Commentary: The high cost of low accountability for autism therapy

By Addie Angelov - August 18, 2025

Students identified with Autism Spectrum Disorder or ASD are a rapidly growing exceptionality category of students who display a very individualized and complex set of needs. Many families choose to supplement the educational services offered by their school with private ABA therapy.

Applied Behavior Analysis (ABA) therapy is a commonly used technique for autism symptoms. When implemented with fidelity per research based best practices in combination with a school experience, ABA therapy can be a powerful tool for early intervention to support students navigating ASD. 

In 2024, the US Department of Health and Human Services Office of Inspector General released a blistering report of Indiana’s growing ABA clinic landscape. The report tells a cautionary tale of a field with no billing caps, no quality control, no oversight, no parent voice, and audacious fiscal improprieties. According to the report, Indiana made at least $56 million in improper fee-for-service Medicaid payments for ABA therapies from 2017-2020.

The report cited Indiana’s ABA clinics ballooning their Medicaid billing from $14.4 million to $101.8 million in just three years, the second highest in the country. The report documented examples such as an individual student receiving more than $677,000 in individual services in a three year period. Another example documented an individual student receiving more than $28,000 in services per month over multiple years. All while not preforming background checks on service providers or showing any impact on student growth. 

Autism spectrum disorder as a disability category has experienced an unprecedented level of advocacy, funding, research, and attention in the mainstream over the last 20 years. Indiana’s own Rep. Dan Burton made advocating and funding autism his own personal issue. While in office, he funneled millions to our state to better understand ASD and serve this population. As a grandfather of a child with autism, he fought tirelessly for the right of families to have high quality support.

Based on his efforts, our state has an unusually high level of expertise in this area including the Autism Center at Riley Children’s Hospital and the Indiana Institute on Disability and Community at Indiana University. Given our state’s history with ASD funding and expertise, the 2024 report is all more concerning. We are a state that should have known better than to allow this to happen to our families. 

There are multiple layers of special education accountability that schools must navigate to serve students with ASD, including the Individuals with Disabilities Education Act and Indiana’s Article 7. Currently, stand-alone ABA clinics do not have to adhere to any of the laws put in place to protect students with disabilities within educational settings.

Schools are held accountable by the individual families via federally required annual meetings, where a child’s individualized education plan and progress toward annual goals are documented and discussed. They are held accountable for the academic progress of students with exceptionalities in their publicly accessible state reporting and accountability processes via the Indiana Department of Education, which includes reporting the academic achievement data of students identified as having exceptionalities. Charter schools have an additional layer of accountability as part of their authorizing processes to ensure services are provided, students are growing, and the law is being met.

Private schools across the state offer special education support to their families in a way that matches their mission and traditions. Additionally, alternative schools, disability focused schools, recovery high schools, and adult high schools are all held accountable for the services they provide to students with exceptionalities.

Hoosier families that have children with exceptionalities deserve high quality and trustworthy options for their children. Hoosier taxpayers deserve for their tax dollars to help as many people as possible via the Medicaid system. Unfortunately, in Indiana we have not implemented an accountability process for ABA clinics, leaving the door open for predatory practices. While Medicaid, private insurances, and schools all have strict regulations and accountability processes in place to ensure quality; ABA clinics were allowed to operate with none. 

During his first few weeks in office, Gov. Braun released his executive order on ABA Therapies. His orders were clear, ABA clinics using Medicaid as a bottomless ATM must stop. The ABA Therapy commission was established to tackle this issue.

The big question now is whether the commission will start protecting Hoosier families by holding ABA clinics just as accountable to policies and regulations as every other organization serving students with ASD. 

Read this commentary on the Indiana Capital Chronicle website here.