Does Medicaid Cover Chiropractic in Indiana?

Medicaid, a joint federal and state program, provides healthcare coverage to eligible individuals and families with limited income and resources. In Indiana, this program helps residents access various medical services. Chiropractic care focuses on musculoskeletal disorders, often using manual therapy like spinal adjustment to address conditions such as back pain, neck pain, and headaches. This article outlines Indiana Medicaid’s coverage for chiropractic services.

Medicaid Chiropractic Coverage Parameters in Indiana

Indiana Medicaid does cover chiropractic services, but specific conditions and limitations apply to ensure medical necessity. Coverage generally focuses on treatments for acute or chronic pain and functional impairment of the musculoskeletal system. Chiropractors must ensure that the services provided are medically necessary and align with specific diagnostic codes for reimbursement.

The Indiana Health Coverage Programs (IHCP) limits reimbursement to 50 chiropractic visits per member within a rolling 12-month period. Of these 50 visits, a maximum of five can be office visits, with the remaining visits typically allocated to spinal manipulation or physical medicine treatments.

Variations in coverage exist across different Indiana Medicaid programs. For instance, the Healthy Indiana Plan (HIP) Plus offers six spinal therapy visits per year, and these visits do not require a referral or pre-approval from the managed care entity. In contrast, the HIP Basic plan generally does not include coverage for chiropractic manipulation services. Pregnant members enrolled in HIP Maternity also receive chiropractic care.

For members under Hoosier Healthwise Package C, chiropractic services are limited to five visits and 14 therapeutic physical medicine treatments annually. If additional treatments beyond this limit are medically necessary, up to 36 more treatments may be covered with prior authorization. Covered services include spinal manipulation, physical medicine treatments, radiology (one series of X-rays per year), and certain laboratory tests like blood and urine analysis, provided they fall within the chiropractor’s scope of practice. However, Indiana Medicaid does not reimburse for durable medical equipment (DME) or electromyogram (EMG) testing when provided by chiropractors. Certain types of comprehensive office visits are also not eligible for reimbursement.

Finding an Approved Chiropractor

Locating a chiropractor who accepts Indiana Medicaid requires utilizing official resources and direct communication. The Indiana Health Coverage Programs (IHCP) offers an online Provider Locator tool to find enrolled healthcare providers. This tool allows searches by provider type (chiropractors are specialty 150), specialty, and geographic location.

When using the IHCP Provider Locator, specify “chiropractor” as the provider type or specialty to narrow results. After identifying potential providers, contact each office directly to confirm current acceptance of Indiana Medicaid plans and verify if they are accepting new patients.

Many Indiana Medicaid beneficiaries are enrolled in managed care plans such as Healthy Indiana Plan (HIP), Hoosier Healthwise, Hoosier Care Connect, or Indiana PathWays for Aging. If enrolled in one of these plans, individuals should also contact their specific Managed Care Entity (MCE), such as MDwise, Anthem, MHS, CareSource, UnitedHealthcare, or Humana. These MCEs often have their own provider directories and networks, and confirming in-network status with the specific plan is important to ensure coverage. The MCE can provide a list of chiropractors within their network, further streamlining the search process.

Steps to Access Covered Chiropractic Care

Once a suitable chiropractic provider accepting Indiana Medicaid has been identified, several steps facilitate access to covered care. The initial step typically involves scheduling an appointment with the chiropractor’s office. During this process, individuals will need to provide their Medicaid identification information.

For HIP Plus members, a referral from a primary care physician (PCP) is not required to access chiropractic services. Similarly, for Hoosier Healthwise members, chiropractic services are often categorized as “self-referral,” meaning a direct referral from a PCP might not be strictly necessary for initial access. However, for those in certain managed care plans, a referral from a Primary Medical Provider (PMP) may be needed for specialized services, so it is always prudent to consult with your plan or PMP if unsure.

Prior authorization (PA) is another aspect to consider, although it is not universally required for all chiropractic services. For routine office visits, prior authorization is generally not necessary. However, specific services like manual or electrical muscle testing do require prior authorization. Additionally, if the proposed treatment plan exceeds the standard visit limits, such as the 50-unit annual limit or the specific limits for Hoosier Healthwise Package C, prior authorization based on medical necessity will be required. The chiropractor’s office typically handles the submission of prior authorization requests to the appropriate Medicaid entity or managed care organization.

When attending the initial consultation, individuals should bring their Medicaid card and any relevant medical records that could assist the chiropractor in their assessment. The chiropractor will conduct an examination and develop a treatment plan that aligns with Indiana Medicaid’s medical necessity criteria and covered service limitations. This plan will adhere to specific billing and diagnostic codes to ensure proper reimbursement for the services provided.