Answer: $800 an hour
Question: What unethical ABA Therapy companies got as a HOURLY reimbursement rate PER CLIENT.
Congratulations Hoosier taxpayers. This is what we get when you combine corporate greed AND lack of Indiana Medicaid oversight. Unethical ABA Therapy providers billing up to $2,000.00 per hour and receiving 40% of what they billed.
You might want to read what I wrote about the ABA Workgroup and lack of oversight at Indiana Medicaid a few months ago. What I wrote then still applies today. https://www.myautismally.org/blog/response-to-indiana-aba-work-group-recommendations
What’s happened since? A bombshell article from the Wall Street Journal article was published earlier this month titled The Boom in Autism Therapy Is Medicaid’s Fastest-Growing Jackpot . You can access the whole article through most public libraries. Allen County Public Library card holders can access the Wall Street Journal for free at https://www.acpl.lib.in.us/digital-resources Other local libraries do the same, so check with yours if you live outside Allen County.
One can imagine just how embarrassing this is for the Braun Administration and Indiana Medicaid. I’m sure some people in this administration are having uncomfortable conversations with politicians, bureaucrats, lobbyists and business leaders all due to a national article highlighting the legal Medicaid billing practice of ABA Therapy within Indiana. Yes, I said legal. There was a loophole that Indiana Medicaid created when they removed the standardized rates and decided that they would pay 40% of the bill ABA Therapy providers submitted. Unethical providers made the decision to increase their billing rates to excessive amounts and you guessed it - their 40% take was as much as $800 an hour. One Indiana ABA Therapy company billed for 84 clients and walked away with $29,000.000.00. That’s 29 MILLION. For ONE YEAR! This is corporate greed, plain and simple. And this company wasn’t alone.
Who convinced Indiana Medicaid to remove standardized rates and adopt this 40% rule, this open billing without a cap? This didn’t magically happen. Someone lobbied for this rule change and Indiana Medicaid would have the documentation to tell us who. (Right here is where Hoosier taxpayers should be demanding accountability.)
Why did Indiana Medicaid ignore their own rules already in place regarding auditing and billing?
Who else benefited from the decision to go from a fixed fee schedule to open billing without a cap? (It wasn’t just ABA Therapy companies.)
Where was the oversight of Indiana Medicaid? (A good question to ask your elected official at their next town hall.)
Let’s be perfectly clear. Indiana Medicaid knows who billed in excess. They paid them. It was legal. They had rules already in place regarding auditing and billing, yet they ignored them and made the decision to pay these excessive claims. This isn’t news to anyone who is more deeply involved and understands billing practices in the ABA Therapy community. This fiasco was one of the reasons the ABA Workgroup was formed last year. Many of the workgroup’s recommendations addressed the concerns regarding the lack of ethics of some providers and ways to address it. There were pages of recommendations made, good ideas that would help Hoosiers in the long term. Instead, our children got cuts to their services and ABA Therapy providers got rate reductions.
You might be reading this thinking “Good! Those greedy @#$%^&* deserve less money.” But let’s think this through…
Not all ABA Therapy providers were billing in excess. In fact, the majority of companies were not. (Yet they’re being penalized as if they did.)
Those who did bill in excess, did it legally. It was a change at Indiana Medicaid and their lack of oversight that allowed the spending to continue. (This is why we had a flood of new providers enter Indiana from out of state. Nationwide in ABA circles, Indiana became known as a place to open new clinics and make big $$$.)
Those who billed in excess can outlast their competition who didn’t. (Remember they’ve got millions in the bank.)
This means ethical companies (primarily Hoosier owned) will be forced to close because they can’t afford to keep staff, operate under the lower reimbursement rates and the increase in burdensome regulations.
Which leaves us with the unethical companies to provide ABA Therapy. (Does anyone think rewarding these companies is a good idea? Do we really want these companies as the only option left for our children?)
We are already starting to see local ABA Therapy providers speak out against their peers. I highly recommend this statement from our friends at Partners In Autism titled Response to Peers Medicaid Greed. The owner, Tommy Guest is a personal friend of mine and on the board of directors of My Autism Ally. I am happy to see that there are some within the ABA Therapy community that are willing to speak frankly about what’s happening and how it is going to impact Hoosier autistics and their families in the years to come.
“If the Wall Street Journal hadn’t published this article, would we even be talking about this?”
As much as I’d like to see accountability for those who abused the system, I doubt that it can happen. I’m sure we’ll hear plenty from legislators and administration officials in the coming weeks that say otherwise. But ask yourself this. If the Wall Street Journal hadn’t published this article, would we even be talking about this? Personally, I think we wouldn’t. Not just because what these ABA Therapy providers did was legal and Indiana Medicaid paid the claims. But these things happened years ago and it has been known within Indiana Medicaid and the Braun administration for quite a while. You didn’t hear them talking about it much before now did you? We’re only hearing from them now because this article has caused our elected officials’ national embarrassment, as it should.
Finally, if you’re asking yourself who’s responsible, you’re not alone. I already stated in November 2025 and previously in this article that Indiana Medicaid willingly ignored its own rules already in place regarding auditing and billing. Indiana Medicaid is also responsible for the rule change regarding reimbursement as well. They have the documentation for all of this. I say start looking there.
Always Advocating,
Susan Crowell
Founder and Executive Director
My Autism Ally