LWV Looks Into 36-Month Cap on ABA Therapy

Nothing has been spared in the recent budget overhauls at the state level, including funding for individuals receiving Applied Behavior Analysis (ABA) therapy, the most common and data-supported intervention for children on the autism spectrum. But recent billing discrepancies and lack of regulation flagged by state and federal regulators, coupled with climbing Medicaid payouts, prompted scrutiny that could limit the amount of therapeutic services available to kids with Autism Spectrum Disorders. As proposed, Applied Behavior Analysis services would be capped at 36 months over a lifetime.

As the 2025 Legislative Session kicked off, Indiana Capital Chronicle reported that state regulators say a jump in demand and cost of services, which hit $639 million in 2023, was “unsustainable.” The cost had been $120 million in 2019, then climbed to $276 million in 2021 and $439 million in 2022. Federal oversight agencies flagged the payouts and audited providers, noting $133 million in improper or potentially improper claims. The Chronicle reported on one provider who resolved fraudulent billing accusations by paying back $2 million.

Representative Becky Cash (R-Zionsville), whose child receives ABA services, proposed HB 1414 to force a study and prohibit limits to Medicaid funding until the study reported to the General Assembly. Her bill didn’t pass, and Governor Braun’s office, in response to advocacy, responded in writing this week, saying:

“Changes to ABA therapy coverage are proceeding through administrative action by the Family and Social Services Administration … These changes include the implementation of a 36-month lifetime cap on comprehensive ABA services.” Capping services began on April 1 and was not retroactive, but will apply going forward, so families will have full coverage through April 1, 2028, but after those 36 months have expired “coverage for high-intensity, comprehensive ABA services will be limited after that time.” His office noted that “families may still qualify for focused ABA therapy if it is determined to be medically necessary. Focused ABA is a lower-intensity, targeted form of treatment, often addressing specific behaviors or skills rather than broad developmental goals.”

To understand the situation, the League of Women Voters spoke with Ophelia Weir, director of operations at Indiana Full Spectrum Therapy, which operates in Waynetown and Attica. Weir, who is also a board-certified behavior analyst and has worked at two different companies, acknowledges that there are valid reasons for the state and federal audits.

“One of the things that was found with those audits was that Medicaid essentially allowed,” said Weir. While Indiana Full Spectrum set its rates to align with insurance rates, which tend to be more uniform, other companies didn’t.

One state audit found that 97 percent of sampled claims contained at least one improper payment due to inadequate oversight, including services provided by uncredentialed staff, undocumented sessions, and therapy during children’s naps. This led to new funding restrictions that will reshape autism support across the state.

Full Spectrum provides one-on-one therapy, rather than group sessions. Weir explained how those services work. Registered Behavior Technicians (RBTs), supervised by a BCBA such as Weir, provide direct one-on-one therapy focusing on skill-building, communication (including use of communication devices such as tablets), social interaction, and behavior management through rapport-based interventions. RBTs are clinically supervised by BCBAs who conduct each client’s assessment and write an individualized treatment plan with goals. BCBAs also provide parent training. Services are delivered flexibly in clinics, homes, or schools (district-dependent), with one-on-one therapy as the primary model. Group therapy exists but is less common due to billing complexities, Weir noted.

The surge in demand, Weir said, is due to diagnostic expansion: Earlier autism assessments and increased parental awareness have led to more children qualifying for services and the breadth of services that comes with a growing recognition of co-occurring conditions (e.g., OCD) requiring behavioral support beyond core autism symptoms.

While auditing misuse is necessary, Weir said the reforms risk overlooking clinician input and clinical realities, including inflexible hour allocations–tiered hours may not match individual needs, as BCBAs emphasize personalized hour recommendations over standardized tiers. Policies were crafted without input from ABA specialists, leading to mismatched solutions like the three-year cap.

“The three-year cap will be a major barrier. What if a child exhausts their coverage early, then develops new behavioral needs at school later? We’re not set up for that reality,” said Weir.

Under the proposed policy, after exhausting the 36 months of treatment, families may only access limited “focused ABA” for specific behavior and will lose out on comprehensive developmental support.

Weir said this could exacerbate early intervention gaps. It’s critical to receive a diagnosis as early as possible, especially in the crucial 0-5 years when a child’s brain is forming synaptic connections in language, problem-solving, emotional regulation and other skills. While 1–2 years of ABA may suffice for some young children, others with complex needs risk losing critical support during formative developmental windows. Depending on where a person is on the autism spectrum, they may face other challenges throughout adolescence and adulthood. Behavioral needs often evolve with age (e.g., school-related aggression or OCD management). Those who used childhood coverage may lack access later despite emerging needs.

Furthermore, this increases family economic strain. Many parents rely on ABA for childcare to maintain employment. Reduced hours or coverage loss could force career reductions or financial instability. Furthermore, Indiana’s Medicaid waiver, which allows paid family caregiving, has a multi-year waitlist, leaving few alternatives when ABA coverage ends.

Indiana’s Medicaid restructuring aims to curb fraud but imposes rigid constraints on a therapy supporting over 7,300 individuals statewide — The governor’s office anticipates 8,000 children will receive services in 2026. The tiered-hour system and lifetime cap prioritize fiscal control over clinical flexibility, potentially leaving families without sustainable long-term solutions. As the 2025 implementation approaches, balancing oversight with adaptable support remains critical—especially for those whose needs extend beyond arbitrary time limits.

The League of Women Voters is a nonpartisan, multi-issue political organization which encourages informed and active participation in government. For information about the League, visit the website www.lwvmontcoin.org; or, visit the League of Women Voters of Montgomery County, Indiana Facebook page.