Nebraska Medicaid Adjusts Applied Behavior Analysis (ABA) Rates to Ensure Sustainability and Align with National Standards
LINCOLN, NE – The Nebraska Department of Health and Human Services (DHHS) announced adjustments to Medicaid payment rates for Applied Behavior Analysis (ABA) services, effective August 1st. This decision, following months of dialogue with providers, aims to address escalating costs and align Nebraska’s rates with those of neighboring states while maintaining access to crucial services for families. The department emphasized that these adjustments are essential for the long-term viability of ABA services within the state’s Medicaid program.
The move comes in response to a dramatic surge in ABA service expenditures, which skyrocketed from approximately $4.6 million in 2020 to $85.6 million in 2024, representing a staggering 2,025% increase. DHHS CEO Steve Corsi underscored the agency’s commitment to ensuring uninterrupted access to ABA services for Nebraska families. “DHHS is fully committed to continuing ABA services to Nebraska families receiving Medicaid,” stated Corsi. “We will continue to operate in the best interest of children and families.” He emphasized that the rate modifications were designed to create a sustainable system for ABA service delivery without compromising the quality of care.
A comprehensive review conducted by DHHS revealed that Nebraska’s Medicaid reimbursement rates for ABA services were significantly higher, sometimes exceeding double the rates of other state Medicaid programs, making Nebraska an outlier nationally. This disparity prompted the need for adjustments to establish a more equitable and sustainable payment structure. Drew Gonshorowski, Director of the Medicaid and Long-Term Care Division, explained, “We found that Nebraska’s rates for these services have been significantly higher, some more than twice as high, as those of other state Medicaid programs. This rate change puts Nebraska more in line with ABA rates, not just in the region, but nationally.”
While acknowledging the concerns surrounding the rate adjustments, DHHS officials stressed that the new rates remain competitive. They highlighted that even after the modifications, Nebraska’s Medicaid reimbursement rates for commonly billed ABA services will remain above the national average and median. This approach seeks to strike a balance between fiscal responsibility and ensuring access to high-quality care. The department emphasized their continued commitment to working with providers to ensure a smooth transition and minimize any disruptions to services.
The Munroe-Meyer Institute (MMI), a leading developmental disability center and an academic unit of the University of Nebraska Medical Center (UNMC), expressed support for the DHHS’s decision. Dr. Karoly Mirnics, Dean and Director of MMI, stated, “We will continue working with DHHS as close partners to develop evidence-based guardrails to provide the most meaningful, most efficient ABA services for all individuals with autism.” His statement underscored the importance of collaboration between service providers and the state to optimize ABA service delivery based on scientific evidence and best practices. MMI, with its extensive history of serving vulnerable populations, including a significant portion of individuals with Autism Spectrum Disorder (ASD), will play a crucial role in this collaborative effort.
The adjusted rates, detailed in a provider bulletin released by DHHS, reflect the department’s commitment to ensuring the long-term viability of ABA services within the state’s Medicaid program. By aligning Nebraska’s rates with those of neighboring states and national trends, DHHS aims to create a more sustainable system that continues to provide essential support for children with autism and their families. The department reiterated its commitment to transparency and open communication with providers and families throughout this transition period. They encouraged stakeholders to review the provider bulletin for comprehensive information regarding the rate adjustments and emphasized their ongoing commitment to providing high-quality, accessible ABA services to Nebraska’s Medicaid recipients. Further details on the rate adjustments and supporting documentation are available through the DHHS website and associated resources. This adjustment marks a significant step toward creating a fiscally responsible and sustainable model for ABA service delivery, while upholding the quality and accessibility of care for families in Nebraska.