Medicaid spending on autism therapy nearly tripled nationwide between 2020 and 2024, and North Carolina projects spending to rise from $121 million in 2022 to more than $1 billion next year, according to a The New York Times investigation published May 23.
The report examined the rapid growth of applied behavior analysis clinics, a multibillion-dollar industry fueled by rising autism diagnoses, insurance coverage mandates and Medicaid reimbursement.
Here are six things to know:
- Private equity firms acquired at least 500 autism clinics over the past decade. The number of clinics in North Carolina owned by autism therapy providers grew from 61 in 2019 to 409 in 2026, according to data cited by the investigation.
- Current and former clinic workers interviewed by the Times said some clinics prescribed therapy hours based on children’s availability rather than clinical need. Several described recommendations of 25, 30 or 40 hours of therapy per week and, in some cases, advised that children leave school to attend treatment.
- Clinic visits increased from a median of four hours in 2019 to 5.5 hours in 2024, according to an analysis of 34 million Medicaid claims. Appointments lasting eight hours or longer rose from 9% to 16% during the same period.
- Unlike day care facilities, autism clinics generally are not subject to routine inspections. The investigation also found recent federal audits identified clinics in four states that billed Medicaid for nontherapeutic activities such as lunch periods and playground time.
- Compleat Kidz, a North Carolina-based chain of clinics, employs in-house psychologists who can diagnose children and refer them to the company’s therapy programs. Ethics experts told the Times the arrangement creates a conflict of interest, and North Carolina plans to prohibit the practice later this year.
- North Carolina Medicaid opened an investigation into Compleat Kidz after reviewing the Times’ findings. Separately, federal prosecutors recently charged two Minnesota autism clinic operators with allegedly billing $46.6 million for services that were never delivered or provided to children with false diagnoses.
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