The Boom in Autism Therapy Is Medicaid’s Fastest-Growing Jackpot

Some companies have found lucrative opportunities to capitalize on a growing need, billing long hours and extracting payments as high as $800 an hour

By Christopher Weaver, Tom McGinty and Anna Wilde Mathews of The WSJ. Excerpts:

"In 2023, the state [Indiana] paid [Meghann] Mitchell’s company, Piece by Piece Autism Centers, $29 million to provide therapy to just 84 patients" 

"That amount [$340,000 a child] surpassed what Indiana Medicaid typically spends in a year treating a newly diagnosed lung-cancer patient or covering a year of nursing-home care."

"reimbursements as high as $640 an hour for routine therapy that can be administered by workers with little more than a high-school diploma."

"“I don’t think Indiana really had any oversight, or not much,” said Mitchell"

"The number of companies offering such therapy"

"almost doubled between 2019 and 2023. Direct payments from state Medicaid programs to autism therapy providers grew to $2.2 billion in 2023, from $660 million just four years"

"Federal taxpayers financed about 70% of Medicaid spending during that period. Entrepreneurs and investors, including some private-equity firms, have piled into the business."

"The office [inspector general inspector general] has so far found widespread flaws in Maine, Wisconsin, Indiana and Colorado" and "errors in every case, including billing for therapy while patients napped or watched videos"

"Many providers nationwide billed a high number of hours of therapy for nearly every patient"

some "billed an average of 30 or more hours of weekly therapy per child in 2023"

"Evidence-based, broadly accepted guidelines do not exist for autism care" 

one firm "paid bonuses for working more hours of “treatment delivery” services, starting at 30 hours per week"

"Medicaid [in Indiana] spending on autism surged—from $21 million in 2017 to $611 million in 2023"

"No one monitored providers’ billing practices during those years"

one company "company threw Christmas parties with an open bar at local country clubs and a downtown Indianapolis karaoke bar"

one firm "In October 2023 . . . boosted its therapy prices again, raising them to $1,600 an hour"