finally, families can also use a combination of private insurance and Medicaid to pay for ABA therapy services

Families need to remember that they have options for paying for autism services. With a bit of research, they should be able to find a solution that meets their needs.

Other Options

Aside from Medicaid and Insurance plans to cover the costs of ABA therapy for children with autism, other options are available to families. 

Waivers

Medicaid home and community-based services waivers are an option for some children with autism in Indiana. 

These waivers provide funding for specific services and supports to help children with autism live in their own homes or communities instead of institutions. 

To be eligible for a waiver, a child must be eligible for Medicaid and have a disability that meets the criteria for one of the waiver programs. Let’s look at two waivers in particular.

  1. The Family Supports Waiver. The family support waiver is a Medicaid program that helps families with children with autism or other developmental disabilities. 

The waiver pays for services and supports that help the child live at home and participate in the community. To be eligible for the waiver, the child must be under 21.

The child must also have a diagnosis of autism or another developmental disability and be eligible for Medicaid. The waiver covers a wide range of services, including: 

  • Applied behavior analysis (ABA) 
  • Therapies 
  • Respite care 
  • In-home support 
  • Equipment and supplies

All these services offered with the Family Supports Waiver can go a long way to alleviating some of the many challenges faced by families with children on the autism spectrum.

  1. Community Integration and Habilitation Waiver. This waiver is available for children with autism who are five years of age or younger and provides services and supports that enable the child to be integrated into the community.

To qualify for this waiver, a child must: 

  • Have a diagnosis of autism
  • Be five years of age or younger
  • Meet the functional criteria for waiver services

Children who receive services under this waiver are eligible to receive Medicaid benefits.

Children’s Special Health Care Services

The Children’s Special Health Care Services program in Indiana helps children with autism and their families get the care and services they need. 

The program provides medical, dental, mental health, developmental, and case management services to eligible children from birth to age 21. 

To be eligible for the program, a child must have a chronic physical, developmental, behavioral, or emotional condition that has lasted or is expected to last at least one year or longer.

The child’s condition requires more care than what is typically available through a family’s private health insurance. 

United Healthcare Children’s Foundation

The function of the United Healthcare Children’s Foundation is to help pay for a child’s health care treatments, services, and equipment when commercial health insurance does not cover all of the expenses.

To be eligible for a grant from the United Healthcare Children’s Foundation, children must be 16 years old or younger and have a medical condition diagnosed by a licensed physician. 

The Foundation also requires that families have private health insurance, and there are some income requirements as well.  Applications for a grant can be completed online, and families will be notified of a decision within four to six weeks.

Grants

There are other payment options for ABA therapy in Indiana, such as: 

  • Autism Speaks Family Services Grants. The Family Services Grant is a one-time award of $2,500 to help with ABA therapy costs.
  • Autism Society of Indiana. This organization provides grants for ABA services to eligible families. The amount of the gift and the number of recipients varies each year.
  •  ComForCare Home Care.  Providing in-home ABA services for children with autism and other developmental disabilities, ComForCare Home Care offers a sliding scale fee based on income and accepts various insurance plans. 

If you’re struggling with the challenges surrounding ASD, reach out to some of these resources and websites. You aren’t alone; help is out there.

You Don’t Have to Do it Alone

Parenting a child with autism can be challenging, but it can also be gratifying. If you’re struggling to find help affording ABA therapy for your child with autism, know that you don’t have to fight alone.

We hope this article helped you find some payment options to help you afford the treatment your child needs. Don’t wait; get support today!

 

If you are ready to work with the best ABA therapy provider in Indiana, give us a call at (732) 402-0297. Our dedicated team is ready to help and we will treat you like family.

 

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