Ohio’s Medicaid system needs reform. Taxpayers deserve accountability and providers should be held to high standards. Fraud, waste, and abuse should be identified and eliminated wherever they exist. But if Ohio is serious about reducing Medicaid spending over the long term, policymakers must be careful not to confuse costs with investments. Many of the services currently under scrutiny are not driving future expenditures, they are preventing them.

Home- and community-based services help older adults and individuals with significant disabilities remain in their homes instead of entering far more expensive institutional settings. Intensive behavioral health services for children can prevent psychiatric hospitalizations, emergency room visits, residential treatment placements, and involvement with crisis systems. These programs should absolutely be monitored and evaluated, but they should also be judged by the costs they help Ohio avoid.

The current conversation too often focuses on what Medicaid spends today without considering what Ohio will spend tomorrow if services disappear.

Autism provides a clear example. Autism diagnoses continue to increase across the globe. This is not an Ohio-specific issue or even a United States-specific issue. Researchers estimate that roughly 30% of autistic individuals may meet criteria for profound autism, meaning they will require substantial support throughout their lives.

For many children with autism, early intervention represents the greatest opportunity to increase independence, improve quality of life, and reduce the need for lifelong intensive services. Yet Ohio faces a troubling reality. Waitlists, convoluted rules, and provider shortages hinder many families from obtaining meaningful early intervention services. As autistic children become teenagers and adults, services become increasingly scarce. Families encounter limited adult behavioral health services, insufficient day programming, and a growing housing crisis for adults with significant developmental disabilities. The result is predictable. When adequate support are unavailable, costs do not disappear. They simply shift into more expensive systems of care.

Ohio Medicaid needs to consider options that will decrease costs in the future as well as ensuring current costs are spent the most effectively. That is why House Bill 453 deserves serious consideration. HB 453 does not create a new autism insurance mandate. Ohio already requires autism coverage. Instead, the bill aligns coverage decisions with nationally recognized standards of care, removes arbitrary age and visit limits that conflict with medical necessity, and strengthens reimbursement so families can access care through their commercial insurance rather than shifting costs to Medicaid.

When effective early intensive behavior intervention services are in place, there is a real savings of more than $200,000 per child through early adulthood and more than $1 million over a lifetime. This savings comes in the form of reduced support needed because people with developmental disabilities then have the life skills needed. Even if only a portion of those savings are realized, the long-term fiscal impact for Ohio could be substantial.

More importantly, the impact is not measured solely in dollars. It is measured in whether a child learns to communicate, whether a family can remain in the workforce, whether a teenager can participate in school and community life, and whether an adult can live with greater independence and dignity.

Ohio lawmakers face difficult decisions about Medicaid spending. They should absolutely pursue fraud, waste, and abuse. But they should do so with precision. A scalpel identifies ineffective services, poor outcomes, and bad actors. A sledgehammer risks dismantling programs that save money, strengthen families, and support Ohio’s most vulnerable citizens. The goal should not simply be spending less, but instead spending wisely. For children and adults with developmental disabilities, wise spending today is often what prevents far greater costs tomorrow.

Jen Gonda is the Director/Owner at Community Behavior Consulting, a small business serving children with disabilities.