The Politics of Autism includes an extensive discussion of autism service providers. Private equity firms now own many of them. Insurance mandates and Medicaid spending have contributed to the growth trend.
Sarah Kliff and Margot Sanger-Katz at NYT:
A New York Times investigation has found that this rapid expansion has played out with little regulatory oversight and brought allegations of children being harmed by profit-motivated practices. In interviews, dozens of current and former clinic workers described how clinics frequently overprescribe hours — even recommending that some families remove children from school so they can receive more therapy.
Marquisha Richards worked at two private-equity-backed chains in Texas. She said she became disillusioned about how financial considerations repeatedly drove care decisions. “The science is beautiful, but the industry is very ugly,” she said.
Nationwide, Medicaid spending on autism therapy nearly tripled between 2020 and 2024. In some states it grew much faster: Colorado Medicaid now spends more on autism therapy than on all emergency department visits. North Carolina, which spent $121 million in 2022, projects it will spend over $1 billion next year....
Autism treatment did not become big business until the mid-2010s, after state laws began requiring insurers to cover it. Medicaid soon followed, and the industry boomed.
In North Carolina, the number of clinics owned by autism therapy providers grew from 61 in 2019 to 409 in 2026, according to data compiled by Daniel Arnold, a health economist at Brown University....
The clinics are enticing to health care investors: Demand is high and payment rates far exceed labor costs.
Medicaid often pays about $70 per hour ($83 in North Carolina) for therapy largely provided by workers with high school diplomas who earn around $20.
Private equity firms have acquired at least 500 clinics over the past decade. “There’s just huge opportunities to grow these businesses and help increase access to care,” said Jon Krieger, a managing partner at Calex, a financial firm that assists with autism clinic mergers and acquisitions. He estimates the market could grow to $90 billion.
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Nationally, clinic visits have grown longer since private equity entered the business, from a median of four hours in 2019 to 5.5 hours in 2024, according to an analysis of 34 million Medicaid claims by the health data firm Trilliant.
