How has legislation limited access so far?

Over the past two years, Indiana has made a series of Medicaid policy changes intended to control rising costs for ABA therapy. While cost control is important, these changes have made it (at best) unfairly difficult or (at worst) impossible for children and families to access medically necessary care.

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Here’s how that access has been reduced:

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1. Significant cuts to reimbursement rates

Indiana moved from an unregulated billing system to fixed Medicaid rates and then continued lowering those rates.

• Initial rate-setting in 2023 reduced payments by up to 45% for front-line providers and 28% for clinicians.

• Additional cuts of around 6–10% have been proposed or implemented since.

Why this causes harm:
ABA therapy is labor-intensive and relies on a trained workforce. When reimbursement drops:

• Providers struggle to pay competitive wages.

• Staff turnover increases.

• Clinics reduce/eliminate their Medicaid slots or close entirely.

The result is that fewer providers remain available, especially in rural or underserved areas. This translates to longer waitlists and lost access for families.

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2. Weekly hour caps on therapy

Recent proposals and policy changes include caps of around 30 hours per week for comprehensive ABA services.

Why this causes harm:
ABA therapy is prescribed based on medical necessity, not a one-size-fits-all limit.

• Children with higher support needs require more intensive therapy.

• Arbitrary caps override experienced clinical judgment.

This can slow progress, increase unsafe behaviors, and ultimately require more costly interventions later.

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3. Lifetime limits on ABA services

Indiana has introduced or proposed lifetime caps (such as ~4,000 total hours or multi-year limits) on ABA therapy.

Why this causes harm:
Autism is a lifelong condition, and needs do not follow a fixed timeline.

• Some children need longer-term support to build independence.

• Progress is not linear, and pauses or regressions happen.

• Not all clinics are of equal quality, and time spent at an ineffective clinic cannot be regained.

Lifetime caps risk cutting off therapy before goals are achieved, leaving individuals without the skills needed for safety, communication, and daily living.

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4. Increased (non-medically relevant) credentialing requirements

Recent policy changes have added stricter credentialing, enrollment, and compliance requirements for providers and staff.

Why this causes harm:
While quality oversight is important, these requirements often

• Increase administrative costs.

• Create barriers to hiring and retaining staff.

• Delay service delivery due to wait time for paperwork and approvals.

These requirements go beyond what is clinically necessary, pulling time and resources away from direct client care.

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Indiana’s Medicaid spending on ABA grew rapidly in recent years, prompting understandable concern and a push for reform. But instead of attacking inefficiencies and fraud with a targeted approach, the selected policy changes applied broad restrictions:

• Lower pay for providers

• Less therapy time for children

• Hard limits on care duration

• More red tape for those delivering services

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These hurt everyone.

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It's already clear: access is shrinking. Families are facing longer waitlists, reduced hours, or losing services altogether because the system has become harder to navigate and sustain.

 

Reform was needed, but the selected policy changes prioritized cost control over client need. Protecting access to ABA therapy means fixing the system without limiting medically necessary care.