Children with autism learn to accomplish some of life’s most important skills through highly effective, evidence-based therapies like applied behavior analysis. I’ve seen it throughout my career, and it never becomes less remarkable to me. Seeing the profound impact that meaningful care can have on the life of an entire family still leaves me in awe.

ABA is a common therapy that reduces harmful behaviors and increases skills in people with autism, with a proven record of helping children develop functional skills leading to increased independence.

Despite its success, access to this service is under threat for Indiana children and families affected by autism spectrum disorder, including nearly 40,000 Hoosier children who rely on Medicaid coverage for autism care. Autism diagnoses in children have increased over the last decade due to better screening techniques and diagnostic tools. Greater awareness of autism has helped children get diagnosed sooner, and importantly, more children are getting autism therapy earlier as a result, during their most critical stages of development.

Greater uptake of care has unquestionably increased Medicaid spending in Indiana for ABA. When spending goes up, policymakers look at it as a potential source of waste. In 2024, the federal government reviewed Medicaid payments to autism therapy providers in Indiana and issued a report about alleged improper payments. But more children requiring and receiving treatment does not mean ABA is rife with fraud and abuse. The false presumption jeopardizes access to medically necessary care for the children and families in Indiana who depend on it.

State coming down on autism therapy providers that potentially abused system

ABA is vital to improving the lives of many children with autism. Its effectiveness is backed by more than five decades of clinical research and supported by every prominent pediatric-focused medical society. I hear regularly from parents across the state how they rely on ABA to make a positive difference in their child’s life.

As one parent recently relayed, losing ABA services would have a significant impact on both their child’s progress and their entire family. Since starting ABA therapy, the child has made meaningful gains in areas that were once extremely challenging. ABA therapy is helping him build communication, social, behavioral, and daily living skills that are essential for his independence and safety. His providers have built trusting relationships, understand his individual needs, and have developed treatment strategies that are helping him succeed.

Because each child with autism has unique needs, treatment plans are highly tailored, including how many hours of care are provided and where therapy is delivered. For some children, that can mean 30-to-40 hours per week, while for others it could mean less. These decisions are made between parents and clinicians based on what’s best for each child, guided by generally accepted standards and medical necessity.

Policymakers are correct to call out and punish all verifiable instances of fraud, waste, and abuse. But last spring, the Indiana Family and Social Services Administration proposed policies to lower spending. This includes setting a lifetime limit on comprehensive ABA treatment hours. It also includes new requirements that are inconsistent with best practices for case supervision and technician oversight. While the efforts may be well-intended, they are poised to leave many children without medically necessary care.

Helping Indiana’s children build important skills is the singular goal that drives the work of autism care providers. That’s why we want to hold ourselves accountable to the highest standards.

We cannot let children with autism lose access to needed therapy. Medicaid is a lifeline for tens of thousands of Hoosier families. Cutting autism treatment risks leaving families already squeezed by the ongoing affordability crisis to potentially forgo medically necessary care.

Indiana policymakers have difficult decisions to make about Medicaid spending, and those decisions deserve thoughtful consideration. But we cannot allow frustration with the cost of Medicaid to come at the expense of children with autism.

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