States cut Medicaid payments for autism ABA therapy
An NPR/KFF Health News report on Dec. 23, 2025 details how multiple states, including North Carolina, Nebraska, Colorado and Indiana, are cutting or considering cutting Medicaid payments and hours for applied behavior analysis (ABA) autism therapy as program spending soars following federal coverage mandates. North Carolina, where ABA Medicaid payments are projected to rise from $122 million in FY 2022 to $639 million in FY 2026, has already halved weekly therapy hours for at least some children, while Nebraska has imposed cuts of up to nearly 50% for some providers amid 1,700%–2,800% spending increases in several states and looming federal Medicaid reductions under President Trump’s One Big Beautiful Bill Act.
📌 Key Facts
- North Carolina Medicaid spending on ABA therapy grew from $122 million in FY 2022 to a projected $639 million in FY 2026, a 423% increase.
- Nebraska and Indiana have seen Medicaid ABA spending jumps of roughly 1,700% and 2,800% respectively in recent years, leading Nebraska to cut payments by nearly 50% for some providers.
- North Carolina has reduced one 3‑year‑old child’s ABA hours from 30 to 15 per week, and officials in Colorado and Indiana are also weighing rate reductions as state budget managers respond to looming federal Medicaid cuts from Trump’s One Big Beautiful Bill Act.
📊 Relevant Data
In 2022, autism prevalence among 8-year-old children in Maryland was highest among Black children at 1 in 27, followed by Asian or Pacific Islander children at 1 in 28, Hispanic children at 1 in 29, and White children at 1 in 34.
New CDC Report Shows Increase in Autism in 2022 with Notable Shifts in Race, Ethnicity, and Sex — Johns Hopkins Bloomberg School of Public Health
Black, Hispanic, and Indigenous children are more likely to be diagnosed with autism later or only when additional intellectual disabilities are present, compared to White children.
Autism Society of America Responds to New CDC Report on Updated Autism Prevalence Rates — Autism Society
Racial and ethnic minoritized autistic children experience significant disparities in geographic access to autism services, with lower access in areas with higher proportions of non-White populations.
Racial and Ethnic Disparities in Geographic Access to Autism Resources in the US, 2017-2018 — JAMA Network Open
The increase in autism prevalence is largely attributable to broadened diagnostic criteria and increased awareness, rather than a true rise in incidence.
The Real Reason Autism Rates Are Rising — Scientific American
Applied Behavior Analysis (ABA) programs are moderately to highly effective in improving cognitive, language, social/communication, problem behavior, adaptive behavior, emotional, and autism symptoms in children with autism spectrum disorder.
The effectiveness of applied behavior analytic interventions for children with Autism Spectrum Disorder: A meta-analytic study — ScienceDirect
There is no evidence that higher intensity interventions, such as more hours of ABA therapy, provide increased benefits for young autistic children compared to lower intensity.
New Study Suggests Higher Amounts of Intervention May Not Be More Helpful for Children on the Autism Spectrum — UNC Health News