INDIANAPOLIS — Indiana's Medicaid program for Applied Behavior Analysis (ABA), a widely-used therapy for children with autism, faces sustainability challenges, prompting state officials to seek cost-cutting measures to maintain the program. Governor Mike Braun signed an executive order to form a task force dedicated to exploring potential funding solutions
"Without the coverage from Medicaid, they wouldn't receive those services,” Kayla Kirkpatrick, a mother of two elementary school children on the autism spectrum, said.
Kirkpatrick put her kids in ABA therapy last summer. She said that before they were in ABA therapy, simple tasks like haircuts and grocery shopping were difficult for her children. Since ABA, though, she says they are now thriving.
WATCH | Families fear the impact of FSSA's ABA program cuts
"I am super protective of them," Kirkpatrick said. "I just want what is best for them and seeing how much they have grown and changed in the short amount of time that they have been in ABA therapy really reassures me that I made the right choice for them."
According to the governor's office, by 2026, more than 8,000 Indiana families are expected to rely on Medicaid funding for ABA therapy, with costs projected to reach $645 million. The newly formed task force aims to ensure the continuation of this essential program while identifying areas for cost reductions.
“We are going to do everything to take care of the underlying need to put the resources together but we are not going to deficit spend to do it or anything else in our state government,” Braun stated.
A recent federal audit revealed that Indiana made $39 million in improper payments for ABA therapy. In response to that, FSSA made changes to the program.
Initially, there would have been a lifetime cap of three years starting on April 1, meaning many people would have had to stop treatments immediately. However, due to concerns from providers, advocates and parents, the state made the following changes.
Weekly Limitation on Services
- For individuals diagnosed with ASD Level 1 – Not more than 30 hours per week
- For individuals diagnosed with ASD Level 2 – Not more than 32 hours per week OR the number of hours prescribed by the recipient’s health care provider
- For individuals diagnosed with ASD Level 3 – Not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider
- For individuals not diagnosed with ASD, but have a documented disability for which ABA therapy is deemed medically necessary – Not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider
Lifetime Limitation on Services
- For all individuals – Not more than 36 months of comprehensive ABA therapy
- For purposes of calculating the length of time in treatment, the time starts on the effective date of the State Plan Amendment (i.e., regardless of the number of months that an individual has already received ABA therapy, the individual will be able to continue services at least until 4/1/2028)
- Following the 3-year limitation, individuals may still qualify for limited-hour, behavior-specific, focused ABA based on medical necessity.
Additionally, FSSA will continue to require prior authorization for services, with peer review potentially required for individuals who require services for two or more years.
Providers welcome the opportunity presented by the task force to communicate with policymakers about the existing practices and challenges.
Julie Gordon, owner of The Hope Source ABA provider, emphasized the importance of reviewing the audit findings and creating clear guidelines for providers.
“Looking at the federal audit, dissecting all of that, like what is actually going on, how can we make clear guidelines, how can we make sure that providers are following that,” she said.
She says there are barriers they currently face when treating clients that she feels could be fixed by having conversations with policymakers. Some include complicated billing practices others are limitations when it comes to treatment.
"As providers, we have a lot of kids with mental health needs," Gordon said. "But they aren't allowed to have mental health treatment and ABA therapy at the same time. With trained mental health professionals, you can decrease the ABA therapy over time."
The task force will include parents, providers, and government stakeholders, with their findings expected to be delivered to the governor by November 30.
