Indiana and Georgia ABA Providers Face Rate Cuts as Scrutiny of Autism Therapy Mounts

ABA providers in Indiana and Georgia are the latest to face rate cuts as scrutiny of the widely popular autism therapy grows nationwide.

Applied behavioral analysis is considered the gold-standard of autism therapy, yet recent audits of Medicaid spending on ABA by the OIG, as well as investigations from the Wall Street Journal, have fueled critics’ claims that the specialty is a breeding ground for fraud, waste, and abuse. The Trump Administration and Health Secretary Robert F. Kennedy, Jr. have also pushed this narrative, calling for federal and state regulators to investigate state spending on ABA and tamp down on perceived excess costs.

ABA providers argue that the presence of improper payments does not equate to fraud. They note that many of the errors listed in the OIG report are related to documentation issues rather than clinical deficiencies. Compliance experts largely agree, saying for the most part ABA suffers from ambiguous and confusing documentation rather than a slew of bad actors.

Still, rising scrutiny of ABA this year has led some payers to raise the bar for coverage. Indiana’s new policies for Medicaid coverage, which went into effect April 1, include eligibility updates, heightened provider qualifications, and reimbursement cuts.

Here’s what changed:

• Phased-in rate reduction: Effective April 1, a 6% max fee rate reduction applies to all non-group ABA services. An additional 4% max fee rate reduction will apply to both individual and group services effective April 1, 2027.
• Treatment is only for 21 and under: Providers can submit reimbursement for patients over the age of 21 through the summer, however they may not receive reimbursement after October 1, 2026.
• Weekly and lifetime caps on care: The state introduced a lifetime hour cap of 4,000 hours. Patients will begin counting hours toward that cap starting on April 1, regardless of previous ABA treatment history.
• Expansion of who provides care: Previously only RBTs could bill CPT code 97513. Now, 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”) can offer ABA therapy.

The changes come two years after the OIG audited Medicaid ABA payments in the state and found evidence of at least $56 million in improper payments, and one year after Gov. Mike Braun issued an executive order creating a working group to develop a plan to cut ABA-related costs.

Meanwhile, CareSource Georgia — the main Medicaid CMO serving ABA providers in the state — announced it will only reimburse providers at 80% of the state Medicaid fee schedule beginning early next month.

The move is striking given that Georgia had actually increased its ABA rates in 2025.

The cut could destabilize the ABA community in Georgia as they face a difficult choice: accept the cut or terminate the contract. Industry veterans report absorbing a 20% reduction without significant workforce cuts is, practically speaking, not possible.

The move from CareSource is notable, because it is one of the first CMOs to unilaterally cut reimbursements. While Indiana is one of many states cutting rates or at least considering it — see Nebraska or North Carolina — there have been far fewer reports of CMOs making rate cuts independently.

UnitedHealth Care was accused of trying to reduce utilization by raising medical necessity requirements in Nevada earlier this year — but this is different. Even when providers get all the documentation right and clear every hurdle, they'll still walk away with less money.