The Nebraska Legislature's Health and Human Services Committee convened on September 5, 2025, to discuss the sustainability of Applied Behavioral Analysis (ABA) services for families in the state. Chair Hardin opened the meeting, highlighting several pressing concerns regarding ABA services, particularly in relation to Medicaid reimbursement rates, compliance issues, and the lack of background checks for behavioral technicians.

Chair Hardin noted that Nebraska's Medicaid reimbursement rates for ABA services were approximately 2.6 times higher than the national average, with middlemen reportedly taking significant portions of these rates, sometimes charging as much as $144.44 per hour. This situation has led to the state being out of federal compliance until August 1, raising alarms about the safety and quality of services provided to vulnerable populations, especially autistic individuals.

Matthew Ahern, Deputy Director for the Division of Medicaid and Long-Term Care, provided further insights into the situation. He reported that Medicaid payments for ABA services in Nebraska surged from $4.6 million in 2020 to $85.6 million in 2024, marking an increase of nearly 1800%. This spike was attributed to a rise in providers entering the market, driven by relaxed telehealth requirements during the pandemic and high Medicaid rates.

Ahern expressed concerns about the quality of services, referencing investigations by the Office of Inspector General (OIG) that uncovered improper payments in other states. He indicated that Nebraska could face similar risks, potentially leading to significant financial repercussions. In response to these challenges, the department has implemented revised service definitions and adjusted payment rates to align with neighboring states, aiming to balance the need for quality care with fiscal responsibility.

The meeting concluded with Ahern assuring that ABA services would remain available for all Medicaid members and that the state would continue to support providers in delivering quality care. The committee's discussions underscored the ongoing efforts to ensure that vulnerable populations in Nebraska receive the necessary services while addressing financial and compliance challenges.