Lighthouse Autism Center was notified that Anthem/Carelon Medicaid, a Managed Care Entity (“MCE”) elected to terminate our provider agreement under a contractual “without cause” provision. This means the payer exercised a contractual right to end the agreement without alleging wrongdoing or providing a specific reason. 

No, this only impacts learners with Anthem/Carelon Medicaid. There is no change or impact on learners with commercial Anthem insurance or any other insurance. 

No impact is expected. Your primary insurance will continue to process claims as usual, and Anthem/Carelon Medicaid will process any remaining secondary responsibility according to their coordination of benefits guidelines. 

With the information we currently have, all Anthem/Carelon Medicaid learners will be eligible to receive Diagnostic and ABA services at Lighthouse until August 1, 2026.  

• Our insurance team will be working to ensure continuity of care to the extent possible with your consent and on your behalf to continue services after August 1, 2026, if allowable by Anthem/Carelon Medicaid. 

• These options will be reviewed with you at your individual meeting with your clinical team in the coming week. 

Yes. We anticipate that all children currently enrolled can maintain their current schedule and enrollment until at least August 1st.  

Our team is actively collaborating with FSSA and Anthem/Carelon to navigate this transition smoothly. Depending on the outcomes of those conversations as well as each family’s unique needs, this could result in a variety of options families can pursue to continue care at Lighthouse.  We will provide individualized guidance to each family to outline their specific next steps to protect each learner’s care.  

No. The payer has not alleged fraud, waste, abuse, compliance violations, ethical concerns, or deficiencies in quality of care. We have partnered with this payer for nearly eight years and have maintained strong standards surrounding compliance, clinical quality, and ethical care. 

While we cannot speak directly about the payer’s internal decision-making, we know the ABA industry nationally is facing increased pressure from payers and Medicaid systems, and Lighthouse is not the first provider to be impacted in this way.  

Across multiple states, including Indiana, ABA providers have experienced: 

• network closures, 

• increased authorization scrutiny, 

• reimbursement reductions, 

• and provider terminations. 

This is part of a broader shift occurring across the industry. 

Leadership is actively evaluating all available options and engaging in ongoing discussions with both Anthem/Carelon and FSSA. At this stage, our focus is on advocating for families, protecting continuity of care, and ensuring responsible next steps. With that in mind, we encourage all families to begin exploring their available options now to help avoid any disruption or uncertainty in August. 

Questions related to possible ABA transitions or day-day ABA services should go to your child’s BCBA. Questions related to insurance changes should be directed to Jordan Kujawski at jkujawski@lighthouseaba.com.

The timing of your child’s return to Lighthouse will depend on several factors, including when your new insurance coverage becomes effective, the completion of any required authorizations, and availability at your preferred center location. 

Families impacted by this transition who later return to Lighthouse with an in-network insurance plan will have their original document submittal date honored (the way by which we determine priority of waitlist). Because you already have an established relationship with Lighthouse, this will allow us to efficiently reestablish services, pending staff availability at that time. While we cannot guarantee an exact start date, our team is committed to minimizing disruptions in care and helping your child reconnect with services as quickly as possible. 

Once you have selected a new MCE and your updated insurance information is available, we encourage you to contact Lighthouse right away so we can begin coordinating next steps and provide the most accurate information regarding timing and availability for your child. 

If you have questions about Open Enrollment or would like assistance understanding your options, please contact Nicole Dohm at (219) 246-2492.