An audit by the U.S. Office of Inspector General has identified a minimum of $56 million in improper payments by Indiana's Medicaid for Applied Behavioral Analysis (ABA) therapy for children with autism. With an additional $76.7 million categorized as "potentially improper," the findings underscore deep flaws in Indiana's oversight of its Medicaid expenditures. Between 2017 and 2020, the state's ABA therapy spending jumped from $14 million to a remarkable $102 million, making it the second highest in the nation, as reported by FOX59.
Meanwhile, facing a Medicaid budget shortfall, the state has implemented cost-cutting measures, which ironically included waitlists for waiver services and child care vouchers, as highlighted by IndyStar. The audit's revelation comes at a time when Indiana was already contending with a budget that had been vastly outstripped by Medicaid costs growing faster than overall state revenues, leading to a continued shortfall.
The improper payments were discovered to result from various lapses, including incomplete documentation and billing for non-therapy time. Moreover, some payments were made to uncredentialed providers, and services were billed without proper referrals, as stated in the audit findings. Indiana Senate Minority Leader Shelli Yoder has responded to the audit, emphasizing the impact on families depending on the services. "When Medicaid payments go unchecked, it’s the families who rely on these services that suffer the most," Yoder told FOX59, pressing for reforms and proper use of these crucial resources.
The practice of ABA therapy plays a pivotal role in the lives of children with autism, helping to improve social and communication skills. Despite this importance, the state's spending on ABA has continued to grow significantly, reaching $210.7 million in 2023 for fee-for-service Medicaid, and totaling $639 million when Medicaid managed care payments are included, according to a report by the NWITimes. The federal government is now requesting a repayment of $39.4 million from Indiana for the impropriety and urging the state to make substantial revisions to its Medicaid documentation processes.
In response to these alarming findings, Yoder is calling on the Family and Social Services Administration (FSSA) to "act swiftly" to recover the improper payments and to enforce better training and accountability to legitimize future transactions. The health and wellness of Indiana's vulnerable children, who stand in great need of care that this Medicaid funding is intended to secure, hang in the balance as officials grapple with the systemic gaps revealed by the audit.
