The Centers for Medicare & Medicaid Services released a toolkit to help state Medicaid and Children’s Health Insurance Program agencies strengthen oversight of applied behavior analysis (ABA) services for children with autism, according to an Aug. 4 news release from the federal agency.
This toolkit comes as Medicaid spending on autism therapy has surged in several states in recent years. In Colorado, Medicaid spent more on autism therapy for children last year than on emergency room care for all patients, according to a recent investigation by The New York Times. The investigation also found some clinics prescribe 25 or even 40 hours of therapy each week for young children. Average daily appointments also have increased over time, according to Medicaid data analyzed by Trilliant Health.
Here are five things to know:
1. The toolkit focuses on oversight, not limiting care. CMS said the resource is designed to help states ensure ABA services are medically necessary, individualized and evidence-based while identifying fraud, waste and abuse. The agency said it does not establish new federal requirements, reduce Early and Periodic Screening, Diagnostic, and Treatment obligations, endorse a single ABA treatment approach or limit access to medically necessary care.
2. ABA spending has outpaced growth in autism diagnoses. CMS data showed Medicaid and CHIP spending on ABA services increased 421% between 2021 and 2025, while the number of children with an autism spectrum disorder diagnosis receiving services increased 67%.
3. The toolkit covers multiple policy and operational areas. It includes guidance on clinical standards, Medicaid benefit design, payment methodologies, provider enrollment, credentialing, utilization management and program integrity strategies. It also provides a checklist to help states assess their ABA policies and oversight practices.
4. The resource is based on multiple sources. CMS said the toolkit was informed by Medicaid data, a review of more than 40 literature sources, an assessment of more than 240 publicly available state Medicaid coverage and policy references, and input from state agencies, providers, advocates and other stakeholders.
5. CMS plans to continue working with states. The agency said it will continue collaborating with states to strengthen oversight of ABA services, protect children and families, promote evidence-based care and help ensure Medicaid resources are directed toward medically necessary services.
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