U.S. Medicaid and the Children’s Health Insurance Program spent $10.1 billion on applied behavior analysis (ABA) in 2025, as treatment schedules at large autism therapy chains came under scrutiny.
The Centers for Medicare & Medicaid Services (CMS) reported $1.94 billion in payments for ABA in 2021. The totals cover all ABA recipients, including people without an autism diagnosis. Over the same period, the number of children with an autism diagnosis receiving ABA through Medicaid or CHIP rose 189%, CMS said. ABA is used to build skills such as communication and daily living.
The Wall Street Journal compared 2024 Medicaid billing records for five private equity-backed chains with those of local providers. Taken together, the chains billed 29% more treatment hours per patient each week, its analysis found. Four of the five were above their local comparison groups.
Centria Healthcare’s weekly average in Arizona was 94% higher than that of local competitors, while Action Behavior Centers’ average in Colorado was 81% higher, the Journal reported. Hopebridge and Lighthouse Autism Center also billed more hours than their local peers. Learn Behavioral billed fewer.
Former employees of several large chains told the Journal they felt pressure to maintain lengthy schedules. The companies disputed those accounts. All five said children’s clinical needs determine treatment hours, and the four with higher billing averages told the Journal that differences in patient needs limit what the comparisons can show. Billing hours alone cannot establish whether an individual child’s care was appropriate.
Long schedules can affect time available for school. LaDeana Thompkins told the Journal that her family sought to reduce her son’s roughly 40-hour weekly schedule at Action so he could attend kindergarten. Action challenged parts of the family’s account and said it supports families who choose school even when clinicians recommend otherwise.
CMS notes that payments generally rise with billable hours and cautions against setting care by a uniform schedule designed to maximize revenue. In a March 12, 2026, statement, the Council of Autism Service Providers said its guidelines do not call for 40 hours for every child and argued that intensive treatment can help some children.
An August 2026 CMS toolkit advises states to review intensive schedules against each child’s circumstances, including time for school, rest and family activities. The toolkit creates no new federal requirements and does not direct clinicians’ judgment.
