Autism Therapy Spending Quintuples, Prompting Federal Push For State Oversight

Key TakeawaysMedicaid autism therapy spending hit $10 billion in 2025, five times the 2021 totalFederal officials urge states to require prior authorization and review high-hour treatment plansIndustry group says a child's clinician should set treatment hours, not blanket policy.WEDNESDAY, Aug. 5, 2026 (HealthDay News) — Medicaid spending on autism therapy quintupled in four years, climbing to $10 billion in 2025 from about $2 billion in 2021, reports The New York Times.Spending per child more than doubled over that period, rising from a median of $8,903 to $21,203. Median means half had higher spending; half had less.That growth far outpaced the 67% increase in autism diagnoses during those years, The Times said.The federal Medicaid office responded Tuesday with a 173-page toolkit of best practices for regulating autism clinics.It advises states to limit how much therapy a provider can bill before giving a child a break, require prior authorization for high numbers of hours and track clinic outcomes more closely."We were seeing quite an explosion in costs," Caprice Knapp, a Medicaid senior policy official, told The Times. "We want to make sure the profit motivation isn't overtaking what's in the best interest of children."Thousands of autism clinics have opened across the country in recent years with little regulatory oversight, a Times investigation found earlier this year.Dozens of current and former clinic workers told reporters their employers overprescribed hours and sometimes urged families to pull children out of school so they could receive more therapy, all to turn a greater profit.Medicaid typically pays for that therapy in 15-minute increments. At some North Carolina clinics, young children were allowed to nap for just seven minutes so they would be awake for most of a 15-minute chunk of time, The Times found.Officials also point to the role of private equity firms, which have bought or opened hundreds of clinics nationwide.Some newer clinics are prescribing 40 hours a week of therapy to children as young as 3, The Times found.The new guidelines push back on 40-hour therapy weeks, saying that level is "not a best practice" and has not been shown to produce better outcomes. Kids also have too little time left for everyday activities such as toileting, napping and eating, the guidelines say.The Council of Autism Service Providers, an industry group, advises that 30 to 40 hours a week is best for comprehensive treatment. Lori Unumb, its chief executive, acknowledged that not all children need that much treatment but said it remains best practice for some. "A child's clinician should be the one making the determination on hours, on an individualized basis," she said in a statement.Recent audits of Medicaid programs in Indiana, Colorado, Wisconsin and Maine found clinics billing for nontherapeutic activities such as lunch and playground trips. The guidelines urge states to review documentation more carefully.Some states are already acting. North Carolina is on track to spend $1 billion on autism therapy next year, compared with $121 million in 2022, and recently passed a law requiring special review of treatment plans for more than 16 hours a week.Dan Brillman, who oversees Medicaid for the Trump administration, told The Times every state faces the same problem and that the guidance is meant to help state Medicaid directors and governors work with their legislatures.More informationVisit the U.S. Centers for Disease Control and Prevention for more information about autism treatment and intervention.SOURCE: The New York Times, Aug. 4, 2026 .What This Means For YouParents of children receiving Medicaid-covered autism therapy should be aware that some states are starting to require extra review of high-hour treatment plans..Sign up for our weekly HealthDay newsletter

Autism Therapy Spending Quintuples, Prompting Federal Push For State Oversight

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