Indiana Governor Mike Braun has signed an executive order aimed at addressing the rising Medicaid costs for Applied Behavior Analysis (ABA) therapy, a treatment commonly used for children with autism. The order comes as a response to the growing concern over the unsustainable rate at which these costs are increasing. In 2017, the cost of ABA therapy was approximately $14.4 million, but by 2019, this figure had skyrocketed to $120 million. Projections suggest that if left unchecked, the cost could reach $645 million by 2026, which translates to over $80,000 for each of the estimated 8,000 children who use Medicaid to access this therapy.

The governor's decision to sign this executive order is largely driven by the findings of an audit conducted by the U.S. Office of the Inspector General in 2019 and 2020. The audit revealed that Indiana made at least $56.5 million in improper Medicaid payments for ABA therapy, primarily due to issues with provider credentialing and a lack of necessary evaluations, referrals, and documentation. Braun has emphasized the need to address these improper payments and instances of outright fraud, which are significantly contributing to the escalating costs. The executive order establishes a working group comprising parents, legislators, subject matter experts, physicians, and ABA therapy providers to explore solutions for containing these costs while maintaining the quality of care.

The working group is tasked with evaluating potential solutions and presenting the governor with actionable recommendations. Meanwhile, the Family and Social Services Administration (FSSA) is revising its rules for ABA therapy in an effort to control costs. Initially, proposed changes included a 30-hour per week limit on therapy with a lifetime three-year cap, but after feedback from parents, these proposals have been reworked into a tiered system. Under the revised plan, the number of hours of therapy a child can receive per week will be determined by their diagnosis level, with options for additional therapy based on a doctor's prescription for levels 2 and 3. This tiered approach aims to balance the need to manage costs with the necessity of providing effective and accessible care to children with autism.

The situation highlights the challenges faced by states in managing Medicaid costs while ensuring that beneficiaries, especially vulnerable populations like children with autism, receive the quality care they need. The response to the proposed changes and the governor's executive order demonstrates the importance of community engagement and advocacy in shaping healthcare policy. As the working group begins its work and the revised rules for ABA therapy are implemented, it will be crucial to monitor the impact on both costs and the quality of care provided to children with autism in Indiana.

In conclusion, the executive order signed by Governor Braun marks a significant step towards addressing the rising Medicaid costs for ABA therapy in Indiana. The establishment of a working group and the revision of rules for ABA therapy are part of a broader effort to ensure that children with autism receive necessary care while also managing the financial sustainability of the Medicaid program. As this issue continues to evolve, it will be important to consider the perspectives of various stakeholders, including parents, healthcare providers, and policymakers, to find a balance that prioritizes both cost containment and the well-being of children with autism.