How Will Medicaid Cuts Impact Autism And Other Behavioral Health Services?

By Gordon HopkinsAn audit of Applied Behavioral Analysis (ABA) services provided by the Department of Health and Human Services (DHHS) is underway just as DHHS cut Medicaid reimbursement rates for those services, which includes services for autism.DHHS CEO Dr. Steve Corsi recently received a letter from State Auditor Mike Foley, indicating he would need more time to complete an audit for ABA services. In that letter, Foley wrote, “Based on our preliminary work on ABA claims, additional audit time and testing will be necessary related to the preliminary issues identified by my audit staff.” DHHS responded in a statement, “DHHS is committed to cooperating with the audit.”ABA is research-based behavior therapy for people with autism and other developmental disorders.In that statement, DHHS points out, “Over the last five years, the cost of providing ABA services in Nebraska has skyrocketed. In 2020, Medicaid paid $4.6 million for ABA services. Last year, that number exceeded $85 million, a more than 2,000 percent increase. DHHS has taken several steps over the past year to rein in the unsustainable costs.” Medicaid ExpansionWhat that statement doesn’t mention is that October 1, 2020 was the year Medicaid expansion took place, meaning the number of individuals eligible for Medicaid dramatically increased. According to Nebraska Appleseed, a nonprofit advocacy organization, more than 90,000 Nebraskans became eligible on that day.Initiative 427, which was approved by Nebraska voters in 2018, required the state government to provide Medicaid for persons under the age of 65 whose incomes are equal to or below 138 percent of the official poverty line. Reimbursement CutsBeginning Friday, August 1, DHHS adjusted the rates to providers for ABA services.“DHHS recently completed a thorough review of Nebraska Medicaid rates for ABA services and observed that Nebraska’s rates are significantly higher than all 49 other states. In fact, ABA rates in Nebraska are more than double the national average,” DHHS noted in its statement. “As a result of the review, beginning August 1, DHHS will adjust ABA payment rates to align more closely with those of neighboring states. After these adjustments, rates remain competitive with surrounding states and continue to remain above the national average.”DHHS has also adjusted medical necessity definitions “to align with other states and clarified the importance for parental engagement during sessions.”“DHHS is committed to getting the skyrocketing cost of ABA services under control to ensure services are sustainable and continue for Nebraska Medicaid recipients in need of care,” said Dr. Corsi. “I appreciate Auditor Foley’s efforts to safeguard taxpayer dollars and has DHHS’s full cooperation.” ABA Providers in Rural NebraskaThese cuts come as much of rural America, including Nebraska, is having to increase pay to bring health care providers to underserved areas. In a recent story in Autism Business News (ABN), a news media outlet that focuses on autism, “On the whole, providers have also told ABN that having such high rates helped attract BCBAs (board-certified behavior analysts) from outside of the state to relocate there. They often did so with steep retention and relocation bonuses and industry-leading salaries. They also said that the increased rates did little to spur the development of homegrown clinicians.”According to Mariel Fernandez, vice president of government affairs for the advocacy group the Council of Autism Service Providers, “There still are not enough behavior analysts in the state of Nebraska to meet the Medicaid need alone, let alone the combined need across all potential funding types.”ABN indicated the cuts include 48 percent to reimbursement for direct therapy provided by a behavior technician, “Other major payment cuts are coming for parent training (51 percent), care plan and protocol adjustments by BCBAs (37 percent) and treatment assessment development (28 percent), according to a bulletin by Drew Gonshorowski, director of the Medicaid and long-term care division of the Nebraska Department of Health and Human Services (DHHS), issued on July 1.”

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