POLICY PRIORITIES: THE CHALLENGE:
ONE BIG BEAUTIFUL BILL ACT
The One Big Beautiful Bill Act represents the most significant restructuring
of Medicaid financing since the Affordable Care Act. For autism and ABA service providers — who serve hundreds of thousands of children through Medicaid — the implications are profound and immediate.
KEY CONCERNS
FOR AUTISM PROVIDERS
THE FINANCIAL SQUEEZE:
The One Big Beautiful Bill Act cuts over $1 trillion from
federal Medicaid funding over the next decade - forcing
states to find savings wherever they can. ABA services have
become a primary target, with states implementing rate
cuts, therapy caps, and tighter eligibility requirements to
balance their budgets.
STATE RATE CUTS:
Facing unprecedented budget shortfalls, states across the
country are slashing ABA reimbursement rates. These cuts
threaten provider sustainability - forcing some organizations
to exit Medicaid entirely - and reduce access to care for the
children and families who depend on these services.
THERAPY HOUR CAPS:
To control costs, states are implementing lifetime and
weekly caps on ABA therapy hours. These arbitrary limits
ignore clinical evidence and medical necessity, forcing
families to ration care or go without the intensive
treatment their children need.
MCO NETWORK PRESSURE:
Managed care organizations are absorbing financial pressure
from states by terminating provider contracts, proposing
significant rate reductions, and tightening their networks.
Leading ABA providers are being pushed out of MCO
networks, leaving families with fewer options and
longer wait times.
ADMINISTRATIVE BURDENS:
New prior authorization requirements, pre- and post-payment
reviews, and stricter documentation demands are delaying
care and increasing costs for providers. These
administrative barriers add complexity without improving
outcomes - and ultimately hurt the children waiting for
treatment.
COVERAGE DISRUPTIONS:
Work requirements, shortened redetermination cycles, and
tighter eligibility rules will create constant eligibility churn
for Medicaid families. When a parent loses coverage - even
temporarily - their child's autism treatment is disrupted,
undermining months or years of therapeutic progress.
OUR ADVOCACY
PRIORITIES
Protecting Medicaid Access
We advocate for policies that maintain and strengthen Medicaid coverage for children with autism, including exemptions from work requirements for caregivers of children with disabilities, reasonable redetermination timelines, and protections against coverage gaps that disrupt treatment.
Fair Reimbursement Rates
Autism and ABA services require highly trained professionals and intensive therapy hours. We fight for reimbursement rates that reflect the true cost of delivering high-quality care, ensuring providers can maintain sustainable operations while serving Medicaid populations.
Network Adequacy Standards
Medicaid managed care organizations must maintain adequate provider networks to ensure timely access to autism services. We advocate for enforceable network adequacy standards that hold MCOs accountable for providing the access their members deserve.
Administrative Simplification
Excessive prior authorization requirements, documentation burdens, and administrative barriers delay care for children with autism. We push for streamlined processes that prioritize patient access over bureaucratic complexity.
State-Level Implementation
Federal legislation is implemented at the state level — and every state is different. We provide state-by-state advocacy support to ensure that implementation decisions protect autism services and the families who depend on them.