North Carolina lawmakers moved to add new Medicaid requirements for providers of applied behavioral analysis therapy for autism as state spending on the service rose sharply.
State and federal Medicaid spending on applied behavioral analysis, or ABA, exceeded $505 million in 2025, according to the N.C. Department of Health and Human Services. That was up from $1.9 million five years earlier.
The increase came as ABA providers in other states began offering telehealth services in North Carolina and billing Medicaid for them. Some local providers and advocates said remote services may not be as effective for all patients.
A revised version of House Bill 34 passed the Senate Health Care Committee without debate Wednesday. The bill sought to slow growth in ABA spending by adding requirements for providers.
Sen. Benton Sawrey, R-Johnston, said the measure included recommendations from the Department of Health and Human Services and law enforcement to strengthen Medicaid compliance.
“The other big piece of this bill that we’ve had some conversations about is closing the network for peer support, community support, and our ABA services,” Sawrey said while presenting the bill. “Closing networks in the best interest of making sure that our local providers get those services to the patients is needed.”
Under a closed network, providers would have to submit credentials and meet requirements to qualify for reimbursement.
“There’s a threshold they have to meet in order to gain enrollment,” Sawrey told NC Newsline.
David Laxton, communications director at the Autism Society of North Carolina, said he believed the bill would improve the quality of ABA therapy in the state and help “ensure quality and sustainability” for the treatment.
Autism Speaks Vice President David Sitcovsky said he was concerned that additional requirements could limit access to treatment. He said Medicaid was a “lifeline” for many autistic people and their families because it provides access to ABA and other services.
“As states consider changes to strengthen accountability, they should take a careful, targeted approach that addresses these concerns while protecting access to medically necessary, high-quality care,” Sitcovsky said in a statement. “Efforts to prevent fraud or improper billing should not create new barriers or disrupt services for autistic power and families who rely on qualified providers.”