Cuts could put help out of reach

Shaunna Thompson was running out of child care options. Her daughter Abbie was expelled from day care in 2022 because of “all over the place” behavior. Thompson found an inhome provider for the toddler, but was told Abbie was “too much” to watch every day of the week.

The experiences motivated Thompson to seek assistance for her daughter, who also was missing developmental milestones. Abbie, now 3, was diagnosed with autism spectrum disorder in October of last year.

By March, Thompson enrolled her in applied behavior analysis— a therapy based on learning and behavior focused on improving communicative, social and motor skills — at a local facility in northern Indiana for 40 hours a week. Abbie, nonverbal most of her life, has since said her first word: “Mom.”

“It brought tears to my eyes,” Thompson said.

But Thompson and other families reliant on Medicaid worry changes coming in January will limit access to the therapy as Indiana attempts to limit the cost and, along with other states, cut the size of the low-income health care program.

Indiana’s Family and Social Services Administration said the cost of Medicaid reimbursement for the behavioral therapy — commonly referred to as ABA— has ballooned in recent years because of the growing number of children seeking the services and the amount that providers have billed the state. The state plans a universal, hourly reimbursement rate for the therapy, but the planned amount is lower than what providers have previously received on average.

Advocates and centers worry this will mean accepting fewer patients or even closing, as has happened in other states such as Colorado this year.

“Companies just kept leaving and it just kind of turned into a crisis situation,” said J. J. Tomash, who leads an ABA provider in Colorado called BehaviorSpan. He blamed Medicaid reimbursement rates that have not kept up with the cost of living.

Medicaid began covering the services in 2016. But centers say the new rates are still not enough to keep them running and are far below the previous statewide average of $97 per hour.

Indiana Act for Families, which opposes the new rates, said the proposal is 10% below providers’ operating costs.

DARRON CUMMINGS — THE ASSOCIATED PRESS Natasha Virgil said her family’s ability to participate in activities outside their home markedly improved once 6-year-old Elijah Hill, above, began ABA therapy.