#United States #Indianapolis #Autism Care #Medicaid Cuts #Bierman Autism

Medicaid Cuts Threaten Autism Care in Indiana

Families navigating autism care in Indiana face troubling new proposals from Medicaid, which could significantly restrict access to critical services. On January 17, 2025, it was revealed that Medicaid plans to impose three major changes regarding Applied Behavior Analysis (ABA) therapy coverage, alarming families and advocates alike.

Overview of Proposed Changes

The Medicaid changes include:
1. A 30-hour weekly limit on ABA therapy per child.
2. A three-year lifetime cap on ABA services.
3. Mandatory credentialing for all Registered Behavior Technicians (RBTs).

These changes lack input from parents, professionals, and service providers. Emily Roche, VP of Payer Contracting at Bierman Autism Centers, emphasized that such policies create hurdles for families seeking essential treatments grounded in clinical evidence. "The rushed effective date of April 1, 2025, suggests a pressing agenda that may not withstand thorough scrutiny," Roche stated.

Impact on Vulnerable Children

The implications of these proposals are severe, particularly for children with significant needs who thrive on intensive therapy. Clinical research consistently shows that over 30 hours of therapy a week over several years is critical for the most vulnerable children with autism. The new caps are poised to undermine this standard of care, effectively prioritizing cost reduction over the health and well-being of Indiana’s children.

Furthermore, the changes appear to neglect federal Mental Health Parity laws that safeguard access to adequate mental health services. Medicaid is legally obligated to provide medically necessary treatments—including adequate dosage—without arbitrary limitations. Roche pointed out the inconsistencies surrounding service authorization, which involves additional assessments that conflict with practical clinical treatment.

Notably, the new guidelines include the Behavior Assessment System for Children, Parenting Relationship Questionnaire (BASC-PRQ). This assessment cannot be applied to children under two years old, raising concerns about premature denials of service requests for very young children. In one instance, a family is already grappling with the fallout from this requirement, illustrating that these rules were devised without the necessary insights from clinical experts.

Industry and Legal Concerns

Indiana's Medicaid Director Cora Steinmetz has defended the proposed policies, referencing the MCG Medicaid Necessity Criteria. However, advocates, including Mariel Fernandez from the Council of Autism Service Providers (CASP), have voiced grave concerns about both the policy specifics and the broader context from which they arise.

The recent unfavorable Office of the Inspector General (OIG) report on ABA providers—citing potential fraud and lack of adequate oversight—poses an additional challenge. While acknowledging the need for reform, Fernandez criticized the hard caps on care and the excessive administrative burdens that could obstruct access to vital services.

“Procedural concerns also arise,” Roche noted. “There was no public comment period or public hearing conducted, potentially indicating regulatory bypassing that could have serious implications.” Roche insisted on the necessity for Medicaid to uphold state and federal procedural norms when enacting significant policy shifts.

Call to Action

In light of these developments, families, advocates, and providers such as Bierman Autism Centers are urging a halt to these proposed changes until their ramifications can be comprehensively evaluated. There is a dire need for collaboration among decision-makers, families, and service providers to shape policies that genuinely reflect the best interests of children in need of necessary care.

As Roche aptly concluded, “It is crucial to listen to those who understand the foundational role that evidence-based ABA therapy plays in our children’s lives.”

About Bierman Autism Centers

Bierman Autism Centers stands as a trusted advocate in the autism care landscape, devoted to assisting children and their families since 2006. With over 300 successful graduations, the Centers are committed to providing tailored therapy that fosters essential life skills and encourages personal growth. Learn more at Bierman Autism Centers.

About CASP

The Council of Autism Service Providers (CASP) is a nonprofit representing over 380 autism service provider organizations across the nation. They focus on promoting best practices in services tailored for individuals with autism. Discover more at CAS Providers.