Can the ABA Payment Model Be Sustained?

In May, Alabama became the latest state to pass a law requiring insurance companies to provide some form of coverage for Applied Behavior Analysis for individuals with autism. (Indiana, where my organization, Damar Services is located, passed a similar law in 2001.)

This is a great benefit for Alabama families affected by autism. Applied Behavior Analysis, or ABA, is widely praised for its clear, positive results and the dramatic impact it can have on the lives of people with autism.

Obviously, we at Damar believe in ABA’s effectiveness: We provide ABA therapy through three clinics and use its approaches when appropriate in our campus-based services, as well. We know that Alabama has opened the door to life-changing opportunities for families affected by autism.

At the same time, we know that Alabama is opening the door to ongoing debates about the cost of services and levels of coverage, and, at the same time, heading toward a question that all states will eventually have to wrestle with: How can we offer these services in a way that is financially sustainable?

ABA has been around since the 1960s, but it increased in visibility over the last couple of decades, as more and more service providers made it a part of their therapeutic programs, and more and more families heard about the results and sought ABA providers.

As one might expect with anything involving healthcare and insurers, this increase in supply and demand has come with a corresponding increase in debates about how ABA should be paid for. Driving this debate has been the very nature of ABA: It is an intensive, one-on-one therapy that requires expertise in its delivery. As a result, it can be very expensive.

Over the years, we have seen a variety of approaches on the part of insurance companies and government agencies to limit ABA coverage their exposure to paying for ABA. Some have simply not offered coverage, some have offered coverage for a certain number of hours of therapy per week and others have limited the dollar amount they’ll pay. In many cases, we’ve seen insurers and government funders that initially covered the cost reduce their coverage over time.

While families and providers tend to demonize agencies and insurers who limit or reduce coverage, the truth is the challenge of covering ABA is very real. Those who pay for services know that opening the checkbook and offering unlimited coverage regardless of cost is simply not realistic. On the other hand, payers also can’t argue with ABA’s value, which is seen in the ability of people with autism to more fully participate in their communities and become working, tax-paying, contributing citizens.

Fortunately, this point of agreement – that ABA has value – has opened a dialogue about the pursuit of a sustainable model for paying for ABA services. Payers and providers are talking to each other rather than arguing about invoices and payment rates. Both sides recognize that the answer is not to draw funds from other areas of services, or to simply continue with the current model and demand higher payment rates.

Something will have to change. The good news is that this debate is not stopping the spread of an effective therapy that changes lives. I am committed to engaging in meaningful conversations about resolving this issue, and I challenge my peers and colleagues on both “sides” of this issue to collaborate so we can all be assured that ABA therapy is available to all who can benefit from it, not just those who can afford it.