N. Carolina: Cost for ABA up 347% over 3 yrs; Medicaid beneficiaries up 3,844 to 13,447
- 1 hour ago
- 2 min read
A type of autism therapy called applied behavioral analysis is under scrutiny by North Carolina legislators and the state auditor’s office because of its rapidly increasing costs to the state’s Medicaid program.
ABA is intensive, individualized therapy for people with autism. More than 70% of people who receive ABA are 6 years old or younger.
North Carolina saw costs for ABA balloon 347% from 2022 to 2025, according to the state Department of Health and Human Services. The total number of Medicaid beneficiaries receiving ABA in North Carolina increased from 3,844 in 2022 to 13,447 in 2025.
Nationally, Medicaid spending on ABA increased 300% between 2019 and 2024.
Other states that have seen rapid costs increases for ABA have taken steps to tighten requirements. North Carolina is also considering ways to control costs.
“We are committed to making sure the children who need these services continue to receive these services,” said Melanie Bush, interim Medicaid director, told the Joint Legislative Oversight Committee on Medicaid. “We just want them provided in the amount, scope, and duration that is appropriate for the individual child.”
Sen. Ralph Hise (R-Mitchell) asked how ABA could have expanded so rapidly, when, at least in western North Carolina, there’s a shortage of behavioral health specialists.
“Nothing here can answer the question of where that growth rate is coming from given our current environment,” he said.
Sen. Jim Burgin (R-Harnett) asked if the state could pause Medicaid coverage of ABA until it gets a handle on what’s going on.
“I’m extremely concerned about the dollars versus the services they’re actually getting,” he said.
Meredith McCumbee of New Hanover County told the Medicaid oversight committee that ABA transformed the life of her family and her son, who was diagnosed with autism when he was 4 ½ years old. . . .
Providers sometimes cut costs by having certified behavioral analyst supervisors oversee more technicians and cases than they should, he said.
“There’s a financial incentive for providers to reduce their supervision,” Filer said. “If they lower their supervision, it allows them to serve more kids, but with lower supervision for every single individual patient that they’re seeing.”
The patients and North Carolina’s Medicaid program are the losers, Filer said. “You’re spending more money in the short term, and you’re losing in the long term because they’re not getting the health outcomes that you’re expecting from these services.”
Of the certified behavioral analysts licensed in North Carolina who serve those supervisory roles, 47% don’t live in the state, Filer said.
At a different legislative committee meeting Tuesday morning, North Carolina Auditor Dave Boliek said his office is also taking a detailed look at ABA spending.
“That is one area that we did identify that needed a really, really, really close look,” he said.
Comments