Stepping Stones Behavioral Solutions, an organization with one of the nation’s largest shares of Medicaid reimbursements, shuttered with limited notice to staff and families.
The company’s owner and CEO, Veronica Napier, had her assistant inform managers at the Indianapolis, Indiana-based autism therapy provider around 3 p.m. on June 11 of the decision to close, effective June 12 at 4 p.m. Managers communicated the news to staff soon thereafter, and a letter was sent to families and staff at the end of the day on June 11.
Stepping Stones Behavioral Solutions was once a high-flying, fast-growing company that held itself out as among the fastest-growing in the nation. It ranked at No. 3,046 with 133% revenue growth during the three-year period ended in 2024, according to the latest Inc. 5,000 list. The company also appeared on the list in 2022, 2023 and 2024.
It was also among the best-paid organizations by any Medicaid program in the U.S. According to BHB’s analysis of Medicaid payment data compiled by the federal government, Stepping Stones Behavioral Solutions accumulated $45.5 million from 2019 to 2024. It was just behind fellow now-defunct Indiana-based operator Piece By Piece Autism. During that time, it had the second-highest average payment per claim for direct therapy at $838.56. It had the highest average per-claim payment for supervision during that time frame at $566.96.
Neither Napier nor the company has responded to requests for comment.
“You showed up every single day for children who needed you,” Napier said in the letter, addressing employees. “Through every insurance change, every policy shift, every appeal, every restructuring — you kept showing up. The system failed this company, but it never failed because of you. I am proud of every one of you. I am so sorry this is how it ends. This field asks more than it gives back, and I gave everything I had.”
The company’s downward spiral started in November, according to the letter. Indiana Medicaid froze the company’s payments as part of a fraud review that concluded without action in February 2026. Also in November, Indiana Medicaid parted ways with MDwise as a contracted managed care organization, with the move effective at the start of 2026.
“We were already doing damage control on multiple fronts simultaneously,” the letter states.
The company consolidated its seven-location footprint in Northern Indianapolis and rural communities west of the city down to four locations in February. The company employed about 70 people.
Then, in April, Stepping Stone Behavioral Solutions was told it would no longer be a part of the Anthem Medicaid network. Anthem, whose parent company Elevance Health (NYSE: ELV) is headquartered in Indianapolis, dominates Medicaid enrollment. Public data from the state shows that Anthem commands 51% of all enrollments for Hoosier Healthwise, Indiana’s CHIP program.
Actions by managed care organizations can have a profound impact on providers. UNIFI Autism Care, another Indiana-based provider, shut down, citing, in part, Anthem not allowing it in its network.
The letter also notes there were protracted delays in getting new providers contracted with health plans generally. While a perennial challenge in the industry, Napier’s letter said the situation was worsening and becoming insurmountable. Ex-employees said the challenges with credentialing were being addressed. They also contend that the company’s management found ways to adapt and adjust, something the company had been doing since 2024.
Before then, autism therapy providers were paid 40% of whatever they billed Medicaid. This loose reimbursement structure allowed providers to effectively set their own rates and allowed organizations such as Stepping Stone Behavioral Solutions to secure generous reimbursement. This in turn led to higher-than-market-rate wages for BCBAs and RBTs and investment in amenities at centers that elevated their feel.
“I wanted my clinics to [have] the private insurance vibe but still accept Medicaid and private insurance kids, too,” Napier previously told BHB. In September 2025, when she spoke with me, about 80% of the company’s patients were covered by Medicaid. And at that time the company had about 200 employees. Wages for new RBTs were cut back after Indiana Medicaid established a fee schedule for the first time for autism therapy. It went into effect on Jan. 1, 2024.
After that, there were several signs of belt tightening: budgets were reduced, supplies dwindled, pay incentives disappeared, as did toys and other tools for use in clinics. Ex-employees describe several efforts to adapt, which, to some degree, were seen as successful and keeping things going.
Napier didn’t see it that way.
“To keep the doors open through all of this, I exhausted every option available to me. I took out loans. I liquidated my personal savings. I spent countless nights trying to find a path forward,” the letter states. “It was not enough.”
She also said it was her ethical and legal duty to end Stepping Stones Behavioral Solutions when it became clear the organization could no longer ensure that it could pay employees for all hours worked. Throughout the year, the company laid off staff at its clinics as it rationalized its footprint. The letters state that employees were given a 60-day notice of the end of the company. Many employees say that it is not true.
Many ex-employees dispute this statement. In large part, ex-employees describe a shaky environment within a company rocked by substantive market developments as well as flighty management decisions. But no ex-employees reached by Behavioral Health Business said they felt that the collapse of the company was imminent.
Indiana, something of a hotbed for autism therapy companies, is home to several notable organizations that got their start in the Hoosier state. Some include Hopebridge, Bierman Autism Centers and Lighthouse Autism Center. However, the Medicaid program has become much more stringent as it reworks its oversight of autism therapy to be more prescriptive under the pressure and assistance of federal scrutiny.
The state has placed a moratorium on new autism therapy providers, specifically applied behavior analysis (ABA), from joining Medicaid. Effective June 6, the federal government cleared the state’s request to bar new enrollments for six months. It will also prevent companies that have a change in ownership from participating in the program. The state has also rolled out several other provisions, including hourly treatment caps, treatment-supervision ratios and mandated that provider organizations get accreditation from the Council for Autism Service Providers (CASP).
A 2024 review by the U.S. Department of Health and Human Services’ (HHS) Office of the Inspector General found that Indiana Medicaid made $76.7 million in potentially improper payments from Jan. 1, 2019, through Dec. 31, 2020. The review recommended the state pay back $34 million. Indiana and other states are under continued pressure to develop and implement fraud-fighting efforts in parts of health care that are considered high-risk. Autism therapy has such a designation. One specific effect includes a mid-year provider reverification campaign.
Minnesota recently completed such a reverification effort. The process, according to providers in the state, was chaotic and led to hundreds of organizations being kicked from Medicaid that felt they were wrongly denied.
Similar dynamics are playing out in other states, leading to layoffs in some cases. BHB has tracked layoffs at Centria Autism, ABA Centers of America and Ample Joy ABA. In other cases, providers are halting expansion plans, such as Autism Learning Partners did in New York.