ABA Therapy Coverage, Medicaid and the “1634 Transition”

To: Parents of Children with Autism Receiving Applied Behavior Analysis (ABA) Therapy Services

From: Your Indiana Family Advocacy Organizations – About Special Kids (ASK), The Autism Society of Indiana (ASI), The Arc of Indiana, Covering Kids and Families (CKF), Family Voices, The Indiana Chapter of the American Academy of Pediatrics (INAAP), and The Indiana Resource Center for Autism (IRCA)

Re: ABA Therapy Coverage, Medicaid and the “1634 Transition” (Also called “The June 1st Changes”)

Because of a transition at the state level, some parents have heard conflicting information regarding the type of Medicaid their child must have after June 1, 2014, if the child also has Supplemental Security Income (SSI).

We want to provide parents with accurate information and provide a way to contact  the Office of Medicaid Policy and Planning (OMPP) and the Family and Social Services Administration (FSSA) to clarify any of their questions.  Much of this confusion is based upon the “1634 Transition” that Indiana began on June 1, 2014.

What is the 1634 Transition?  Simply put, in the past, the State of Indiana used different eligibility criteria for disability determination than the Social Security Administration, which is a federal entity.  In July 2012, the state started accepting Social Security Administration (SSA) determinations of disability.  As of June 1st, the “1634 Transition” means that the State of Indiana must now cover all SSI recipients automatically without meeting other criteria other than receiving SSI, and must abide by the eligibility determination by the Social Security Administration, whether approval or denial of disability eligibility.

For more information please visit: www.in.gov/fssa/files/1634_Stakeholder_Presentation_FINAL.pdf or

For example, several families report that their child has been moved from MDWise under Hoosier Health Wise (HHW) a managed Medicaid program, which covers ABA, to what is being called “MASI”, which does not cover ABA.  MASI is a different category; it is SSI-related Medicaid coverage.

If this happens, you have the option to switch to MASI, or remain on Hoosier Health Wise (HHW) if still eligible.   If the child is under MDWise, to keep ABA service coverage, contact your local DFR and tell them you would like for your child to remain on MD Wise with HHW.

If your contact at your local DFR tells you that you must accept MASI, we recommend that you give them the information below from Matthew Cesnik, the Eligibility Director for OMPP.

Individuals that receive SSI will be enrolled into the new category, MASI.  However, individuals may opt into another category for which they may qualify, such as a children’s Medicaid category under Hoosier Healthwise.  An individual cannot opt into CHIP (Children’s Health Insurance Program) if eligible for a Medicaid category.

Protections were put into place in the State’s eligibility system for children receiving ABA services so the children would remain on the Hoosier Healthwise Medicaid category for the month of June in order to allow time for the family to contact DFR.  If the families believe that coverage was switched in June, DFR should contact OMPP Eligibility Director.

We hope that having this reference to give to DFR will make the process of switching your child back to a Medicaid category that covers ABA a little easier for you, if you choose to switch from MASI.  Please share this information with your ABA provider and ask them to check on your status with Medicaid more frequently as they file claims for their services to be sure that your child remains in a Medicaid category that covers ABA.

Parents may contact any of the advocacy organizations listed below for assistance with these types of coverage issues.   We will contact OMPP Eligibility on your behalf so that they can assist you and work with DFR leadership on your particular situation.

Thank you.

The Arc of Indiana
PH: 317-977-2375
Toll Free: 1-800-382-9100

About Special Kids (ASK)
PH: 317-257-8683
Toll Free: 1-800-964-4746

The Autism Society of Indiana (ASI)
Toll Free: 1-800-609-8449

Covering Kids and Families (CKF)
PH: 1-574-968-1645

Family Voices
PH: 317-944-8982

The Indiana Resource Center for Autism (IRCA)
Toll Free: 1-800-825-4733

The Indiana Chapter of  The American Academy of Pediatrics
PH: 317-586-0732