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.
“We were seeing quite an explosion in costs,” Caprice Knapp, a top Medicaid official, told The New York Times, adding, “We want to make sure the profit motivation isn’t overtaking what’s in the best interest of children.”
Thousands of autism clinics have sprung up across the country in recent years, an expansion that has played out with little regulatory oversight, an investigation by The Times found earlier this year. Dozens of current and former clinic workers told The Times that their clinics were overprescribing hours and even recommending that some families remove children from school to receive more therapy, all so they can turn a greater profit.
On Tuesday, the federal Medicaid office will roll out a “toolbox” of best practices and policy guidelines for regulating autism clinics. The 173-page document advises states to set limits for how much autism therapy a provider can bill before giving a child a break, require prior authorization for high numbers of hours and better track clinic outcomes.
Medicaid officials said in interviews that the new restrictions were necessary to deter the behavior of profit-oriented clinics that were taking advantage of state mandates that require the public health plan to cover autism treatment.
Medicaid spending on autism therapy hit $10 billion in 2025, a fivefold increase from about $2 billion in 2021. Spending per child increased significantly over the same time, from a median of $8,903 to $21,203.
Ms. Knapp said that the quick growth, which outpaced the 67 percent increase in autism diagnoses over the same time, was likely due to the overprescription of care and the emergence of private equity firms, which have bought or opened hundreds of clinics around the country.
Some newer clinics routinely prescribe 40 hours of care to children as young as three — not because they need so much treatment, The Times previously found, but because they are available to attend.
The Council of Autism Service Providers, an industry group for clinics, advises that 30 to 40 hours of weekly treatment is “best” for comprehensive treatment.
The new Medicaid guidelines challenge 40-hour therapy weeks as the standard. They state that such high treatment levels are “not a best practice” in part because the research does not show better outcomes for children and because so much treatment may not give children enough time for “activities of daily living such as toileting, napping and eating.”
Medicaid typically pays for autism therapy in 15-minute increments, creating a strong incentive to keep treatment sessions long and breaks short. At some clinics in North Carolina, The Times found, children were allowed to nap only seven minutes, so they would be awake for a majority of the 15-minute billing unit.
The new Medicaid recommendations will suggest that states set a limit for how many 15-minute units can be stacked on top of one another before requiring a break for a child.
It also suggests that states monitor possible signs of overuse by giving extra scrutiny to clinics that bill maximum hours for 80 percent of patients or grow rapidly after joining the Medicaid program.
Recent government audits of four state Medicaid programs — in Indiana, Colorado, Wisconsin and Maine — found that clinics routinely billed Medicaid for nontherapeutic activities like lunch time and trips to the playground.
The new Medicaid guidelines recommend that states better monitor documentation to ensure that clinics are providing the care that they submit claims for.
Some states have already begun enacting similar policies on their own after experiencing rapid growth in autism therapy spending. North Carolina, for example, is on track to spend $1 billion on autism therapy next year, compared with $121 million in 2022. The state’s legislature recently passed a law requiring a special review of treatment plans that suggest more than 16 hours of weekly treatment.
“All the states, it doesn’t matter who they are, all have the same problem,” said Dan Brillman, who oversees Medicaid for the Trump administration. He added that the administration was releasing the guidelines so state Medicaid directors and governors can “go to their legislatures to build the right policies.”
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