Autism therapy costs soar for NC Medicaid. Auditor and lawmakers take closer look

A sharp rise in spending on autism therapy in North Carolina’s Medicaid program has prompted the state auditor’s office to take a closer look, State Auditor Dave Boliek told lawmakers Tuesday morning.

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Boliek said his office recently began scanning state programs for unusual spending increases and quickly identified a major spike in Medicaid spending on applied behavior analysis therapy for children with autism.

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Spending on ABA and related behavioral therapies was projected to increase about 425%, from $121.7 million in the 2022 fiscal year to about $639 million in 2026, according to the report.

Projections have since increased.

The DHHS report said part of the increase may be due to more providers entering the market and a 15% reimbursement rate increase for providers in 2024.

However, the report noted that spending increases are not evenly distributed across providers and are rising much faster than the rate of autism diagnoses in the state.

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