Controversy Sparks Medicaid Cuts to ABA Therapy in US States

By John Pranay (Editor)

A major controversy has erupted in the United States as several states, including North Carolina, Nebraska, Colorado, and Indiana, begin to scale back their Medicaid spending on applied behavior analysis (ABA) therapy for children with autism. The therapy, considered the "gold standard" in autism care, has seen a significant surge in demand due to increased awareness and diagnosis of the condition. As a result, states are facing mounting pressure to rein in costs, with some attempting to cut payments to ABA providers by as much as 50%. The move has left families like Gaile Osborne's, who have seen their child's progress halted due to reduced therapy hours, scrambling to find alternative solutions.

In Alexander, North Carolina, Gaile Osborne's 3-year-old daughter, Aubreigh, had made significant strides in her ABA therapy, learning to control outbursts, eat consistently, and even make friends at school. However, in October, Aubreigh's weekly therapy hours were abruptly halved from 30 to 15, a direct result of the state's effort to cut Medicaid spending. This is not an isolated incident; other families across the country are facing similar challenges as state officials make deep cuts to Medicaid. The Council of Autism Service Providers estimates that the treatment can range from 10 to 40 hours of services a week, with comprehensive therapy often requiring 30-40 hours of direct treatment per week.

The use of ABA therapy for autism has a relatively recent history, with the federal government ordering states to cover autism treatments in 2014. However, it wasn't until 2022 that all states were required to cover ABA therapy, which is considered the "gold standard" in autism care. The therapy has seen a significant surge in demand in recent years, with payments for ABA providers in North Carolina projected to hit $639 million in fiscal 2026, a 423% increase from fiscal year 2022. This growth has put pressure on state budgets, with some officials seeking to trim the autism therapy and other growing line items in their Medicaid spending.

The impact of reduced ABA therapy hours is being felt by families like the Osbornes, who are struggling to find alternative solutions for their children. Aubreigh's progress has been halted, and her family is now facing the daunting task of navigating a complex healthcare system to find additional resources. The humanitarian impact of these cuts is significant, with many families relying on ABA therapy to help their children develop essential skills and lead more independent lives. The international autism community is also taking notice, with the World Health Organization (WHO) estimating that 1 in 100 children worldwide have autism.

The risks associated with scaling back ABA therapy are multifaceted. Reduced therapy hours can lead to a decline in child development, increased behavioral problems, and a higher likelihood of institutionalization. Furthermore, the financial risks are significant, with some estimates suggesting that the cost of treating autism can range from $50,000 to $100,000 per year. The regulatory risks are also substantial, with the Centers for Medicare and Medicaid Services (CMS) warning states that they must ensure that Medicaid beneficiaries have access to necessary services, including ABA therapy.

The diplomatic outlook for ABA therapy is uncertain, with several states continuing to scale back their Medicaid spending on the treatment. However, there are signs of resistance from families and advocacy groups, who are pushing back against the cuts. In North Carolina, a group of parents has launched a petition to restore funding for ABA therapy, while in Nebraska, lawmakers are considering legislation to increase funding for autism services. The outcome of these efforts remains to be seen, but one thing is clear: the fate of ABA therapy hangs in the balance.

The controversy surrounding ABA therapy is a symptom of a broader trend: the increasing burden of autism care on state Medicaid programs. As the prevalence of autism continues to rise, states are facing mounting pressure to provide adequate funding for treatment. However, the pace of change is slow, with many states struggling to keep pace with the growing demand for ABA therapy. This suggests that the current system is inadequate, and that a more comprehensive approach is needed to address the needs of families like the Osbornes. Crucially, this overlooks the potential benefits of investing in early intervention and prevention programs, which could help reduce the long-term costs of autism care. By prioritizing prevention and early intervention, states can help mitigate the financial and humanitarian risks associated with scaling back ABA therapy.

Our internal tone gauge currently reads: Neutral for this development.

1. KFF Health News: It's the 'Gold Standard' in Autism Care. Why Are States Reining It In? — https://goldrushcam.com/sierrasuntimes/index.php/news/local-news/73982-kff-health-news-it-s-the-gold-standard-in-autism-care-why-are-states-reining-it-in

Methodology: This analysis combines real-time data aggregation from manually selected global sources with advanced AI synthesis, engineered to provide neutral and data-driven insights.