Key facts
- Autism therapy providers are warning that aggressive Medicaid crackdowns are hurting children with autism.
- Providers report losing staff, facing growing waitlists, and absorbing financial losses due to new regulations and reduced reimbursement.
- The Trump administration and states are increasing oversight and implementing new rules for Medicaid autism therapy services.
- Medicaid spending on autism therapy has jumped from $660 million in 2019 to $2.2 billion in 2023.
- A federal audit found hundreds of millions of dollars in potentially improper Medicaid payments for autism therapy across four states.
- Nebraska implemented new rules in July tightening therapy supervision, impacting providers and patient access.
Autism therapy providers are warning that aggressive Medicaid crackdowns, intended to curb fraud, are inadvertently restricting access to essential services for children with autism. These providers, many of whom have not been found guilty of fraud, are facing increased costs, staffing shortages, and administrative burdens due to new regulations and funding cuts.
Providers report significant impacts, including losing staff and facing growing waitlists for children needing therapy. One Nebraska provider, Heartland ABA, recently lost half its staff and has a waitlist of 40 children. A small practice in Colorado is absorbing tens of thousands of dollars in losses by continuing to treat a child whose care was suddenly denied. An autism clinic in New York has stopped accepting Medicaid patients altogether.
These issues stem from a push by the Trump administration and states to root out bad actors in Medicaid spending on autism therapy. While acknowledging the existence of fraud, providers argue that the current oversight methods are too broad and are harming legitimate businesses and the children who rely on their services. Mehmet Oz, who oversees Medicaid for the Trump administration, has prioritized combating fraud, and a federal audit identified hundreds of millions of dollars in potentially improper payments across four states.
States have implemented various changes, including tighter supervision requirements, reduced reimbursement rates, and capped therapy hours. For example, Nebraska cut Medicaid reimbursement nearly in half for a popular autism therapy, and Virginia placed a 20-hour-a-week cap on therapy for children on Medicaid. Providers argue these changes make it difficult to sustain operations and meet the rising demand for autism therapy, which has increased due to improved diagnostic criteria and expanded coverage mandates.