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INDIANA: Medicaid cuts to ABA possible; "unsustainable" cost

Aug 11, 2023, Fox 59, Indianapolis: Proposal could cut Indiana Medicaid reimbursement rates for autism therapy for kids https://fox59.com/news/politics/proposal-could-cut-indiana-medicaid-reimbursement-rates-for-autism-therapy-for-kids/

Nearly 60 parents and advocates signed a joint letter to Gov. Holcomb asking to stop proposed cuts for autism therapy this week.

Last year, Indiana Medicaid programs provided 6,200 kids with what’s known as “Applied Behavior Analysis Therapy,” or “ABA” for short.

Tuesday, the Family and Social Services Administration (FSSA) alerted ABA providers across the state it would propose a standard reimbursement rate for care administered by an RBT of $55 per hour. However, several providers say the average market rate is closer to $100 per hour, which means the proposal could cut funding by almost half across the board.

Our entire clinic is Medicaid families who depend on these services,” said Courtney Hodge, the owner of Shine Pediatric Therapy.

Hodge said since the clinic opened in October 2022, 38 of 40 families served have used Medicaid vouchers. Hodge said she fears proposed cuts to Medicaid reimbursement rates could mean decreased staffing, training and personalized care for kids.

”It’s not like taking a ten percent reduction in rate, it’s taking almost a 50 percent reduction in rate,” Hodge said….

This week, the advocacy group Indiana ACT for Families released a letter signed by 55 concerned parents and advocates addressed to Gov. Holcomb.

Part of the letter said, “…We worry that our ABA centers will be forced to close, and our children will lose access to the care they need…”

Miller said her nonverbal eight-year-old son has received ABA for five years—something she said private insurance generally does not cover.

”They just deny it every time, and so he has to have that Medicaid coverage,” Miller said. However, the FSSA [IN Family and Social Services Administration] argues that the current reimbursement rate is unsustainable. The agency said Medicaid programs spent $420M on ABA alone in 2022, and that over the last three years, ABA expenses increased by more than 50 percent each year.

”I get what they’re coming from with that—I think that right now, ABA’s kind of the wild west,” Hodge said. “We are definitely in support of a standardized fee schedule, but I think also looking at how many years kids receive services does a play a role in that inflated value.”

The FSSA says it will present its findings to the State Budget Committee later this fall. If the proposal is approved, the FSSA anticipates those changes will most likely go into effect sometime in December.


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