FSSA backs off proposed therapy cuts through Medicaid for kids with autism

INDIANAPOLIS — A plan to limit therapy for Hoosier kids with autism on Medicaid has been reworked by the Family and Social Services Administration. 

Applied Behavior Analysis (ABA) therapy is one of the most effective treatments for children and adults with autism. Under a proposed change, that treatment would have been limited to 30 hours per week, with a lifetime three-year cap on treatment.

The updated plan, which still needs to be approved, would operate on a tiered system based on the level of Autism Spectrum Disorder (ASD) the child has been diagnosed with: 

• Level 1 – not more than 30 hours per week
• Level 2 – not more than 32 hours per week OR the number of hours prescribed by the recipient’s health care provider
• Level 3 – not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider

If someone doesn’t have an ASD diagnosis but they do have a disability for which ABA is medically necessary, they would have the same rules as ASD level 3. 

There would still be a three-year cap on ABA therapy, but it would not be retroactive. 

The Arc of Indiana has come out in support of the changes, while pushing to remove the lifetime cap on services “as it does not reflect the needs of individuals who may require continued therapy to make progress.” 

Indiana State Rep. Robb Greene (R-District 47) came out in support of the changes. 

“My son’s autism diagnosis was the reason I ran for the legislature, so this issue is missional to me. Governor Braun leaned into this early on and listened to families, stakeholders and providers,” Greene said in a statement. “I applaud him, and Secretary Roob, for not only stopping the proposed cuts, but for replacing them with a compassionate, child-first model.”

Morgan Herron, who has a daughter who receives ABA therapy through FSSA sent 13News the following statement: 

“First off I want to thank FSSA and all the State Representatives for listening to our concerns as an Autism community!! The cap of 3 years not being retroactive gives us time to help our kids transition into the next steps. It allows time for us parents/ caregivers to figure out the step next as well! I would like to ask that the lifetime cap of 3 years still be reviewed as kids with autism grow up to be adults with autism. There are so many transitions through childhood alone we have to take into account. If a child starts ABA therapy at age 3 that would transition them into kindergarten but we have middle school. Then there is puberty and hormones, then high school then adult hood. Our kids need this therapy throughout childhood to soak in all they can to be able to set them up for success as adults. ABA therapy is about setting up a child for success in all things like  life skills examples showering, brushing their teeth or even being able to complete homework. They also help work through emotional and behavioral issues that come with transitions like their parents getting divorced, moving houses and even how to work through death of a loved one. ABA helps these kiddos learn, understand and work through what we as neurotypical people unfortunately take for granted as it just comes easier for us whereas these kids work hours upon hours to master basic daily living skills.”