Indiana FSSA Overhauls Medicaid Autism Therapy
INDIANAPOLIS – The Indiana Family and Social Services Administration (FSSA) today announced a comprehensive plan to reform the state’s Medicaid-funded Applied Behavior Analysis (ABA) therapy program. The recommendations, issued by the newly convened ABA Working Group, aim to address the program’s explosive growth and ensure its long-term quality and financial sustainability while protecting access for Hoosier families.
FSSA Secretary Mitch Roob stated the plan is a commitment to “thoughtful reform over arbitrary cuts,” ensuring ABA therapy remains available for children and families who rely on this vital service.
ABA therapy is an evidence-based treatment for children with Autism Spectrum Disorder (ASD), providing life-changing support for developing essential skills and increasing independence. However, since Medicaid coverage began in 2015, the program’s cost has skyrocketed—from approximately $17 million in 2017 to $611 million by 2023—an almost 3,000% increase in six years. Without intervention, costs were projected to reach $825 million by 2029.
Deputy Secretary Eric Miller acknowledged the severity of the issue: “When Medicaid coverage for ABA therapy began in Indiana, the program was small and costs were manageable. But with little oversight, spending skyrocketed to unsustainable levels.”
A prior administration’s proposal to retroactively cap therapy at three years, which would have removed half of the children from services by April 2025, was rejected by Governor Braun. Upon taking office, the Governor directed FSSA to form the ABA Working Group to develop cost-containment strategies that minimize negative impacts on families.
From May through September 2025, the Working Group—comprising state leaders, clinicians, educators, parents, providers, and advocates—held four public listening sessions, received over 170 written submissions, and reviewed data to develop the new strategy.
Their key findings included unsustainable financial growth, quality concerns (including a federal audit that found $56.5 million in improper payments), lack of program oversight, and the concentration of services in urban areas, leaving rural counties underserved.
The Working Group issued five interdependent recommendations:
- Align ABA Utilization with Clinical Evidence
Implement a flexible service allocation of up to 4,000 hours of comprehensive ABA per child, followed by targeted therapy.
Require caregiver involvement to reinforce strategies in daily life.
Explicitly tie the benefit to EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) standards. - Ensure High-Quality Care and Optimal Outcome
Establish mandatory BCBA-to-RBT supervision ratios (Board Certified Behavior Analyst to Registered Behavior Technician).
Require accreditation of all ABA therapy centers.
Implement a temporary moratorium on new sites, coupled with incentives for providers to expand into underserved areas. - Establish Sustainable Rates
Adjust reimbursement rates for individual therapy as necessary to align with the agency’s appropriated budget.
Introduce rate modifiers to encourage group therapy where clinically appropriate.
Explore future quality incentive payments tied to measurable outcomes. - Strengthen Program Management and Oversight
Create a dedicated ABA program office within FSSA for centralized management.
Improve and enforce enhanced auditing, documentation, and compliance monitoring.
Strengthen transition planning for children moving from ABA services to school or other settings.
5. Support a Sustainable Ecosystem for ABA
- Work to ensure commercial insurers reimburse ABA therapy above Medicaid rates.
- Enhance collaboration with schools to support smoother transitions and coordinated care.
- Improve the state’s third-party liability (TPL) tracking to appropriately bill commercial insurers for costs.
FSSA is now moving the recommendations into the implementation phase, working closely with all stakeholders—providers, families, schools, and insurers—to ensure a smooth transition.
“We are protecting children and preserving access to ABA therapy for the children and families who depend on it,” Secretary Roob concluded.
