by James C. Sherlock
Autism therapy is the wild west of medical qualifications and spending.
Autism is real, but industry professionals and the non-profits who lobby for limitless autism spending have richly earned widespread skepticism of the industry by not policing their own. They have created a closed loop for eternally increased spending:
- The profession describes limitless demand.
- Therapy is thus supply-driven, raising practitioners’ reimbursements. (That increases the demand for online college courses that too often result in debt and a failed professional exam.)
- The Virginia government buys that story unquestioningly, at least in part because the regulatory system here is utterly broken.
- The budget committees of the Virginia General Assembly, whose Health committees designed that regulatory system, allocate new “slots” for kids each year in the Medicaid budget and raise the payment rates in the same session.
- There are long waiting lists – see above for limitless demand.
- Slot access depends on the severity of the diagnosed need.
- As diagnosed by the profession.
- That describes the demand as limitless.
Autism spectrum disorder (ASD) was not defined until 2013. ASDs are a group of developmental disabilities characterized by impairments in social interaction and communication as well as by restricted, repetitive, and stereotyped patterns of behavior.
This article will discuss autism in Virginia, specifically:
- The widely diverging genders of patients and therapists,
- The education of Board Certified Behavior Analysts (BCBAs), the top tier of treatment specialists, and
- The exploding spending on treatment.
An autism diagnosis for a child is typically made by a pediatrician, a child psychologist, a child neurologist, or a child and adolescent psychiatrist. The populations of both autism patients and therapy providers have exploded, making Applied Behavioral Analysis (ABA) the fastest-growing and most troubled program in both Medicaid and private health insurance.
According to Behavioral Health Business
Medicaid spending on core Applied Behavioral Analysis (ABA) autism services increased by 403% from 2019 to 2024. The number of provider entities delivering these services to Medicaid recipients increased 346%. This suggests that much of the increase in spending is driven by new providers opening their doors.
So autism treatment growth actually is supply-driven, not demand-driven. The Wall Street Journal has been on top of the ugly side of that story. Virginia’s troubles have been discussed in this space and will be again.
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