Human Services committee votes 'do not pass' on bill to expand Medicaid ABA coverage

The Human Services committee voted to recommend "do not pass" on Senate Bill 2190, a proposal to add applied behavioral analysis (ABA) services to medical assistance for individuals with autism for the lifespan. The motion, to recommend do not pass, was moved by Representative Holly and seconded by Representative Anderson; the motion carried on a roll call vote with a tally reported as 6 yes, 4 no and 3 absent.

Committee members said they supported expanding access to ABA in principle but raised repeated concerns about the bill's fiscal impact and the wisdom of enacting lifetime coverage without first testing a narrower approach. Vice Chairman Freilich said he had watched testimony and was "concerned that we're adding it for the lifespan of the individuals," and proposed amending the bill to limit coverage "up to the age of 21" as a pilot and then evaluate the fiscal effect after two years.

Supporters of a narrower pilot argued a report tied to the amendment could show whether the fiscal note would fall if coverage were cut off at age 21. Representative Davis asked that the study examine both the fiscal effect for the 21-and-under cohort and the fiscal implications of lifespan coverage. Committee members discussed how the fiscal office had estimated costs: one witness during testimony reported the fiscal note used 25% of an estimated roughly 707 individuals who could qualify, a figure committee members said would need further analysis to confirm.

Testimony cited by committee members noted that North Dakota Medicaid already covers ABA therapy for children up to age 21; the bill would extend coverage beyond that age. Representative Belinski asked whether services are typically lifetime or commonly limited to 21; the committee heard that some services on waivers end at 21 while others do not, and that post-21 services often shift to county or social-services systems depending on severity.

Representative Fegley observed that long-term needs depend heavily on the severity of autism and on what local social-service capacity exists. Several members raised workforce and capacity questions that could affect program implementation, including whether provider capacity and staffing would allow a rapid expansion of services.

After limited discussion, Representative Holly moved a do-not-pass recommendation. The clerk conducted a roll-call vote and the motion carried, recorded in committee as 6 yes, 4 no, 3 absent. Committee members said a narrower approach with a required report and more precise fiscal analysis would be worth considering in future amendments or sessions.

The committee concluded by scheduling additional hearings and said members would continue working on related bills and potential amendments as information from fiscal staff and testimony becomes available.