States Adjust Medicaid Funding for Applied Behavior Analysis Therapy\n\nApplied behavior analysis (ABA) is a therapy frequently utilized to assist individuals diagnosed with autism in enhancing social interactions and communication skills. The Council of Autism Service Providers (CASP) identifies ABA therapy as a "gold standard" treatment. Federal mandates from 2014 required states to cover autism treatments, with full ABA coverage by all states implemented by 2022. The therapy can be intensive, ranging from 30 to 40 hours of direct treatment per week, or more limited at 10 to 25 hours per week, according to CASP guidelines.\n\n## Rising Costs and State Budget Pressures\n\nIn recent years, state Medicaid programs have experienced significant increases in spending on ABA therapy. North Carolina's payments for the therapy, $122 million in fiscal year 2022, are projected to reach $639 million by fiscal year 2026, representing a 423% increase. Nebraska recorded a 1,700% rise in spending, and Indiana observed a 2,800% increase during recent years. This escalation is attributed partly to increased awareness and diagnosis of autism, leading more families to seek treatment.\n\n## Reasons for Funding Adjustments\n\nStates are implementing measures to adjust spending on ABA therapy and other growing Medicaid line items due to several factors:\n* Budget Shortfalls: States are facing their own budgetary constraints.\n* Anticipated Federal Spending Reductions: Potential federal Medicaid spending reductions are influencing state financial planning.\n* Audit Findings: Several state and federal audits have raised concerns regarding payments to ABA providers.\n * A federal audit of Indiana's Medicaid program estimated at least $56 million in improper payments during 2019 and 2020, citing instances of billing for excessive hours, including during nap times.\n * A similar audit in Wisconsin identified an estimated $18.5 million in improper payments in 2021 and 2022.\n * In Minnesota, 85 investigations into autism providers were open as of summer, following FBI raids on two providers related to Medicaid fraud investigations.\n\n## State-Specific Actions and Impacts\n\n* North Carolina: The state initially attempted a 10% reduction in payments to ABA providers. This decision led to a lawsuit filed by families of 21 children with autism. In early December, Governor Josh Stein canceled all Medicaid cuts enacted in October, citing ongoing lawsuits and the state's budget deficit in Medicaid.\n* Nebraska: The state implemented payment reductions ranging from 28% to 79% for certain ABA services. One of the largest providers, Above and Beyond Therapy, initially announced its withdrawal from Nebraska's Medicaid program but reversed the decision a week later. Nebraska officials stated that the state previously had the nation's highest Medicaid reimbursement rates for ABA and that the adjusted rates remain competitive with neighboring states.\n* Colorado: The state is requiring prior authorization and reducing reimbursement rates for ABA therapy, prompting a lawsuit from a group of providers and parents.\n* Indiana: Facing significant spending increases and federal audit findings, the state is also considering payment reductions.\n\n## Reactions and Perspectives\n\n* Families and Advocates: Efforts to reduce ABA spending have generated opposition from families who rely on the therapy. Legal challenges have been initiated in North Carolina and Colorado. Advocacy groups, such as the Autism Family Network in Nebraska, have expressed concerns that reduced funding could limit access to treatment for children who have shown progress.\n* Providers: While some providers have expressed concerns regarding sustainability, others have supported the rate adjustments. Corey Cohrs, CEO of Radical Minds in Nebraska, has advocated for clinical decision-making over blanket service hours, stating that the new rates are workable unless a provider's business model is solely based on high Medicaid rates. Nebraska has also implemented a 30-hour-per-week cap on services without additional review.\n\nThis article details a complex situation involving healthcare policy, state budgets, and the provision of essential services for individuals with autism.