Just months ago, Gaile Osborne (left) didn’t expect her adoptive 3-year-old daughter, Aubreigh, would make friends at school. Aubreigh was diagnosed with autism at 14 months old. After struggling to control outbursts and sometimes hurting herself, she started a therapy program called applied behavior analysis. “It’s not perfect,” Osborne says. “But the growth in under a year is just unreal.”
Katie Shaw for KFF Health News
hide caption
toggle caption
Katie Shaw for KFF Health News
ALEXANDER, N.C. — Aubreigh Osborne has a new best friend.
Dressed in blue with a big ribbon in her blond curls, the 3-year-old sat in her mother’s lap carefully enunciating a classmate’s first name after hearing the words “best friend.” Just months ago, Gaile Osborne didn’t expect her adoptive daughter would make friends at school.
Diagnosed with autism at 14 months, Aubreigh Osborne started this year struggling to control outbursts and sometimes hurting herself. Her trouble with social interactions made her family reluctant to go out in public.
But this summer, they started applied behavior analysis therapy, commonly called ABA, which often is used to help people diagnosed with autism improve social interactions and communication. A technician trained in the therapy comes to the family’s home five days a week to work with Aubreigh.
Since then, she has started preschool, begun eating more consistently, succeeded at toilet training, had a quiet, in-and-out grocery run with her mom, and made a best friend. All firsts.
“That’s what ABA is giving us: moments of normalcy,” Gaile Osborne said.
But in October, Aubreigh’s weekly therapy hours were abruptly halved from 30 to 15, a byproduct of her state’s effort to cut Medicaid spending.
Other families around the country have also recently had their access to the therapy challenged as state officials make deep cuts to Medicaid — the public health insurance that covers people with low incomes and disabilities. North Carolina attempted to cut payments to ABA providers by 10%. Nebraska cut payments by nearly 50% for some ABA providers. Payment reductions also are on the table in Colorado and Indiana, among other states.
Efforts to scale back come as state Medicaid programs’ spending on the autism therapy has ballooned in recent years. Payments for the therapy in North Carolina, which were $122 million in fiscal year 2022, are projected to hit $639 million in fiscal 2026, a 423% increase. Nebraska saw a 1,700% jump in spending in recent years. Indiana saw a 2,800% rise.
Heightened awareness and diagnosis of autism means more families are seeking treatment for their children, according to Mariel Fernandez, vice president of government affairs at the Council of Autism Service Providers. The treatment is intensive, comprehensive therapy that can include 30-40 hours of direct treatment per week, while more limited therapy may still consist of 10-25 hours per week, according to guidelines released by the Council.
It’s also a relatively recent coverage area for Medicaid. The federal government ordered states to cover autism treatments in 2014, but not all covered ABA, which Fernandez called the “gold standard,” until 2022.
