Autism Therapy Providers Are Raking It in From Medicaid

Taxpayer-funded autism therapy has quietly become one of Medicaid's richest growth markets, and one of its biggest headaches. The Wall Street Journal reports that direct Medicaid payments for applied behavior analysis, or ABA, more than tripled, to $2.2 billion, between 2019 and 2023, even as federal auditors are flagging pervasive billing errors and states are scrambling to rein it all in. In Indiana, one rapidly growing provider, Piece by Piece Autism Centers, collected $29 million in 2023 to treat just 84 children—about $340,000 per patient—with hourly reimbursements that at times soared to $640, and for therapy sometimes delivered by workers with only a high school diploma. The Journal links that surge to weak oversight, loose rules, and a rush of entrepreneurs and private equity into a field where there are few clear standards on the type of care that children actually need.

Federal inspectors say they've found documentation errors in every autism therapy claim they sampled in four states: Colorado, Indiana, Maine, and Wisconsin. Minnesota's program is now at the center of a high-profile fraud crackdown that led to $260 million in federal funds being withheld, and North Carolina officials are also looking into their own cases. Parents in Arizona, meanwhile, recently protested after Medicaid insurance plans nixed contracts with two of the state's major providers for autism therapy, per Axios. "This is not a luxury. This is the difference between a child thriving and a child disappearing back into silence," one mother of three boys with autism says. More here, or check out the quick takeaways file from the Journal.