Medicaid Tightens Oversight of Autism Therapy Providers
Wilson and 16 other attorneys general say states need authority to pursue beneficiary fraud as Medicaid improper payments hit $37.39 billion.
- On Tuesday, the Centers for Medicare and Medicaid Services released a 173-page toolkit urging states to tighten oversight of autism therapy providers to curb fraud and ensure clinically appropriate care.
- Medicaid spending on applied behavior analysis surged 421% between 2021 and 2025, rising from roughly $1.94 billion to about $10.1 billion, far outpacing the 67% increase in children receiving services.
- The new guidelines advise states to require prior authorization for high therapy hours and better track clinic outcomes, following Medicaid officials' concerns that profit-oriented clinics prioritize billing over patient needs.
- South Carolina Attorney General Alan Wilson led a coalition of 16 states urging Congress to pass the STOP Fraud in Medicaid Act, which would empower states to investigate and prosecute recipient fraud.
- Because Medicaid administration varies by state, the toolkit's practical impact depends on individual state agency adoption; families retain appeal rights if services are reduced, and EPSDT obligations for children under 21 remain in force.
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Autism Providers Back Trump Medicaid Fraud Crackdown Amid Allegations Millions Were Stolen From Children
Internewscast Journal Internewscast Autism care providers across the United States are voicing support for the… This Post: Autism Providers Back Trump Medicaid Fraud Crackdown Amid Allegations Millions Were Stolen From Children first appeared on Internewscast Journal
Autism providers support Trump admin crackdown after millions allegedly stolen through Medicaid fraud
The group argues that every dollar allegedly stolen by fraudsters should have been used to help a child with autism learn to communicate, gain independence and receive the care they need.
Autism providers cheer Trump crackdown after millions allegedly stolen from children through Medicaid fraud
Autism care providers back the Trump administration's Medicaid fraud crackdown but warn policymakers not to create barriers for families of autistic children.
Medicaid urges states to increase autism therapy oversight
The Trump administration will advise states on Tuesday to place new restrictions on autism therapy providers to curb a sharp increase in Medicaid spending for a treatment that has raised concerns of waste and fraud.
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