States Are Gutting Autism Therapy Coverage and Families Are Terrified
Three-year-old Aubreigh Osborne from Alexander, North Carolina just made her first friend at school. A few months ago her family couldnt take her to Walmart because her autism made social situations overwhelming. Then she started ABA therapy and everything changed.
Last month the state cut her weekly therapy hours from 30 to 15.
Shes not alone. States across the country are slashing Medicaid funding for applied behavior analysis therapy and families are watching their kids’ progress unravel.
The Scope of These Cuts
KFF Health News reports the situation state by state:
– North Carolina: Attempted 10% payment cuts to ABA providers (recently reversed after lawsuit)
– Nebraska: Slashed payments by nearly 50% for some providers
– Colorado: New prior authorization requirements plus rate reductions (being sued)
– Indiana: Payment reductions on the table
The spending numbers explain why states are panicking. North Carolina Medicaid spent $122 million on ABA in fiscal 2022. Projected spending for fiscal 2026? $639 million. Thats a 423% increase in four years.
Nebraska saw 1,700% growth. Indiana 2,800%. These arent typos.
Why ABA Costs So Much
Applied behavior analysis is intensive. Were talking 10 to 40 hours per week of one-on-one therapy. A technician comes to your home or a center works with your kid for hours every day teaching social skills, communication, self-regulation.
Stateline notes autism diagnosis rates have climbed dramatically as awareness increased. More diagnoses means more families seeking treatment that Medicaid is legally required to cover since 2014.
The therapy works – Aubreigh’s mom Gaile says the growth “in under a year is just unreal.” But it costs $60,000 or more per year per child. Multiply that by thousands of newly diagnosed kids and you get budget-busting numbers.
The Nebraska Disaster
Cathy Martinez from Lincolns Autism Family Network spent years advocating for ABA coverage after her family went bankrupt paying out of pocket for her son. Now she watches the state slash rates she fought to establish.
Her fears materialized in September when Above and Beyond Therapy – the biggest ABA provider in Nebraska getting $28.5 million from Medicaid last year – announced theyd stop taking Medicaid patients. They reversed course after “tremendous outpouring” from families but the scare was real.
Nebraska officials say they previously had the highest reimbursement rates in the nation and new rates are still competitive. Providers say otherwise.
Fraud Concerns Driving Some Cuts
Its not purely about money. Federal audits found significant improper payments – $56 million estimated in Indiana alone for 2019-2020. Some providers billed for excessive hours including during nap time. Minnesota has 85 open investigations into autism providers.
So states have legitimate concerns about oversight. But blanket rate cuts hurt everyone including families doing everything right.
Where This Goes
North Carolina Governor Josh Stein just cancelled the cuts after families sued. But he warned Medicaid “still does not have enough money to get through the rest of the budget year.”
With nearly $1 trillion in federal Medicaid cuts potentially coming under Trump’s budget plans this problem isnt going away. Families like the Osbornes are caught between state budget crises and their kids’ medical needs.
ABA gave Aubreigh her first friend. Whats it worth to keep that going?
