Don't abandon New York's children with autism: The impact of medicaid cuts on ABA therapy

To the editor:

New York State is on the brink of a disastrous decision that will harm thousands of children with autism. The proposed Medicaid cuts to Applied Behavior Analysis (ABA) therapy will widen existing health disparities, deprive low-income families of critical services and in the long run, cost the state much more. 

As a developmental pediatrician and the parent of a daughter on the spectrum, I live this. I have seen first-hand how access to ABA therapy can change lives. ABA, the most proven-to-be-effective treatment for autism, helps children develop essential communication and social and daily living skills. Providing ABA early in life is crucial, with research showing that children who receive those services at a young age have significantly better long-term outcomes. 

For years, Medicaid did not cover ABA therapy in New York, depriving low-income families of a crucial service that was available to those with private health insurance. This was a glaring injustice. Children from wealthier families had access to therapy that could help them thrive, while those from lower-income backgrounds were left behind. In 2021, New York finally corrected this inequity by extending Medicaid coverage to ABA therapy. 

Now, just two years later, the state is poised to reverse that progress with drastic funding cuts. The proposed reductions will make it even harder for families to find behavioral providers, as low reimbursement rates already deter many ABA professionals from accepting Medicaid patients. The cuts will also reduce services during the critical Early Intervention (0-3 year) period, when ABA is most crucial. 

This is not just a health issue, it is a social justice issue. Well-off families will continue to obtain ABA through private health insurance or paying out of pocket, while poor families will be left with limited or no access to the same life-changing services. These cuts will deepen existing disparities in autism care, disproportionately impacting communities that are already underserved. 

Beyond the ethical implications, these cuts are fiscally irresponsible. Failing to provide ABA therapy in early childhood leads to higher special education and mental healthcare costs later in life. Many children on the autism spectrum go on to develop significant mental health challenges, requiring expensive crisis care and long-term state-funded support. The state is already spending billions on crisis intervention and mental health services for individuals with developmental disabilities – yet is it now proposing to slash funding for the very therapy that could prevent these crises from occurring. 

Imagine a river where people keep falling in, struggling to stay afloat. Instead of investing in guardrails and safety measures upstream, we keep spending money on emergency rescues. Cutting ABA funding is like removing those guardrails – and more people will fall into the river rather than preventing the problems at their source. 

New York must not abandon its most vulnerable children. Instead of gutting Medicaid coverage for ABA therapy, the state must invest in improving access, increasing reimbursement rates to match private insurance, and ensuring high-quality services through provider training. These changes will not only improve outcomes for children with autism, but will also save the state money in the long term by reducing the need for costly crisis interventions. 

Gov. Hochul and the state legislators must act now. The decision to cut ABA therapy funding will have lasting consequences for a huge number of families across New York. Our children’s futures are at stake, and we cannot afford to turn our backs on them. 

Harris Huberman, MD, MPH