Unveiling of the new Vanderburgh County Therapeutic Work Release Litter Patrol van on Thursday, November 13, 2025 at 2 PM.

The Litter Patrol is the centerpiece of the Vanderburgh County Clean Streets Initiative. The program uses work release participants and defendants ordered to complete community service hours to staff the Litter Patrol under the supervision of an officer from Work Release.

This initiative was made possible thanks to generous support from the Vanderburgh County Solid Waste District and the Vanderburgh County Council.

Additional support that helped make this initiative possible came from Republic Services, the Vanderburgh County Commissioners, and the Evansville City Council and Mayor’s Office.

INDIANAPOLIS – Indiana Family and Social Services Administration (FSSA) Secretary Mitch Roob today announced the recommendations of the Applied Behavior Analysis (ABA) Working Group, convened earlier this year to address the rapid growth and sustainability challenges of Medicaid-funded ABA therapy.

ABA therapy is a widely used, evidence-based treatment for children with autism spectrum disorder (ASD). For many Hoosier families, it has been life-changing—helping children develop essential skills, reduce barriers, and increase independence. But while the therapy’s value is clear, the way Indiana’s Medicaid program has managed it since coverage began in 2015 has created serious challenges.

“When Medicaid coverage for ABA therapy began in Indiana, the program was small and costs were manageable,” said Deputy Secretary Eric Miller. “But with little oversight, spending skyrocketed to unsustainable levels. These recommendations protect access, improve quality, and ensure the program is sustainable for the long term.”

Background: How We Got Here

• 2015–2017: Indiana began covering ABA therapy under Medicaid. With costs around $17 million annually, the lack of oversight was not seen as urgent. Providers were reimbursed based on a percentage of their reported costs.
• 2017–2023: As autism diagnoses increased and ABA therapy expanded, costs ballooned to $611 million by 2023—an almost 3,000% increase in six years. Managed Care Entities raised alarms, but the program had already grown to an unmanageable size.
• Prior Administration: In response, standardized rates were introduced in January 2024, but costs continued to rise as utilization increased. A State Plan Amendment (SPA) was then proposed to cap ABA therapy at three years, which would have removed half of children from services by April 2025, because the 3-year therapy limitation on services was to be applied retroactively. Schools were expected to absorb these children but had not been consulted and were unprepared.
• Governor Braun’s Approach: Upon taking office, Governor Braun rejected this approach, stating Indiana would not retroactively apply ABA therapy limitations to allow for appropriate transitions for children and their families. Instead, through Executive Order, he directed FSSA, in collaboration with the Department of Education, to form the ABA Working Group to evaluate and develop cost containment strategies that minimize the negative impact felt by ABA enrollees and their families.

The Working Group’s Process
The ABA Working Group, led by FSSA Deputy Secretary Eric Miller and Indiana 211 Director Tara Morse. The group included Shelbyville Representative Robb Greene and other state leaders, clinicians, educators, parents, providers, and advocacy organizations. From May through September 2025, the group:

• Held four public listening sessions across the state and one statewide virtual session, hearing from nearly 60 Hoosiers.
• Received over 170 written submissions from families, providers, and advocates.
• Reviewed statewide utilization and cost data, national benchmarks, and best practices from other states.
• Conducted a comprehensive review of quality, eligibility, utilization, reimbursement, provider oversight, and transitions.

Key Findings

• Unsustainable growth: Without reform, Medicaid spending on ABA therapy was projected to reach $825 million by 2029.
• Quality concerns: A federal audit found $56.5 million in improper payments and systemic documentation failures
• Provider distribution: Services are concentrated in urban areas, leaving rural counties underserved.
• Lack of oversight: No dedicated program office, weak supervision standards, and no accreditation requirements.

