Does Managed Health Services Cover ABA Therapy?
Yes, in Indiana. Managed Health Services (MHS) covers ABA therapy for Indiana Medicaid members under 21 when it's medically necessary, and MHS must approve it first. In Wisconsin, MHS Health members get ABA through ForwardHealth, the state's Medicaid program. Alpaca Health doesn't have BCBAs in Indiana or Wisconsin today, so we can't promise ABA care to MHS members.
How Managed Health Services covers ABA therapy
Two Medicaid health plans use the MHS name, one in Indiana and one in Wisconsin. Each state pays for autism care its own way.
- Indiana programs: MHS in Indiana runs plans for Hoosier Healthwise, Hoosier Care Connect, and the Healthy Indiana Plan (HIP) for adults.
- Who the plans cover: Hoosier Healthwise covers children and pregnant people, and Hoosier Care Connect covers people under 60 who qualify through blindness or a disability.
- Where the rules live: Indiana Medicaid's provider manual and a 2026 policy bulletin set the ABA rules, and those rules apply to MHS members too.
- Part of EPSDT: Since April 1, 2026, Indiana has covered ABA only through EPSDT (the federal rule that Medicaid pays for the treatment children need before age 21).
- Wisconsin works differently: MHS Health Wisconsin runs BadgerCare Plus and Medicaid SSI plans in every county, but its member handbook says ForwardHealth, the state's Medicaid program, covers autism treatment instead.
What your child needs to qualify
1. Indiana Medicaid through MHS, under age 21
Your child needs Indiana Medicaid through MHS and must be 20 or younger. In Wisconsin, ForwardHealth sets the rules for MHS Health members.
2. An autism diagnosis from a full evaluation
A trained clinician must evaluate your child for autism. That can be a licensed psychologist (HSPP), a doctor, an advanced practice nurse, or a physician assistant trained in the DSM autism criteria. The evaluation includes an interview with you, a structured look at how your child talks and plays, and a review of past school or therapy reports.
3. A referral for ABA
One of those clinicians must also refer your child for ABA. Under Indiana's referral rules, a BCBA can't write it. If the evaluation is more than a year old, your child needs a new referral and an updated behavior assessment before therapy starts.
4. A behavior assessment and treatment plan
A BCBA or psychologist tests your child's skills and behavior with standard tools such as the Vineland. The BCBA then writes a treatment plan with measurable goals, and you sign both.
5. Time for parent coaching
Every ABA request must include time for parent coaching. For comprehensive ABA, which runs 16 or more hours a week, plan on at least 12 hours of coaching every six months. If a serious problem such as an illness or a custody change gets in the way, the BCBA can ask for fewer hours.
How prior authorization works with Managed Health Services
This step means getting MHS's approval before ABA starts, which MHS calls prior authorization. MHS puts every ABA billing code on its approval list. In Wisconsin, ForwardHealth handles this step instead.
- What gets sent: The evaluation, the behavior assessment, the treatment plan, and support for the hours requested go to MHS.
- Six months at a time: Each approval lasts up to six months, and every reauthorization (a renewed approval) needs a new assessment and an updated plan.
- Progress counts: Renewals need measurable progress on each goal, and ABA can end when your child no longer needs it or stops making progress.
- Stay in network: MHS closed its ABA network statewide on March 26, 2026, and it approves an out-of-network provider only when no in-network one is available.
- Step 1DiagnosisA qualified clinician completes the full autism evaluation Indiana requires.
- Step 2Referral and assessmentThe clinician refers your child for ABA, and a BCBA runs the behavior assessment.
- Step 3Treatment planThe BCBA sets measurable goals and a plan for parent coaching.
- Step 4MHS approvalMHS reviews the request and approves up to six months of therapy.
- Step 5Progress reviewsA new assessment and updated plan go to MHS at least every six months.
What Managed Health Services covers for ABA therapy
Your child's BCBA asks MHS for hours under the billing codes (CPT codes) below, and MHS has to approve each one.
