Autism Therapy Providers Are Raking It in From Medicaid
A child works on a sorting problem during an applied behavior analysis in his home in Ayer, Massachusetts, on Jan. 16. (AP Photo/Shelby Lum)
Government spending on autism treatment through Medicaid has expanded rapidly in recent years, bringing both massive growth and growing scrutiny.
According to reporting by The Wall Street Journal, direct Medicaid payments for applied behavior analysis (ABA) therapy climbed from 2019 to 2023 to reach about $2.2 billion—more than triple the earlier amount. At the same time, federal auditors say the system is riddled with billing problems, prompting several states to attempt tighter controls on the program.
One example highlighted in the report involves an Indiana company called Piece by Piece Autism Centers. The provider received $29 million in Medicaid payments during 2023 while serving just 84 children. That works out to roughly $340,000 per child. Some therapy sessions were reimbursed at rates as high as $640 an hour, and in certain cases the therapy was delivered by staff whose formal qualifications extended only to a high school diploma. The Journal says the rapid growth of the industry has been fueled by loose oversight, minimal rules governing what treatment is appropriate, and heavy investment from entrepreneurs and private equity firms.
Federal inspectors reviewing claims in several states found widespread issues. Auditors reported documentation errors in every autism therapy claim they examined in Colorado, Indiana, Maine, and Wisconsin. Other states are facing their own investigations as concerns about fraud and improper billing mount.
Minnesota has become a focal point in the crackdown after federal authorities withheld $260 million tied to the state’s autism therapy program amid fraud investigations. Officials in North Carolina are also reviewing suspected abuses.
At the same time, families who rely on the therapy say the services are essential. In Arizona, parents recently demonstrated after Medicaid insurance plans canceled contracts with two major autism therapy providers in the state. One mother with three autistic sons said the therapy is critical to their development, describing it as the difference between a child making progress and withdrawing into silence.
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