North Carolina legislators over the past few months have sought to lower healthcare costs, especially those caused by fraud and abuse within the Medicaid system. Now they’re taking on the skyrocketing costs of an increasingly popular therapy for autism.
State and federal Medicaid spending on applied behavioral analysis therapy, known as ABA, surpassed $505 million in 2025, according to the N.C. Department of Health and Human Services, an exponential increase from $1.9 million just five years prior.
The steep jump in cost has happened at the same time as ABA providers in other states started offering telehealth services in North Carolina and billing them to Medicaid, although some local providers and advocates say the remote services may not be as effective for all patients.
A rewritten version of House Bill 34 aims to rein in the growth of spending on ABA by adding new requirements for providers. It passed the Senate Health Care Committee without debate Wednesday.
NC legislators, alarmed over increasing cost of autism therapy, search for ways to control it
Sen. Benton Sawrey (R-Johnston) said the measure incorporated suggestions from DHHS and law enforcement to strengthen compliance with Medicaid.
“The other big piece of this bill that we’ve had some conversations about is closing the network for peer support, community support, and our ABA services,” Sawrey said while presenting the bill. “Closing networks in the best interest of making sure that our local providers get those services to the patients is needed.”
Under a closed network, providers would need to provide credentials and meet certain requirements to be eligible for reimbursement.
“There’s a threshold they have to meet in order to gain enrollment,” Sawrey told NC Newsline.
David Laxton, communications director at the Autism Society of North Carolina, thinks the bill will improve the quality of ABA therapy in the state.
He said he sees the measure as a necessary step to “ensure quality and sustainability” for the treatment.
“If we address some of the long-term sustainability issues, then that means access to the service is going to continue to be there for the folks that need it,” Laxton told NC Newsline. “It doesn’t mean that some people may have fewer options, but it means that the quality and the ability to continue offering the service would be there.”
However, Autism Speaks Vice President David Sitcovsky expressed concern about adding barriers to treatment. He said Medicaid serves as a “lifeline” for many autistic people and their families, since it provides access to ABA and other essential services.
“As states consider changes to strengthen accountability, they should take a careful, targeted approach that addresses these concerns while protecting access to medically necessary, high-quality care,” Sitcovsky said in a statement. “Efforts to prevent fraud or improper billing should not create new barriers or disrupt services for autistic power and families who rely on qualified providers.”
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