Bill
HB 2428
Illinois would raise Medicaid ABA reimbursement by 3.5% starting Jan 1, 2026, to boost provider participation and maintain access to autism treatment for Medicaid children.
Status snapshot
- Bill number: HB 2428
- Sponsor: Rep. Nabeela Syed (primary)
- Statute amended: Illinois Public Aid Code, 305 ILCS 5/5-30.11 (Treatment of autism spectrum disorder)
- Effective date in bill: January 1, 2026 (rate change takes effect)
- Current procedural status (per provided record): Rule 19(a) / Re‑referred to Rules Committee; introduced Feb 4, 2025; public hearing noted April 21, 2025.
Purpose / intent
- To increase Medicaid reimbursement rates for applied behavior analysis (ABA) services used to treat autism spectrum disorder (ASD), with the stated intent of raising provider payment levels and supporting continued access to ABA services for Medicaid enrollees with ASD.
Key provisions
- Rate increase: On January 1, 2026, Medicaid reimbursement rates for applied behavior analysis services covered under 305 ILCS 5/5-30.11 are increased by 3.5% compared to the rates in effect on December 31, 2025.
- Scope: The change applies to ABA services already covered under the cited statute (treatment for children with ASD when ordered by an authorized clinician and provided by qualified ABA practitioners). The bill does not add new service types or eligibility categories — it adjusts payment levels only.
- Statutory context: The amended section governs coverage of ABA services under Illinois’ Medical Assistance Program, including prior statutory provisions about provider enrollment, service settings (home, community, office), and State Plan amendments/rules. This bill modifies reimbursement language within that existing framework.
Who is affected
- Medicaid enrollees (primarily children) receiving ABA services for ASD in Illinois — potential indirect benefit from improved provider participation/availability.
- ABA providers (behavior analysts, agencies) enrolled in Illinois Medicaid — will receive a 3.5% increase in reimbursement for covered ABA services effective Jan 1, 2026.
- Illinois Department of Healthcare and Family Services (DHFS) — responsible for implementing the rate change, updating fee schedules and claims/payment systems.
- State budget/Medicaid program — increased program expenditure obligations proportional to utilization of ABA services (no dollar estimate provided in the bill).
Potential impacts and considerations
- Access: A modest reimbursement increase may help retain or recruit providers, which can improve access to ABA services for Medicaid beneficiaries.
- Budgetary effect: The bill increases Medicaid spending, but it does not specify an appropriation or quantify total cost. The fiscal impact will depend on the number of ABA service encounters in Medicaid.
- Implementation: DHFS will need to update fee schedules and payment systems to reflect the 3.5% increase effective January 1, 2026; any operational or regulatory steps are governed by existing statute and administrative procedures.
Procedural / timeline notes (from provided record)
- Introduced: early February 2025 (filed Feb 3/4, 2025; sponsor Rep. Nabeela Syed).
- Listed status: Rule 19(a) / re‑referred to Rules Committee. A public committee hearing and testimony are recorded April 21, 2025. Further committee referrals (Ways & Means, Appropriations — Health & Human Services) are reflected in the provided action list.
If you want, I can:
- Draft a one-page fiscal estimate template for this 3.5% increase, or
- Compare this proposed increase with recent historical rate changes for ABA in Illinois.
Compiled from official sources — confirm details with the bill’s official record.
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