Louisiana ABA Operators Now Face Fingerprinting And Hours Review. Healthy Blue, with 290k Members, To Exit

BATON ROUGE, LOUISIANA – Louisiana is expanding screening of Medicaid ABA providers and reviewing treatment hours as Healthy Blue, a managed care health plan, prepares to leave the program on Dec. 31, 2026. State officials say ABA spending rose 41% over three years. Healthy Blue had more than 292,000 members as of August. Its members are scheduled to move to other plans Jan. 1, with existing ABA authorizations protected for up to 60 days.

Louisiana Medicaid covers applied behavior analysis through managed care plans, which generally require prior authorization. State guidance limits initial approvals to 180 days and permits renewals when medically necessary. Some plans waive separate authorization requirements when Medicaid is secondary insurance. As Healthy Blue clients move, providers must check new plan assignments, network status, and authorization requirements while the state expands oversight.

A 41% Rise and a Treatment-Hours Review

Louisiana Department of Health Secretary Bruce Greenstein said Medicaid spending on ABA grew 41% over three years, The Center Square reported on Sept. 14. The report did not include a dollar total or identify the comparison years. Medicaid Executive Director Seth Gold attributed the increase to more children receiving therapy and more treatment hours per child, not a higher hourly rate.

Gold told The Center Square that Louisiana began re-screening high-risk providers ahead of schedule in late spring and was extending that scrutiny to ABA providers, which the state had not previously classified as high risk. “We’re now subjecting them to higher standards like on-site visits, background checks, and fingerprinting to ensure a more rigorous review of who they are,” he said. Federal Medicaid rules require fingerprint-based background checks for providers and people with at least 5% direct or indirect ownership when subject to high-risk screening.

LDH’s June 16 oversight announcement named durable medical equipment suppliers, home health agencies, hospice providers, and personal care services providers; it did not list ABA. Instead, the department said it was using data analytics and working with the state inspector general to identify unusual billing patterns. Gold acknowledged Louisiana could have placed ABA providers under heightened review sooner.

“I think we should have certainly been on top of this sooner in terms of that review.” – Seth Gold, Medicaid Executive Director, Louisiana Department of Health.

Gold said the department was reviewing policies on authorized treatment hours, medical necessity, and whether children were making meaningful progress. He said these remarks did not announce a new weekly hours limit.

Greenstein said ABA should have measurable goals and an exit strategy. “This should not be an ongoing 40 hours a week for any kid that qualifies,” he said. “This really is a whole package of services made to put itself to zero hours at the end of the service.” He called fraud investigations into Minnesota’s autism-services program a “clarion call” for states to examine providers vulnerable to abuse. Gold described the department’s aim this way: “The goal is making sure that the kids that do need these services can get them.”

In a Sept. 16 opinion column for The Hayride, Jeff Sadow proposed fixed Medicaid payments tied to diagnosis level in place of open-ended billing.

Healthy Blue’s Exit and the Authorization Window

Healthy Blue, offered by Elevance Health and Blue Cross and Blue Shield of Louisiana, had more than 292,000 members as of August, according to LDH’s September legislative materials. By comparison, the Louisiana Illuminator, citing July state figures, ranked it second largest behind Louisiana Healthcare Connections, with about 364,000 members.

The Illuminator reported Sept. 1 that neither LDH nor the plan had explained the departure and that Blue Cross representatives had not responded to its questions. On a July 15 earnings call, Elevance CEO Gail Boudreaux said the company expected to leave additional Medicaid markets over the next 12 to 18 months where it saw no path to sustainable performance. She did not identify Louisiana. Healthy Blue will be the second plan to leave Louisiana Medicaid in 2026 after UnitedHealthcare exited March 31.

LDH says Healthy Blue members should receive letters explaining the change by Oct. 1. They can select a new plan from Oct. 15 through Nov. 16: Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Humana Healthy Horizons in Louisiana, or Louisiana Healthcare Connections. If members do not choose, they will be assigned a plan effective Jan. 1, 2027. LDH will try to keep families together and match members with plans that include their current providers.

Under LDH’s transition bulletin, receiving plans must honor Healthy Blue ABA authorizations for up to 60 days after the Jan. 1 transition or until the authorization expires, whichever comes first. The bulletin also bars prior authorization denials based solely on a provider’s out-of-network status. Providers must submit requests for continued or new services to the receiving plan before the existing authorization expires or within 60 days, whichever comes first. Thus, a 180-day approval issued this fall could extend beyond the period the receiving plan must honor it.

LDH reiterated the 60-day protection in its Sept. 17 legislative materials. Neither its Sept. 1 release nor its transition bulletin identifies how many Healthy Blue members receive ABA or promises an ABA-specific extension. LDH said it would provide further authorization guidance. At the Sept. 17 budget hearing, Greenstein said he had “great assurance” from the four remaining plans’ national leadership that none planned to leave, the Illuminator reported.

New plan assignments will appear in the state’s Medicaid Eligibility Verification System by Nov. 23 for dates of service on or after Jan. 1, 2027, LDH says. Healthy Blue will continue receiving and processing claims under the 365-day timely-filing allowance after its contract ends. The Center Square’s Sept. 14 report did not give a timetable for completing the treatment-hours review.

AT A GLANCE

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