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Autism providers ask Senate to finalize ABA Medicaid rules, set July 1 rates and pause MCO rate cuts
Summary
Autism service providers and parents told the Senate Medicaid subcommittee that inconsistent MCO policies, delayed rules and low Medicaid reimbursement have left most Medicaid‑eligible children with autism unable to access applied behavior analysis (ABA).
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Autism service providers, board‑certified behavior analysts and parents asked the Senate Medicaid subcommittee to finalize Ohio Medicaid rules and funding that would expand access to applied behavior analysis (ABA) for children with autism.
Marla Root, founder of the Ohio Autism Insurance Coalition, told senators that "only 8 percent of kids with autism in Medicaid who are eligible are actually getting access to the most prescribed treatment for autism, which is called applied behavior analysis or ABA therapy." She said providers have not had a Medicaid reimbursement increase since 2016 and that inconsistent managed care organization (MCO) policies and varying reimbursement rates are fragmenting the provider network.
Root and accompanying providers asked the committee to adopt three budget amendments: 1) put the Department of Medicaid's new fee‑for‑service ABA reimbursement rates into effect July 1; 2) impose a two‑year moratorium preventing MCOs from reducing those rates after they take effect; and 3) allow competent behavior technicians to deliver services while completing national board certification (witnesses proposed a 120‑day timeframe for training and credentialing).
"If the Department of Medicaid needs more time, it's only fair to support these amendments so we have stabilization now," provider Jen Gondin told the committee. Several providers said the department's rulemaking timeline had slipped from April to July and then into the fall, prolonging access problems and long provider wait lists.
Board‑certified behavior analysts and parents described long waitlists and real‑world impacts: children missing early intervention during critical developmental periods, parents forced to leave jobs, and adolescents entering more intensive and costly care when preventive early services are not available.
The subcommittee received written requests for fee timing, a temporary moratorium on managed‑care reductions and workforce flexibilities to expand the pipeline of entry‑level technicians. No formal votes occurred; providers said they will submit technical language and modeling to the department and the committee.
The Department of Medicaid has signaled it is working to finalize rules but witnesses said implementation dates have slipped and urged expedited action to reduce delay and provider attrition.
