The dose that never moves: an expert briefing with Ian Goldstein, Soar Autism Center
Applied behavior analysis (ABA), the main therapy for autistic children with intensive needs, has become one of the fastest-growing lines in state Medicaid budgets. North Carolina’s Medicaid ABA spending is projected to reach $639 million in fiscal 2026, up from $122 million in fiscal 2022. Indiana’s grew from $21 million in 2017 to $611 million in 2023. Federal and state audits have found improper payments in Indiana and Colorado, and states are responding with rate cuts and hour limits. Nebraska capped Medicaid ABA at 30 hours a week, and Indiana adopted a 4,000-hour lifetime cap this spring.
In a guest perspective for HTN, Ian Goldstein argues that caps repeat the field’s original mistake from the other direction. A child’s weekly ABA hours are usually set at the first assessment and rolled over at each reauthorization, with little that moves them up or down. His proposal is to treat hours as a dose: agree up front on what a good response looks like, reassess high-hour starts at 90 days, let authorizations move in both directions, and pay in a way that doesn’t penalize stepping down. We’ll cover what that would ask of providers and Medicaid programs, what the National Academies’ 2025 review says about intensity, and where the current wave of state cuts is headed.
Soar Autism Center, founded in 2020, runs integrated autism clinics for young children in Colorado, Arizona and Maryland, built around the Early Start Denver Model, and has a partnership with Children’s Hospital of Philadelphia. Ian Goldstein, MD, MPH, is co-founder and CEO at Soar Autism Center, and will join HTN Live for an expert briefing with HTN’s Martin Cech.
Live event open to everyone, replay and transcript exclusively available for HTN Pros.