Gov. Mike Braun signed an executive order aimed at addressing rising Medicaid costs for Applied Behavior Analysis (ABA) therapy in Indiana.
The order seeks to contain costs while maintaining the quality of care for thousands of children and young adults who rely on ABA therapy as a treatment for autism.
ABA therapy is a proven method for improving communication, social skills and behavior in individuals with autism. Indiana’s Medicaid expenditures on ABA therapy have risen dramatically, from $14.4 million in 2017 to $120 million in 2019. Projections estimate spending could reach $645 million by 2026 for approximately 8,000 Hoosier children.
The U.S. Office of the Inspector General conducted an audit of Indiana’s ABA program in 2019 and 2020, identifying $56.5 million in improper Medicaid payments due to issues such as inadequate provider credentialing and incomplete documentation.
In response, Braun’s executive order establishes a working group of parents, legislators, experts, physicians and ABA providers to develop solutions for cost containment while maintaining access to care.
The group will evaluate the following:
- The best clinical care models to provide the right therapy, at the right ages, in the right setting, to best serve children and families.
- Recommendations for a better coordinated experience for children who need ABA therapy services, but in a financially sustainable manner.
- Proper transitions for children as they grow in their educational, family and social settings.
- Quality metrics for ABA therapy services.
- Potential caps on hours of therapy services provided per week.
- Potential caps on the number of months a child can receive therapy services.
- Creating an appeals process for extenuating circumstances.
- Establishing new provider enrollment and billing requirements for ABA providers to address issues identified in the federal audit.
“Indiana’s $1 billion Medicaid budget shortfall last year means we need to take bold action to contain costs where they are clearly getting out of hand,” Braun said. “When the price our state pays for one service is soaring from $14 million to $120 million in just two years, with over $39 million of improper payments identified in an independent audit, something is clearly wrong and needs to be addressed immediately.”
The order has raised concerns among some families and advocates about the potential impact on care access. Dr. Katherine Johnson, a clinical psychologist and proponent of ABA therapy, emphasized the importance of maintaining availability.
“ABA therapy is life-changing for children with autism and their families,” Johnson said. “Cuts or caps could mean denying these children their best chance at reaching their full potential.”
For more information about ABA therapy and Indiana Medicaid programs, visit Indiana Medicaid Official Website.
This reporting is made possible by a grant from the Indianapolis African-American Quality of Life Initiative, empowering our community with essential health insights. https://iaaqli.org/
Contact Health & Environmental Reporter Hanna Rauworth at 317-762-7854 or follow her on Instagram at @hanna.rauworth.
Hanna Rauworth is the Health & Environmental Reporter for the Indianapolis Recorder Newspaper, where she covers topics at the intersection of public health, environmental issues, and community impact. With a commitment to storytelling that informs and empowers, she strives to highlight the challenges and solutions shaping the well-being of Indianapolis residents.
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