NOTICE: Medicaid changes proposed for ABA therapy

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Beyond The Label is aware of the proposed Medicaid changes in Indiana and has been actively working to inform others about the potential impact. These changes are expected to directly affect not only our BTL families but also thousands of families across the state who rely on ABA therapy.

Summary:

The state initially proposed limiting Medicaid ABA coverage to 30 hours per week for up to three consecutive years, with any additional pre-approved “medically necessary” support capped at 15 hours per week.

Last week (February 14th), the FSSA reported changes to weekly limitations including the following: 

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 

However, a 3 year limitation on services is still proposed and in place for all individuals with ASD.

https://www.in.gov/fssa/applied-behavioral-analysis-therapy/

Impact on families:

This proposal would limit the amount of ABA therapy available to families, potentially preventing children from receiving the medically necessary services they require. It also presents a risk of regression in skills and poor clinical outcomes if implemented. As many families know, ASD is a lifelong condition, and restricting support could significantly hinder the development of individuals with ASD.

The proposed limits could reduce therapy effectiveness, strain providers financially, and disrupt the long-term progress of children with autism. ABA providers may need to adapt service delivery models, advocate for policy changes, and find alternative funding sources to mitigate the impact. Collectively, these impacts are not only affecting the ABA provider but are directly negatively impacting families whom rely on these services.

Individuals with autism spectrum disorder (ASD) encounter several different phases throughout their lifetime, just as any neurotypical individual does. These phases could be labeled as: early intervention (age 0-3), childhood (age 4-11), adolescence (age 12-21) and adulthood (age 22+). Going by these outlined phases, the individuals who receive ABA services will be adults for a much longer time than they will be children. Autism is a lifelong diagnosis and doesn’t end when childhood does. This is a diagnosis that these individuals will have for their lifetime, and they should be able to receive the medically necessary supports needed throughout each of these phases.

Statistically, an estimated 70,000 teens in the US with autism become adults and lose school- based services. These individuals are then dependent on insurance-covered services in order to continue to receive the necessary supports required for them to live independently or experience a high quality of life in their least restrictive setting. However, due to varying state regulations, services for these individuals may cap at a young age (often before they hit adulthood) causing a loss of access to pertinent services and supports. Therefore, parents and families of adults with ASD are forced to fend for themselves often leading to a reduced quality of life for the individuals and their related families.

A study from Roux, et al, 2015 states the following: “young adults with autism have a difficult time following high school for almost any outcome you choose-working, continuing school, living independently, socializing and participating in the community, and staying healthy and safe.” These are all areas that can be supported through the principles of ABA. However, if these individuals were diagnosed at a young age, as most are, and receive a cap on ABA services, they will not be able to access any support for these areas at a time in their life where they will need it most (adolescence through adulthood).

Therefore, placing a cap on ABA services including hours and the length of time services can be delivered will directly affect the quality of life of an individual with ASD by hindering their full potential to lead an independent lifestyle, reducing their chances of being an active and participating member of their society, and jeopardizing their safety and overall wellbeing.

Call to action:

FSSA, Office of Medicaid Policy and Planning

Attention: Madison May-Gruthusen

402 West Washington Street, Room W382 

P.O. Box 7083, Indianapolis, IN

    • COMMENT RE: ABA THERAPY COVERAGE

My name is (your first and last name) and I am a (family member /service provider/advocate/community member) who resides in (city).

I have recently heard there is a proposition to decrease Medicaid funding for ABA therapy services. It has been made public that the proposed limitations are restricting services to 30-38 hours a week with a longevity of services not exceeding 3 years.

I strongly oppose any decision that would change or limit the hours approved for ABA therapy, whether that would be a reduction to only 30 hours a week or decreasing the longevity provided.

 (State why you support or oppose the recommended cuts here. Choose up to three of the strongest points that support your position and state them clearly. Examples include: financial burdens placed on your family, a decrease in support provided for your child or loved one, impacts on local ABA providers, regression of skills for those receiving ABA therapy, etc. 

(Include a personal story. Tell  why the issue is important to you and how it affects you, your family member and your community.)

I appreciate your help and ask that you please reconsider the decrease in funding and coverage limits being placed. I ask that you carefully consider the repercussions that will be a result of this decision as well as listen to the families and advocates who strongly recommend and benefit from ABA therapy.

Sincerely,

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