In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Scams plague the world of autism. Some involve shady or abusive providers.
Christopher Weaver, Tom McGinty, and Anna Wilde Mathews at The Wall Street Journal:
The business of providing therapy to children with autism has surged in recent years across the U.S., fueled by taxpayer-funded Medicaid payments. Some companies have found lucrative opportunities to capitalize on the growing need for such care, sometimes outpacing regulators’ oversight, the Journal’s analysis found.
The number of companies offering such therapy—individualized treatments meant to help patients manage behavior and develop daily living and social skills—almost doubled between 2019 and 2023. Direct payments from state Medicaid programs to autism therapy providers grew to $2.2 billion in 2023, from $660 million just four years earlier, according to the data. Private insurers administering Medicaid benefits paid hundreds of millions more.
That made applied behavior analysis, or ABA, as the therapy is called, the fastest-growing service in Medicaid, the state-run program for low-income and disabled people. Federal taxpayers financed about 70% of Medicaid spending during that period. Entrepreneurs and investors, including some private-equity firms, have piled into the business.
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Indiana became the nation’s hotbed of the booming autism therapy industry, home to nine of the top 10 providers by per-patient spending in 2023. A big part of that was because the state started reimbursing providers 40% of whatever they billed. Unlike the fixed prices that most states use to cap costs, Indiana’s approach became a kind of blank check and therapy providers flooded in to take advantage of the generous reimbursements.
Medicaid spending on autism surged—from $21 million in 2017 to $611 million in 2023, according to a state report.
“Over time you saw an explosion of the children who were diagnosed and in billing practices that in my opinion were the epitome of abuse,” said Mitch Roob, the current secretary of the state’s Family and Social Services Administration and interim Medicaid director.
No one monitored providers’ billing practices during those years, said Roob, who was appointed last year. “If you’re a kid and no one was looking at the cookie jar and the lid was off, would you take another one?”
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The state scrapped the old billing system in 2024, replacing it with a flat rate of $68 an hour for services paid for by the state. Officials are planning an additional 6% cut this year and also plan to cap lifetime hours of service at 4,000 per child.
