Relating to Hawki coverage for the treatment of autism spectrum disorder applied behavior analysis services, and the autism support program

Description

House File 509 repeals the Autism Support Program on July 1, 2027, and requires the Medical Assistance Advisory Council to adopt administrative rules to include applied behavior analysis services for the treatment of autism as benefits covered under the Healthy and Well Kids in Iowa (Hawki) program. The Bill prohibits the Department of Health and Human Services (HHS) from approving new applications for the Autism Support Program on or after July 1, 2025. The HHS will continue to provide treatment and make payments pursuant to the Program for an individual whose application is approved on or before June 30, 2025, if the individual remains eligible for the Program.

The Bill requires, upon the repeal of Iowa Code chapter 225D on July 1, 2027, any unencumbered and unobligated moneys remaining in the Autism Support Fund be transferred to the Hawki Trust Fund.

Background

The Autism Support Program, established in Iowa Code chapter 225D, provides payments to eligible individuals to receive applied behavioral analysis treatment. An eligible individual, as defined in the Iowa Code section 225D.1(8), is a child less than 14 years of age who has been diagnosed with autism, is not otherwise eligible for coverage for applied behavioral analysis treatment or applied behavioral analysis treatment under the medical assistance program or other private insurance coverage, and whose household income does not exceed 500.0% of the federal poverty level (FPL). The maximum annual benefit amount for an eligible individual is set at $36,000, with the program providing a maximum of 24 months of applied behavioral analysis treatment.

Iowa Code section 225D.2(5) establishes the Autism Support Fund to be used for the purposes of funding the Autism Support Program. Currently, the HHS transfers $188,000 from the Health Program Operations appropriation to the Autism Support Fund annually. In FY 2023, Program expenditures were approximately $260,000, and in FY 2024, the expenditures were approximately $310,000. As of March 19, 2025, the balance in the Autism Support Fund was approximately $106,000.

Assumptions

• There are currently 678 children with an autism diagnosis in the Hawki program.
• The HHS estimates that there will be an 18.0% utilization rate for applied behavioral analysis under the Hawki program.
• Actual applied behavior analysis expenditures under the Medicaid program from FY 2023 were used to estimate the annual cost per member.
• The annual cost per member is estimated to be approximately $24,000.
• The State will pay 26.01% of Hawki costs for applied behavior analysis, while the federal government will pay 73.99% for FY 2026.
• After the Autism Support Fund is repealed in FY 2028, the $188,000 allocation from the Health Program Operations appropriation in the Health and Human Services Appropriations Bill will no longer be needed.

Fiscal Impact

House File 509 is estimated to increase State Hawki expenditures by approximately $753,000 in FY 2026 and approximately $756,000 in FY 2027 to add applied behavioral analysis treatment to the Hawki program. Total Hawki provider rate reimbursement expenditures will increase by $2.9 million annually. Figure 1 shows the annual breakdown of State and federal costs. Beginning in FY 2028, there will be no more expenditures for the Autism Support Program. Any unencumbered or unobligated moneys remaining in the Autism Support Fund will be transferred to the Hawki Trust Fund.

Figure 1 — Estimated Annual Costs of HF 509

Sources

• Department of Health and Human Services
• Legislative Services Agency