Idaho has become the first state to explicitly end Medicaid funding for Applied Behavior Analysis (ABA) therapy, closing the door on an era marked by widespread fraud, billing scandals, and unchecked spending in the autism therapy sector. State lawmakers, in collaboration with the Department of Health & Welfare, have taken decisive action that is both fiscally responsible and aligned with the latest best practices in neurodiversity-affirming care. See section 323 of Idaho Admin. Code r. 16.03.26, “Behavioral Intervention and Habilitative Skill Building,” effective July 2025.
Follow the #banABA hashtag to stay in the loop of our Autistic-led activism. Additional resources are at http://www.banABA.us
Proactive Leadership: Lawmakers Protecting Public Funds
Idaho spending on ABA therapy and related codes soared to tens of millions of dollars per year, far exceeding projections. Rather than waiting for the type of federal audits or fraud investigations that have rocked other states, Idaho’s lawmakers passed Medicaid reform legislation (HB 345), mandating agency accountability and new spending controls. This legislation set the stage for the Department of Health & Welfare to submit a State Plan Amendment (SPA 23-0011), removing ABA therapy and its associated billing codes from the state plan and transitioning to habilitative Behavioral Intervention (BI) through the Children’s Habilitation Intervention Services (CHIS) model.
The Transition: From Fraud-Prone ABA to Habilitative Support
For years, Idaho—like most states—recognized ABA as a “medical necessity” benefit for autistic children under Medicaid’s EPSDT provision. ABA’s clinical model, however, was vulnerable to abuse: inflated billing, unqualified providers, “ghost” services, and vague metrics for outcome and necessity. Idaho’s new approach reclassified autism therapy away from private ABA providers to neurodiversity-informed habilitative care administered via schools and local education teams, with oversight by state agencies and direct integration with individualized education programs (IEPs).
Key aspects of the system shift in Idaho Admin. Code r. 16.03.26.323
- ABA CPT codes and medical necessity provisions removed from the state plan.
- Behavioral Intervention (BI) and habilitative skill-building are now the referenced, reimbursable modalities, far less prone to fraud and waste.
- Administrative control shifted from managed care organizations to state and school-based oversight, effectively closing the door to the old fraud-prone system.
Before/After Law Language Comparison Chart
| Feature | Before Amendment (Pre-2025) | After Amendment (Post-2025) |
| Service Modality | Intensive Behavioral Intervention, Applied Behavior Analysis (ABA), Behavioral Modification | Behavioral Intervention (BI), Habilitative Skill Building (CHIS) |
| Legal Reference | “Behavioral Modification delivered by a licensed ABA provider.” | “Behavioral Intervention is a direct intervention… addressing habilitative skill building needs.” |
| Coverage Type | Medical/remedial services, ABA as EPSDT benefit | Educational/habilitative, BI under EPSDT/CHIS |
| Provider Type | Licensed BCBAs/ABA staff, certified ABA paraprofessionals | Qualified BI staff, school district teams, interdisciplinary providers |
| Billing Codes | ABA CPT codes (e.g., 97151, 97153, 97155) | BI/habilitative codes, school-based billing, no ABA CPT |
| Medicaid State Plan Language | “ABA therapy covered when medically necessary for autism.” | “Behavioral Intervention and Habilitative Skill Building are covered for children exhibiting maladaptive behaviors.” |
| Accountability | Outside BACB credentialing, Medicaid managed care review | IEP teams, school districts, state oversight |
Fiscal Responsibility: Savings, Audit Avoidance, and Medicaid Integrity
Idaho’s reforms are projected to save the state $7–10 million annually in Medicaid spending on autism services alone—dollars that can now be redirected to other critical Medicaid beneficiaries, such as adults with disabilities, seniors, and children with complex medical conditions. So far, 7 states have been required to repay their federal match due to medicaid fraud with ABA medicaid claims. By acting before federal intervention was necessary, Idaho’s leaders:
- Kept the state in the clear from federal audits or clawbacks of the federal Medicaid match that have cost other states millions.
- Prevented the cycles of recoupment, legal battles, payment holds, and administrative chaos suffered by states slower to reform.
- Set a bold new national standard for protecting public funds, affirming that Medicaid is for essential, evidence-based, and affirming care—not for lining the pockets of the fraudulent or medically unnecessary ABA industry.
The New Model: Accountability and Inclusion
Behavioral services for autistic children in Idaho are now designed around habilitation, inclusion, and truly educational outcomes—not normalization or compliance for its own sake. This model places IEP teams and local school districts at the center of service provision, subject to robust monitoring, more transparent billing, and meaningful, child-centered progress tracking.
Idaho’s Medicaid reforms close a chapter on ABA excess and scandal and open the door to sustainable public funding, integrity, and inclusion. By proactively amending the state plan, lawmakers have not only protected Idaho’s budget and fellow Medicaid beneficiaries; they have shown the country how to lead. Idaho stands as a beacon for other states: decisive, principled, and future-forward in the fight against Medicaid fraud—while upholding the rights and needs of autistic children.
—
The #banABA initiative is founded by Dr. Henny Kupferstein, an autistic autism researcher. All activism is Autistic-led, in line with the mission of the Doogri Institute non-profit research and advocacy agenda. Please consider donating to support this cause. We proudly accept donor-advised fund (DAF) grants.