ABA Therapy Success Stories
Applied Behavior Analysis (ABA) therapy has transformed countless lives across Nebraska, including that of 6-year-old Liam Szydelko from Lincoln. His father, Chris Szydelko, witnessed a remarkable transformation in his youngest son who has autism through ABA therapy intervention.
Personal Transformation Through ABA
Liam’s journey began with significant challenges. The non-verbal child who avoided physical contact has now graduated from his ABA program, demonstrating the profound impact of consistent behavioral intervention. Chris Szydelko describes the dramatic change: “Within the first week, he was running with joy to me when I went to go pick him up, screaming ‘Dad’ and giving me a big hug, saying he loves me.”
ABA therapy teaches essential life skills including:
- Communication development for non-verbal children
- Emotional regulation techniques
- Social interaction skills
- Daily living activities
- Behavioral modification strategies
Advocacy and Awareness
Inspired by his son’s progress, Chris Szydelko became an autism advocate, writing books and creating emergency identification packages for first responders. His transformation from concerned parent to community leader exemplifies how ABA therapy success extends beyond individual children to impact entire families and communities.
Understanding the Medicaid Rate Cuts
Nebraska’s Department of Health and Human Services implemented significant Medicaid rate reductions for ABA therapy services in August 2024, creating widespread concern among providers and families throughout the state.
Rate Reduction Details
The dramatic Medicaid reimbursement cuts include:
- Previous rate: $36.11 per 15-minute session
- New RBT rate: $18.70 per session (48% decrease)
- New BCBA rate: $22.72 per session (37% decrease)
Drew Gonshorowski, Medicaid director, defended the changes as necessary for long-term sustainability, stating the rates remain “competitive with the rest of the country but still above national averages.”
Service Growth and Cost Concerns
The exponential growth in ABA services prompted state action:
- 2020: $4.6 million served 169 families
- 2024: $85 million served over 1,500 families
Additional regulatory changes include:
- 30-hour weekly service limits per child
- Mandatory two-hour monthly parent meetings
- New service definitions and requirements
Impact on Nebraska Families
Families across Nebraska face uncertain futures as providers struggle to maintain services under reduced reimbursement rates. The financial sustainability crisis threatens access to essential autism services for vulnerable populations.
Geographic Service Limitations
Rural areas face particular challenges, with limited provider options. Carley Starling operates the only high-frequency, high-intensity ABA program in Hastings, serving approximately 20 children. The potential closure of rural programs could leave families without accessible alternatives.
Insurance Equity Concerns
Mariel Fernandez from the Council of Autism Service Providers raises critical questions about healthcare equity: “Why should a child who has commercial insurance or a child who has TRICARE have the opportunity to learn the skills that they need… but a child on Medicaid not get that opportunity?”
Provider Perspectives and Challenges
ABA therapy providers face unprecedented operational challenges following the Medicaid rate reductions. Many are implementing cost-cutting measures while attempting to maintain service quality.
Staffing and Retention Issues
Themis Gomes, CEO of Behaven Kids, describes the human cost: “It breaks my heart to see some of our staff who we’ve taken a long time to recruit… completely leave the industry.” The provider staffing crisis includes:
- Elimination of positions to reduce costs
- Staff departures from the field entirely
- Recruitment challenges for specialized roles
- Training investments lost due to turnover
Operational Sustainability
Providers across Nebraska struggle with basic operations:
- Carley Starling in Hastings: May stop accepting Medicaid patients
- Behaven Kids: Eliminated positions and faces staff shortages
- Multiple providers: Considering leaving Nebraska entirely
Legislative Response and Hearings
The Nebraska Legislature’s Health and Human Services Committee will conduct a comprehensive study of ABA services, recognizing the complexity of the current crisis.
Hearing Details
Friday legislative hearing at 9 a.m. at the State Capitol will examine:
- Current service delivery models
- Provider sustainability concerns
- Family access issues
- Long-term policy solutions
Federal Compliance Concerns
Potential federal regulation violations add complexity to Nebraska’s rate reduction strategy. Three key federal requirements may be compromised:
Early and Periodic Screening Requirements
EPSDT mandates ensure Medicaid recipients receive timely access to necessary care without delays.
Mental Health Parity Act Compliance
Rate-setting processes for mental health services must mirror those for medical and surgical services.
Social Security Act Standards
Reimbursement rates must maintain access comparable to general population healthcare services.
Long-term Sustainability Issues
Kathleen Stengel, a board-certified behavior analyst, provides national perspective on Nebraska’s approach. Having worked across multiple states, she notes the unusual nature of abrupt rate cuts without staged implementation.
Workforce Development Challenges
Nebraska’s BCBA and RBT workforce grew significantly:
- 2020: 459 certified professionals
- 2024: 1,863 certified professionals
However, certification doesn’t guarantee active practice, and new professionals require mentorship from experienced providers to deliver quality care.
Interstate Competition
Reduced Nebraska rates may drive experienced professionals to neighboring states offering better compensation, creating a brain drain effect in autism services.
Future of ABA Services in Nebraska
The path forward requires collaborative solutions involving state officials, providers, families, and advocacy organizations. Chris Szydelko’s call to action reflects widespread sentiment: “Get in contact with me, and I’ll help you make the correct changes. But stop hurting these families.”
Potential Solutions
Sustainable approaches might include:
- Graduated rate adjustments over time
- Provider input in policy development
- Rural service sustainability programs
- Alternative billing code implementations
- Quality-based reimbursement models
Community Impact
The stakes extend beyond individual families to Nebraska’s broader community health and economic development. Carley Starling emphasizes the broader value: “What is that worth to our state, of taking care of our kids and making sure that they have what they need?”
Nebraska’s autism community awaits resolution of this critical healthcare access issue, as providers, families, and policymakers work toward sustainable solutions that preserve essential services for vulnerable populations while maintaining fiscal responsibility.
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