Indiana Medicaid expects caregivers to participate in caregiver coaching and training as part of Applied Behavior Analysis (ABA) therapy. The goal is usually at least 12 hours of training during a six-month authorization period.
However, the state recognizes that some families face challenges that can make it difficult to complete all 12 hours.
If completing 12 hours is difficult, ABA providers should talk with families about any barriers that could make participation difficult before requesting authorization. Examples of barriers include:
- Foster care, adoption, custody, or reunification situations
- Serious illness, hospitalization, surgery, or ongoing medical conditions
- Caring for another family member with significant medical needs
- Homelessness, housing problems, transportation issues, utility shutoffs, or limited internet access
- Natural disasters or other emergencies
- Legal issues such as protective orders, incarceration, or court restrictions
These circumstances may allow a family to have fewer than 12 hours of training approved if the situation is documented and the provider shows that reasonable efforts were made to accommodate the family.
Providers must try to make training accessible before reducing training expectations, providers should make reasonable efforts to help families participate. This may include:
- Offering flexible appointment times
- Providing telehealth options
- Meeting in the home, clinic, or community
- Working with another caregiver who regularly supports the child if the primary caregiver cannot participate
Providers need to document these efforts.
Sometimes a family's circumstances change after services have already been approved. If new barriers arise during the authorization period, providers should document them and explain how they affected the family's ability to participate. This information will be reviewed when services are renewed.
When fewer than the expected training hours are completed, the provider must create a plan describing:
- What barriers made participation difficult
- What steps were taken to address those barriers
- What strategies will be used to increase participation in the future
Examples might include different appointment times, telehealth visits, a new training location, involving another caregiver, or connecting the family with community resources.
Bottom Line
The expectation remains that caregivers participate in ABA training because it helps children be successful. However, Indiana Medicaid recognizes that families sometimes face circumstances beyond their control. When those situations are documented, fewer training hours may be approved, and each situation will be reviewed individually.
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