In a recent meeting of the Nebraska Legislature's Health and Human Services Committee, significant discussions centered around the rising costs and challenges associated with Medicaid's coverage of Applied Behavior Analysis (ABA) services. The meeting highlighted the urgent need for adjustments in funding and service definitions to ensure the sustainability of these essential services for families across the state.

A key point raised was the alarming increase in annual spending on ABA services, which has surged from $4.6 million to an estimated $85.6 million over a five-year period. This dramatic rise has raised concerns about the sustainability of funding within Nebraska's limited state budget. Officials emphasized that maintaining such high payment rates could lead to adverse audit findings and jeopardize the program's future.

The meeting also addressed the broader implications of this spending trend, noting that ABA services have doubled in cost each year since 2020, outpacing the overall growth of other mental health services in the state. While total mental health service spending increased by 78% during this period, ABA services alone accounted for a staggering increase, raising questions about the drivers behind this growth.

Currently, approximately 1,500 members are receiving ABA services through Medicaid, with spending per member rising from $36,000 to nearly $56,000 in just one year. This increase has been attributed to a rise in service utilization, with the number of service units per member increasing by about 55%.

As the committee continues to evaluate these trends, the discussions underscore the critical need for a balanced approach to funding ABA services that ensures accessibility for families while maintaining fiscal responsibility. The committee's next steps will likely involve further analysis of the data presented and consideration of potential policy adjustments to address the challenges highlighted during the meeting.