Florida: Medicaid pays for ABA for 55K children; still 'agonizingly long waitlists'
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“There’s something unusual happening … that deserves a closer look,” the state’s spending on applied behavior analysis was nearly four times that of any other state, prompting scrutiny
Florida in the past two years has spent more money than any other state in the nation providing a therapy called applied behavior analysis (ABA) to children with special needs including autism — $6.57 billion between 2023 and 2025.
That’s the number Shena Grantham, Florida’s deputy secretary for Medicaid policy and quality, gave to members of a blue-ribbon panel in Tallahassee this week reviewing ABA services in the Medicaid program that covers about 55,000 children aged 20 and younger.
Indiana ranked a distant second to Florida, spending $1.65 billion over the same two years. North Carolina ran a distant third, at $1.53 billion.
“There’s something unusual happening … that deserves a closer look,” Grantham told members of the Applied Behavior Analysis Task Force, which held its inaugural meeting last week.
The legislatively mandated “closer look” comes as a number of other issues come to a head. . . .
The DeSantis administration announced in June that it was cracking down on fraud, waste, and abuse in Florida’s $38 billion healthcare safety net program. It was launched after the CMS sent a letter to Florida, as well as California, Maine, and New York, seeking information about Medicaid integrity and oversight and after CMS Director Mehmet Oz said on social media that “Florida has been a hotspot for health care fraud for years.” . . .
‘Agonizingly long waitlists’
Nicole Grabner is a disabled veteran and mother of two children with autism who drove four-plus hours from her home in Brevard County to Tallahassee to tell the task force she’s worried the cumulative changes are hurting Florida families who, she says, already are facing “agonizingly long waitlists” just to be approved for ABA.
Now, she said, the changes are interrupting medically necessary care.
She told task force members that during her drive to Tallahassee she learned her youngest son had lost access to his ABA provider.
“These disruptions are kind of concerning, especially now that we are getting into the new school year, when consistency is most critical,” Grabner said. “Aggressive enforcement or administrative delays must never compound these delays for a child receiving early intervention services when a short pause in therapy causes devastating developmental regression.” . . .
The Legislature established the 10-member task force as part of fiscal year 2026-27 budget negotiations. The task force is reviewing revisions of the state’s healthcare delivery model to “improve care experience and service continuity for enrollees and families receiving ABA services, while safeguarding long term program sustainability.”
Specifically, the legislation directs the task force to submit a report to the Legislature and governor by the end of the year examining at least six ideas:
• Clinical care models that lead to best practices for provision of therapy at the appropriate ages.
• Appropriate transitions for enrollees receiving ABA services across developmental, educational, and community settings.
• Quality metrics for ABA therapy services.
• Limits and use controls related to the length of time applied behavioral analysis services may be authorized.
• Potential caps on the number of months an enrollee may receive ABA services.
• Ways to enhance Medicaid provider enrollment and billing standards for ABA services, to promote program integrity and fiscal accountability.
The task force must submit its recommendations — along with the pros and cons of each proposal — to the governor and Legislature by Dec. 31. . . . .
About 25% of children receiving Medicaid-covered ABA services — roughly 13,698 children — have not been diagnosed with autism spectrum disorder.
Despite cost-savings efforts in the past (which have included pilot programs and a moratorium on ABA provider enrollments) costs have continued to increase.
About 60,000 poor and low-income children in Florida receive applied behavioral analysis at a cost of about $2.3 billion, Grantham said, although she didn’t cite the year. . . ..
According to Grantham, 99% of Medicaid-covered ABA services for children are provided through managed care plans. The plans provide additional safeguards because they are in charge of ensuring a proper network of care providers are available for children, she said, and also are charged with ensuring authorization requirements are followed. . . .
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