POLICY PRIORITIES:
THE CHALLENGE:
ONE BIG BEAUTIFUL
BILL ACT
The One Big Beautiful Bill
Act represents the most
significant restructuring
of Medicaid financing since
the Affordable Care Act.
For autism and ABA service
providers — who serve
hundreds of thousands of
children through Medicaid
— the implications are
profound and immediate.
KEY CONCERNS
FOR AUTISM
PROVIDERS
THE FINANCIAL
SQUEEZE:
The One Big Beautiful Bill
Act cuts over $1 trillion
from federal Medicaid
funding over the next decade -
forcing states to find
savings wherever they can.
ABA services have become a
primary target, with states
implementing rate cuts,
therapy caps, and tighter
eligibility requirements to
balance their budgets.
STATE RATE CUTS:
Facing unprecedented budget
shortfalls, states across the
country are slashing ABA
reimbursement rates. These
cuts threaten provider
sustainability - forcing some
organizations to exit Medicaid
entirely - and reduce access
to care for the children and
families who depend on
these services.
THERAPY HOUR CAPS:
To control costs, states are
implementing lifetime and
weekly caps on ABA therapy
hours. These arbitrary limits
ignore clinical evidence and
medical necessity, forcing
families to ration care or go
without the intensive
treatment their children need.
MCO NETWORK
PRESSURE:
Managed care organizations
are absorbing financial
pressure from states by
terminating provider
contracts, proposing
significant rate reductions,
and tightening their networks.
Leading ABA providers are
being pushed out of MCO
networks, leaving families
with fewer options and longer
wait times.
ADMINISTRATIVE BURDENS:
New prior authorization
requirements, pre- and post
-payment reviews, and stricter
documentation demands are
delaying care and increasing
costs for providers. These
administrative barriers add
complexity without improving
outcomes - and ultimately hurt
the children waiting for
treatment.
COVERAGE
DISRUPTIONS:
Work requirements, shortened
redetermination cycles, and
tighter eligibility rules will
create constant eligibility
churn for Medicaid families.
When a parent loses coverage -
even temporarily - their child's
autism treatment is disrupted,
undermining months or years
of therapeutic progress.
OUR ADVOCACY
PRIORITIES
Protecting
Medicaid Access
We advocate for policies that
maintain and strengthen
Medicaid coverage for children
with autism, including
exemptions from work
requirements for caregivers of
children with disabilities,
reasonable redetermination
timelines, and protections
against coverage gaps that
disrupt treatment.
Fair
Reimbursement
Rates
Autism and ABA services
require highly trained
professionals and intensive
therapy hours. We fight for
reimbursement rates that
reflect the true cost of
delivering high-quality care,
ensuring providers can maintain
sustainable operations while
serving Medicaid populations.
Network
Adequacy
Standards
Medicaid managed care
organizations must maintain
adequate provider networks to
ensure timely access to autism
services. We advocate for
enforceable network adequacy
standards that hold MCOs
accountable for providing the
access their members deserve.
Administrative
Simplification
Excessive prior authorization
requirements, documentation
burdens, and administrative
barriers delay care for children
with autism. We push for
streamlined processes that
prioritize patient access over
bureaucratic complexity
State-Level
Implementation
Federal legislation is
implemented at the state level
— and every state is different.
We provide state-by-state
advocacy support to ensure that
implementation decisions
protect autism services and
the families who depend on
them.