UNIFI Autism Care is shutting down its operations after three years of being frozen out of Medicaid networks in its home state of Indiana, according to its leaders.
The Carmel, Indiana-based autism therapy provider will shutter in mid-March. It is presently seeking new providers for its patient base. The company, founded in 2023, sought to be the go-to partner for pediatricians and act as the coordinator of care for children with autism. Dr. Breanne Hartley, a co-founder and the company’s president and chief clinical officer, previously told BHB in a podcast interview that traditional ABA models failed to account for the existing “care resource teams” parents often have in place by the time they get applied behavior analysis (ABA) for their child.
The company also sought to increase access to children covered by Medicaid in underserved communities. It opened two of its three centers in areas with a large Medicaid population — in Evansville and Mishawaka. Its third location was in north-central Indianapolis. UNIFI Autism Care acquired its buildings in Indianapolis and Mishawaka. Those are now listed for sale.
The company’s other co-founders included Dr. Steven Merahn, Dorron Farris and Erica Outlaw.
“Not only despite my efforts, but also despite Dr. Merahn’s efforts as well, to connect with Medicaid and communicate truly the uniqueness of what we’re providing, it was choking us out, to use your phrase,” Hartley told BHB. “We just found it very difficult to ensure that they truly understood what we were trying to do to elevate the services that children were receiving. It just wasn’t heard. It really wasn’t allowed for us to have a platform to further communicate and illustrate.”
In Indiana, Medicaid and CHIP cover about 750,000 children, according to federal data.
Data from the state government show that Anthem, a part of Elevance Health (NYSE: ELV) — headquartered in Indianapolis — holds the largest share of lives covered by managed care organizations (MCOs) in Indiana Medicaid. Anthem covers 43% of all total Medicaid enrollees and 50% of all Hoosier Healthwise members, the part of Indiana Medicaid that encompasses CHIP. Managed Health Services, part of Centene Corp. (NYSE: CNC), and CareSource cover 31% and 19% of Hoosier Healthwise members, respectively.
The feedback from physical health care providers was much different, according to Hartley. UNIFI Autism Care established partnerships with some of the state’s most significant health systems, including Indiana University Health, Beacon Health System and Deaconess Health System.
“There was really no arm-twisting, no need to further try to convey what it is that we were attempting to do,” Hartley said of working with other health care providers. “But then a very large portion of those physicians’ patients are (covered by) Medicaid. That was a big barrier — to be able to get as much excitement as we did from these various health care systems, but then to need to turn around and say, ‘We can’t actually move forward with this very large portion of the patients that you’re referring to us.’ So it continued to circle back around to that particular issue.”
Hartley and another UNIFI Autism Care executive BHB spoke to said that the Medicaid and commercial health plans claimed they had an adequate number of providers in their respective networks, despite fielding hundreds of referrals for care from members of those plans. They also pointed to aggressive cost containment efforts by the state, which most recently include proposals from a state working group, as a partial cause for the cold welcome.
UNIFI Autism Care was backed by the Mitchell Family Office, a firm founded by Mark Mitchell.