When Money Shapes Autism Care

Private equity has moved quickly into autism therapy. A 2026 JAMA Pediatrics study has documented 574 private equity owned centers across 42 states by the end of 2024. Medicaid payments for Applied Behavior Analysis have risen sharply in recent years, and state audits and national reviews have shown problems in billing and documentation in several states.

Families and clinicians have expressed concern that profit motives can change clinic practice. Staff turnover has increased while training and supervision have sometimes been reduced, and session time has been shortened or billed in large units. Although many clinics provide careful care, federal audits from the HHS Office of Inspector General have identified improper payments in Wisconsin and Indiana. While investigations continue, families can ask for written treatment goals, names and credentials of therapists, and clear session notes that match billed hours.

If a family notices missing records or unclear bills, they can contact their state Medicaid office or ask for a detailed invoice. Keeping copies of reports and asking for regular progress reviews helps families follow care and protect their child’s therapy.