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.
One autism therapy provider in Nebraska recently lost half its staff and has a growing wait list of children who can’t access services. A small Colorado practice is losing out on tens of thousands of dollars as it continues treating a child whose care was suddenly denied. An autism clinic in New York has stopped accepting Medicaid patients.
They say they are suffering because of the Trump administration’s crackdown on Medicaid fraud, even though none of the providers have been found guilty of fraud. Rather, they told POLITICO the push to root out bad actors by both President Donald Trump and the states — through funding cuts, staffing rules and new paperwork — is raising costs across the industry, and curbing access to services for children with autism.
“Yes, there were bad apples, and, absolutely, we agree there should be oversight,” said Holly Creamer, senior clinical director at Heartland ABA, an autism therapy provider in Nebraska. “The oversight should not equate to taking services away from kids and families who need it.”
The fraud crackdown has found plenty of wrongdoing. In Minnesota, providers took advantage of regulatory loopholes to charge outsized fees and billed Medicaid for services they never provided. It cost the program tens of millions of dollars. Similar stories are emerging in other states.
But the crackdown’s impact on legitimate providers — particularly independent, rural clinics — highlights the unintended ripple effects for both the businesses and the millions of American children who need the care. According to the latest federal data, 1 in 31 children has autism, a neurological condition that affects the ability to communicate, up from 1 in 150 a generation ago. Specialists in the condition say it’s mostly the result of improved diagnostic criteria.
Service providers said they support more regular audits to catch fraud, but they need clearer guidelines from states amid an uptick in unexplained Medicaid denials and new, “burdensome” paperwork requirements.
“Right now, there’s really blunt instruments that are being used across the board. They’re going to negatively impact all providers, and then ultimately children and families, because it will reduce access to care,” said Becky Thompson, president of the Wisconsin Autism Providers Association.
Stopping bad actors without inadvertently hurting legitimate providers “requires surgical precision,” but that’s not happening, she said.
