Georgia's Medicaid program, managed for foster children by its contractor Amerigroup, has implemented a 30% reduction in reimbursement rates for Applied Behavior Analysis (ABA) therapy. This change, effective September 1, has prompted providers to reconsider or cease services for foster children, impacting families statewide, including those in South Georgia.
The rate cut has immediate consequences for foster families. Krystina McQueen, a Hall County foster mom, reported that her severely autistic foster son, nearing his third birthday and making progress in specialized behavior therapy, may soon lose access to his provider. According to McQueen, her therapy provider indicated they might no longer be able to treat him due to the reduced rates, and has already stopped accepting new patients at the new rate. Other providers are also reportedly ceasing new admissions or dropping current patients.
Dr. Michelle Zeanah, who operates a clinic in southeast Georgia, confirmed that her office began receiving benefit statements last week reflecting the 30% payment cuts for September therapy appointments. Zeanah expressed concern about the financial viability of her clinic under the new rates, stating, "I can’t do that. From a business perspective, we’ll be too far in the red." She highlighted an existing shortage of providers in rural areas, where her clinic is often the only option for many families.
Amerigroup, an insurer within the Elevance family, notified clinics of the rate reduction in August. The insurer stated the cut is "intended to better align reimbursement across autism services." In an email to the state, Amerigroup also indicated it would increase rates for parent training on therapy strategies, calling it a "more targeted and clinically defensible approach." However, therapy advocates argue that while parent training is important, it cannot replace the work of trained clinicians. A spokeswoman for Amerigroup maintained that medically necessary services continue to be covered and advised patients to maintain appointments.
Georgia's Department of Community Health, which administers the state's Medicaid programs, outsources its Medicaid insurance work to three companies, with Amerigroup solely responsible for the foster child population. According to state spokeswoman Lauren Williams, Amerigroup is required to secure services with an out-of-network provider if an in-network provider is unavailable for an individual patient. However, McQueen stated she had not received such information from Amerigroup.
The potential impact on care access is significant. State Rep. Lee Hawkins, a Gainesville Republican who chairs the House committee on health, has been in communication with both Amerigroup and clinic operators regarding the issue. He reported that surveys conducted by industry representatives suggest 75% of clinics providing ABA therapy anticipate having to reduce or stop serving foster children within three months at the current rates. More than 90% expect to stop accepting new foster patients, which could lead to employee layoffs. Clinics are not facing the same challenge for patients insured under commercial plans like those offered by Anthem Blue Cross and Blue Shield of Georgia. Amanda Free, president of Anthem Blue Cross and Blue Shield of Georgia, who oversees commercial plans, declined to comment on the therapy cuts.
ABA therapy is a specialized treatment designed to teach skill sets to individuals who do not learn in traditional ways, with autistic children making up a large portion of patients. Advocates argue that early investment in this therapy can unlock critical life skills for some severely autistic children, potentially reducing the need for assistance later in life, even if it does not work for every child. Dr. Nathan Call, clinical director for the Marcus Autism Center in Atlanta, noted the strong research supporting ABA's effectiveness for some children, and its recent widespread acceptance with permanent billing codes issued by the American Medical Association in 2019. Families are often advised to seek ABA immediately after an autism diagnosis.
Nationally, concerns about fraud and waste in ABA spending have been raised. The U.S. Centers for Medicare and Medicaid Services (CMS) reported a 421% increase in ABA spending in government programs between 2021 and 2025, which far outpaced the increase in children receiving services after an autism diagnosis. CMS released a toolkit for states to oversee funding and structure, emphasizing the need for stronger oversight to ensure services are based on medical need, not financial incentives. Dr. Mehmet Oz, CMS administrator, stated that "families deserve confidence that ABA services are clinically appropriate, personalized, and delivered by qualified providers."
Anna Bullard, an activist for the therapy, acknowledged legitimate concerns about fraud and overbilling. She noted that all of Georgia's insurance contractors are attempting to mitigate rising autism therapy costs by cutting rates. Bullard emphasized that the core issue of ensuring children have access to quality care remains unaddressed. The therapy itself is costly and technical, requiring painstaking one-on-one analysis to develop individualized plans, with trained technicians and therapists working to break down learning into minuscule parts and rewarding progress.