Recommendations
The Working Group issued five interdependent recommendations to protect access, improve quality, and ensure sustainability:

1. Align ABA utilization with clinical evidence
   • Implement flexible service allocations (up to 4,000 hours of comprehensive ABA per child, followed by targeted ABA therapy).
   • Require caregiver involvement to reinforce ABA strategies across daily routines.
   • Tie the benefit explicitly to EPSDT (federal Medicaid standard for children).
2. Ensure high-quality care and optimal outcomes
   • Establish BCBA-to-RBT supervision ratios.
   • Require accreditation of ABA therapy centers.
   • Implement a temporary moratorium on new sites, while incentivizing providers to expand in underserved areas.
3. Establish sustainable rates
   • Adjust reimbursement rates for individual ABA therapy as deemed necessary to stay within the agency’s appropriated budget.
   • Create rate modifiers to encourage group therapy where clinically appropriate.
   • Explore future quality incentive payments to reward measurable outcomes.
4. Strengthen program management and oversight
   • Create a dedicated ABA program office within FSSA.
   • Improve transition planning.
   • Enforce accountability for providers by enhancing auditing, documentation, and compliance monitoring.
5. Support a sustainable ecosystem for ABA
   • Ensure commercial insurers reimburse ABA therapy above Medicaid rates.
   • Strengthen collaboration with schools to support smoother transitions and coordinated care.
   • Enhance state’s third-party liability (TPL) tracking methods to bill additional costs of ABA therapy to commercial insurers

Next Steps
The recommendations will move into the implementation phase, with FSSA working closely with providers, families, schools, and insurers to ensure a smooth transition.

“This is Indiana choosing thoughtful reform over arbitrary cuts,” said Secretary Mitch Roob. “We are protecting children and preserving access to ABA therapy for the children and families who depend on it.”

By Tom Davies, Idiana Capital Chronicle

Leaders of the General Assembly’s Government Reform Task Force are planning to sponsor a bill in the upcoming session with the goal of eliminating or consolidating an undetermined number of those entities.

“We don’t have transparency or visibility on how some of these boards and commissions are spending taxpayer dollars,” Senate Majority Floor Leader Chris Garten, R-Charlestown, said during last week’s task force meeting. “This is unacceptable.”

Task force members last week endorsed broad guidelines for deciding whether to take action regarding a specific board — including its direct cost, whether it has a clear purpose and the frequency and substance of board meetings.

Garten, the task force’s chair, said the General Assembly has added an average of three boards and commissions a year over the past 50 years.

Such boards have a wide range of authority and activity.

The Indiana Utility Regulatory Commission, for instance, meets dozens of times a year as it oversees electric, natural gas and water utilities around the state.

But the Advisory Council to the Office of the Utility Consumer Counselor has not met in the past three years and hasn’t had members appointed by any governor “for some time,” according to a Legislative Services Agency report on board and commission activity.

A top adviser to Gov. Mike Braun told the task force in August that “we have too many” boards,” at least 224 of which include a gubernatorial appointment.

Rep. Steve Bartels, R-Eckerty, introduced a bill during the 2025 session to eliminate or downsize a couple dozen boards, but no action was taken on his proposal.

What’s next

Bartels, vice chair of the task force, is planning to sponsor a bill in the upcoming session for another attempt at shrinking the number of state boards.

Garten and Bartels haven’t publicly named any specific ones they will target for elimination. The task force recommendations also did not propose such a list — and just what entities are in the crosshairs could stir up defenders of some boards.

That was foreshadowed by Jason Shelley, executive director for Indiana Chapter of the American Institute of Architects, raising concerns last week over the suggestion of eliminating the Fire Prevention and Building Safety Commission.

Shelley said he was concerned about building code decisions and changes being made by state agency staffers or lawmakers without the involvement of the commission, whose members include architects, professional engineers and others with construction experience.

“We worry about adding more expensive, bureaucratic hoops to jump through, with the potential of a decision being made regarding building life safety by someone who may, or may not, have the adequate experience to really make that call,” Shelley said.

Bartels, meanwhile, indicated frustration with several boards that haven’t responded to task force requests for information about their activities. That might put those boards on his list for possible elimination.

“From here, I think the right thing to do is just repeal it if they can’t justify their actions or their existence,” Bartels said.