- Assessments (97151, 97152): Testing and treatment planning happen at the start and at least every six months after that.
- One-to-one therapy (97153): A registered behavior technician (RBT) or a behavior analyst works directly with your child.
- BCBA supervision (97155): Indiana's supervision rule calls for at least 1 hour of BCBA supervision for every 8 hours of technician therapy.
- Caregiver training (97156, 97157): Coaching for parents and caregivers can run up to 18 hours per six-month approval, or more when it's medically necessary.
- Group sessions (97154, 97158): Groups of 2 to 8 children can work together when the treatment plan calls for it.
The treatment plan sets weekly hours based on your child's needs, and providers can request up to 40 hours a week.
What families pay with Managed Health Services
Covered ABA has no copay for children in Hoosier Healthwise Package A or Hoosier Care Connect. Under the state's cost-sharing rules, only HIP and Package C, the Children's Health Insurance Program (CHIP) plan, still have copays.
- CHIP premiums: Families in Package C pay a small monthly premium to the state, and its only copays are for prescriptions and ambulance rides.
- Bills for covered care: MHS's Hoosier Healthwise handbook tells families to call MHS Member Services right away about any bill for a covered service.
- Unapproved outside care: You could owe for care MHS didn't approve if the provider isn't an Indiana Medicaid provider.
- Wisconsin: MHS Health Wisconsin's handbook lists no copay for autism treatment through ForwardHealth.
Where Managed Health Services operates
MHS plans serve families in Indiana and Wisconsin, and Alpaca Health doesn't have BCBAs in either state today.
How Alpaca Health can help families with Managed Health Services
Alpaca Health's independent BCBAs practice in other states, not in Indiana or Wisconsin. If you fill out our short intake form, our team follows up within one business day and tells you whether we can help.
- Benefits check: In the states we serve, we confirm a family's ABA benefits for free before therapy starts.
- Approval paperwork: When we can help, your BCBA writes the assessment and treatment plan, and we handle the submission.
Does MHS require prior authorization for ABA therapy?
Yes. MHS has to approve every ABA service before it pays, and that includes the first ABA assessment. Your child's BCBA sends the request, so ask for the approved dates before sessions begin. If MHS denies a request, you have 60 days from the date on the decision letter to file an appeal.
How many hours of ABA therapy does MHS cover?
In Indiana, it depends on your child's needs and the type of ABA. Comprehensive ABA works on many skills at once, usually for 16 or more hours a week, and it has a 4,000-hour lifetime cap unless a review approves more. Targeted ABA focuses on a few behaviors for up to 15 hours a week. Either way, the treatment plan must justify the hours per week it asks for.
Does MHS cover ABA therapy after age 21?
In Indiana, coverage ends at age 21. Since October 1, 2026, Indiana Medicaid hasn't paid for ABA for anyone 21 or older. Adults already in therapy had six months to switch to other services. The cutoff comes from EPSDT, the federal Medicaid benefit that covers needed care for members under 21. Ask your child's BCBA and MHS care manager early about fading services and other supports.
Does MHS Health Wisconsin cover ABA therapy?
Wisconsin's Medicaid program, ForwardHealth, pays for ABA under its behavioral treatment benefit. MHS Health members show their ForwardHealth card to a provider who takes Medicaid, and the provider gets ForwardHealth's approval before treatment starts. The state added this benefit in 2016, after federal guidance told states to cover autism treatment through Medicaid.
Can my child get ABA through telehealth with MHS?
Only some of it can happen by video in Indiana. Since April 1, 2026, Indiana Medicaid has required assessments and therapy with a technician to happen in person. BCBA supervision and parent coaching can still use virtual ABA sessions, but most supervision should stay in person.
Check your Managed Health Services coverage
Tell us about your child and your plan. We'll follow up within one business day, tell you whether Alpaca Health can help, and look for a BCBA who takes your plan.