Indiana Medicaid implemented significant updates for applied behavior analysis (“ABA”) therapy—one of the most widely used interventions for children with autism spectrum disorder—effective April 1, 2026. The reforms include phased cuts to reimbursement for ABA therapy, updates to member eligibility and revisions to provider qualifications.
The Indiana Health Coverage Programs (“IHCP”) began covering ABA therapy in 2016. Indiana’s expenditures on ABA therapy skyrocketed since coverage began and culminated in increased scrutiny following a Wall Street Journal investigation. Governor Mike Braun established Indiana’s Working Group on Applied Behavior Analysis Therapy to develop recommendations to contain program costs.
The following changes are being implemented:
- Fee Changes: To promote long-term sustainability, the IHCP implemented a phased reduction in maximum fee rates. Effective April 1, 2026, a 6% max fee rate reduction applies to all non-group ABA therapy services. An additional 4% max fee rate reduction will apply to all ABA therapy procedure codes, including both individual and group services, effective April 1, 2027.
- Age Limits: Effective April 1, 2026, ICHP will cover ABA therapy only through Early and Periodic Screening, Diagnostic, and Treatment services, which, under federal law, are available only to Medicaid-eligible individuals under the age of 21. ABA therapy providers may receive reimbursement for eligible members over the age of 21 until October 1, 2026, at which point the IHCP will no longer authorize or reimburse ABA therapy services for members over age 21.
- Cap on Hours: The changes also included weekly caps on ABA therapy hours that the state will reimburse per week, depending on the member’s diagnosis. Additionally, a lifetime hour cap of 4,000 hours of ABA therapy took effect on April 1. Members who exhaust the lifetime allotment may still receive an additional 15 hours of ABA therapy weekly if deemed medically necessary. The 4,000-hour lifetime cap will be calculated for all individuals receiving ABA therapy starting on April 1, 2026, regardless of how many hours of ABA therapy the individual has already received.
- Practitioners Eligible to Provide ABA therapy: Prior to April 1, 2026, only registered behavior technicians (“RBTs”) could render ABA therapies for billing under CPT code 97513. Now, the state expanded the list of practitioners to also include bachelor-level board certified assistant behavior analysts (“BCaBAs”), doctoral-level board certified behavior analysts (“BCBA-Ds”), master’s-level board certified behavior analysts (“BCBAs”) and health service providers in psychology (“HSPPs”).
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- Liz Elias at (317) 977-1468 or eelias@hallrender.com;
- Lauren Hulls at (317) 977-1467 or lhulls@hallrender.com; or
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