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Panel hears plan to broaden Medicaid coverage for applied behavior analysis; department flags cost and workforce concerns
Summary
Senate Bill 2190 would expand Medicaid coverage for applied behavior analysis to treat behavioral problems across the lifespan; advocates said the change boosts equity while the Medicaid division warned of substantial fiscal impact and workforce and program-integrity concerns.
The Senate Human Services Committee heard testimony on Senate Bill 2190, which would broaden Medicaid coverage of applied behavior analysis (ABA) beyond children with autism to include assessment and treatment of common behavioral problems across the lifespan for individuals with a variety of psychological and medical diagnoses.
Supporters including Roxanne Romanek of Designer Genes of North Dakota and Chelsea Florie, Burleigh County human services zone director, described ABA as an evidence-based, individualized approach that can help people with Down syndrome and youth in foster care who present complex behavioral needs. Romanek said restrictive eligibility has left families without services available in other states: "Expanding coverage to include these population aligns with principles of equity and inclusion, ensures that no family is left behind simply because their loved one's diagnosis falls outside a certain criterion." Florie described cases in legal custody where ABA stabilized placements and reduced the need for residential care.
Sarah Acre, executive director of the Division of Medical Services (neutral testimony), said current Medicaid covers ABA for children under 21 with autism and that expanding the service as written would not be in the governor's budget. The department estimated total funds cost of approximately $13,967,000 using diagnoses submitted by behavioral-analysis providers and claims-data assumptions; it estimated an additional $853,613 to expand to adults with autism. Acre also warned that evidence of ABA efficacy is not established for all listed diagnoses, that provider supply and geography already limit access for children with autism, and that program integrity concerns have arisen in other states (Minnesota investigations cited). The department recommended service authorization, authorization monitoring and resources for program integrity.
Committee members discussed workforce capacity, efficacy and fraud risks and asked agency staff and stakeholders to work on targeted language and fiscal safeguards. No committee vote was taken on SB 2190 during the session.
