ABA insurance and Medicaid coverage in Indiana

Autism insurance mandate

State mandate for autism coverage

Yes, the research found a state autism coverage law.

Statute

IC 27-8-14.2 (accident and sickness policies); IC 27-13-7-14.7 (HMO contracts); IC 5-10-8-7.1 (state-employee self-insurance and prepaid plans). Added by P.L.148-2001 (HEA 1122).

Age limits

None. No age limit in IC 27-8-14.2, IC 27-13-7-14.7, or IC 5-10-8-7.1.

Annual cap

None. No autism-specific annual dollar cap or visit cap. Dollar limits, deductibles, and coinsurance may not be less favorable than those that apply to physical illness generally (IC 27-8-14.2-4(b) and IC 27-8-14.2-5(b)). HMO contracts also bar less-favorable copayments (IC 27-13-7-14.7(c) and (e)); the state plan does the same (IC 5-10-8-7.1(e)). IDOI Bulletin 136 (March 30, 2006) treats dollar limits and visit limits as synonymous for this mandate.

Excludes self-funded employer plans

Yes, self-funded employer plans are generally outside state mandates.

Notes

Indiana Code 2026 requires a group accident and sickness policy to cover treatment of an autism spectrum disorder of an insured, limited to treatment prescribed by the insured's treating physician in accordance with a treatment plan, and bars denial, nonrenewal, or restriction of coverage solely because of that diagnosis (IC 27-8-14.2-4). An insurer that issues an individual policy must only offer that coverage (IC 27-8-14.2-5). A group HMO contract that provides basic health care services must cover, and an individual HMO contract must offer, the same treatment (IC 27-13-7-14.7(b) and (d)). The state personnel department self-insurance program for state employees and retired state employees under IC 5-10-8-7(b), and a prepaid health care delivery contract under IC 5-10-8-7(c), must cover it (IC 5-10-8-7.1). ASD is defined as a neurological condition, including Asperger's syndrome and autism, as defined in the DSM (IC 27-8-14.2-3, amended by P.L.188-2013 and P.L.124-2018). IC 5-10-8-7.1(b) still cites the most recent edition of the DSM of the American Psychiatric Association. The statute does not name ABA. IDOI Bulletin 136 (March 30, 2006), still listed on the Department's current bulletin page, says behavioral therapies such as applied behavior analysis may not be subject to the visit limits used for physical, occupational, or speech therapy; exclusions inconsistent with the treatment plan are invalid as to the disorder; the payer must decide the treatment plan in writing within 30 days; and an updated plan may be requested not more than once every six months, at the payer's cost. Bulletin 179 (April 27, 2010) treats a psychologist, or a physician specializing in and treating the disorder, as the treating physician. Bulletin 216 (June 17, 2015) requires payment of the undisputed portion of ABA during an appeal; its 40-hour versus 20-hour discussion is an example, not a cap, and it cites Unfair Settlement Practices Act fines of up to $25,000 per violation, or $50,000 if knowing. IC 27-8-14.2-1(b) excludes accident-only, credit, dental, vision, Medicare supplement, long-term care, disability income, specified-disease, certain short-term plans (renewable for the greater of 36 months or the federal maximum, term of not more than 364 days, and an annual limit of at least $2,000,000), indemnity-only, supplemental, student health, and certain employer Medicare plans. Private self-funded employer plans are outside the insurance mandate: the October 10, 2001 Indiana Commission on Autism minutes state that HEA 1122 addresses insurance coverage but does not address self-funded employer group health plans governed by ERISA. The LSA fiscal impact statement for HB 1122 (February 13, 2001) lists an effective date of July 1, 2001. The Office of Code Revision 2001 table maps P.L.148-2001 to HEA 1122.

Medicaid ABA coverage

Medicaid covers ABA

Yes, per the sources below.

Program

Indiana Health Coverage Programs (IHCP) - ABA therapy services

Agency

Indiana Family and Social Services Administration (FSSA) / IHCP

Provider enrollment

https://www.in.gov/medicaid/providers/

Payers named in our research

Names come from the research behind this page. Appearing here does not mean a payer is accepting new providers or that networks are open. Always confirm directly with the payer.