Short Naps, Long Hours: How Autism Clinics Squeeze Medicaid Dollars Out of Preschoolers
At Compleat Kidz, a fast-growing chain of autism clinics based in North Carolina, the policy is firm: Naps cannot be longer than seven minutes before children are awakened to resume therapy. The company says this is necessary to prevent fraud since clinics can be paid only when children are awake and getting services. But it also allows the clinic to bill insurers or Medicaid for more hours.
Across the United States, where treatment for autistic children was once fairly rare, thousands of clinics have sprung up, turning a once obscure therapy into a multibillion-dollar industry.
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A New York Times investigation has found that this rapid expansion has played out with little regulatory oversight and brought allegations of children being harmed by profit-motivated practices. In interviews, dozens of current and former clinic workers described how clinics frequently overprescribe hours — even recommending that some families remove children from school so they can receive more therapy.
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North Carolina, which spent $121 million in 2022, projects it will spend over $1 billion next year.
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Autism clinics operate with little state oversight. Unlike day care facilities, they are not subject to regular inspections despite young children spending long hours there.
A dozen instances of child abuse at Compleat Kidz facilities have been reported to the police since 2023, according to records The Times reviewed. At least two resulted in criminal charges against employees, and a third is the subject of a lawsuit a parent filed against Compleat Kidz.
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Autism treatment did not become big business until the mid-2010s, after state laws began requiring insurers to cover it. Medicaid soon followed, and the industry boomed.
In North Carolina, the number of clinics owned by autism therapy providers grew from 61 in 2019 to 409 in 2026, according to data compiled by Daniel Arnold, a health economist at Brown University.
The clinics are enticing to health care investors: Demand is high and payment rates far exceed labor costs.
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Advising families not to send their children to school is one common practice that current and former workers at clinics across the country described as increasing profits at children’s expense.
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