Proposed Indiana ABA Medicaid cuts affecting Muncie organization

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Recently elected Indiana Gov. Mike Braun has signed a slew of executive orders in his first months in office. One of them targets Medicaid and applied behavior analysis (ABA).  

Braun signed Executive Order 25-31 on Feb. 18, 2025. Order 25-31, titled “Assuring Prudent Use of Taxpayer Funds by Evaluating Appropriate Provision of ABA Services,” restricts ABA therapy in the state of Indiana as part of a Medicaid cut.  

ABA is the science of human behavior based on well-established principles such as positive reinforcement and stimulus control. That information is then used to improve social outcomes such as behavioral change and experimentation through data collection and comparison across conditions. Results can identify variables that are responsible for improvement, according to Robert Pennington, who has a PhD in applied behavior analysis and is a professor at the University of North Carolina at Charlotte. 

Patients who receive ABA therapy can be children who have just been diagnosed, to older adults. Behavioral changes can be made through ABA therapy to prepare patients for everyday life. 

“When the price our state pays for one service is soaring from $14 million to $120 million in just two years, with over $39 million of improper payments identified in an independent audit, something is clearly wrong and needs to be addressed immediately,” Indiana Gov. Mike Braun said in a press release. “We’re taking decisive action to contain these massive cost increases while maintaining quality of care for the Hoosiers that rely on these treatments.” 

The audit was able to find claims that did not match state documentation, causing improper payments.  

The order is now pending the Centers for Medicare and Medicaid Services (CMS) approval, since all state Medicaid changes must be approved by the federal government.  

The new rules of ABA therapy in Indiana will limit the number of hours and years a client can be in the program. The Family and Social Services Administration lays out how it will affect individuals with Medicaid.  

• For individuals diagnosed with Autistic Spectrum Disorders (ASD) Level 1, they will not have more than 30 hours per week of ABA services.  

• For individuals diagnosed with ASD Level 2, they will not have more than 32 hours per week or the number of hours prescribed by a health care provider.  

• For individuals diagnosed with ASD Level 3, they will not have more than 38 hours per week or the number of hours prescribed by a health care provider.  

• Individuals not diagnosed with ASD, but have a documented disability for which ABA therapy is deemed medically needed are able to have no more than 38 hours per week. These individuals can also differ in the number of hours prescribed by a health care provider.  

Levels are assessed based on the severity of the disorder. According to Autism Speaks, a non-profit that brings awareness to the autism community, Level 3 requires substantial support, whereas Level 1 requires less support. For more information, Autism Speaks breaks down how each is assessed.   

There is also a lifetime limitation on the services. An individual will not be able to receive comprehensive ABA therapy for more than 36 months, a three-year cap, but that same person can still qualify for limited hours of focused ABA therapy based on medical necessity after three years.  

“The rate of acquisition, or their ability to learn new skills, sometimes takes a little bit longer because their learning patterns are different,” Behavior Associates of Indiana Director of Early Intervention and Supervision Katie McDonald said. “It is taking some kids a lot longer than three years. Obviously, if kids could go to ABA for one year and go to school and be great, we all want that. Nobody wants to have to have that long-term continued care.”