State Watch

Policy changes don't happen in a vacuum. Across the country, states are grappling with issues related to Medicaid funding, workforce shortages, reimbursement rates, provider networks, accountability efforts, fraud investigations, and access to care. This page tracks developments affecting ABA and disability services at the state level and will continue to evolve as new information becomes available.

Watch Status: 🔴 Active Advocacy Needed. | 🟡 Developing Concern | 🟢 Monitoring

Disclaimer: The summaries below are intended to identify emerging policy developments and are not legal advice, regulatory guidance, or comprehensive analyses of state law. Last Updated: May 31, 2026

🟡 California

Current Developments

  • Medi-Cal funding and budget discussions

  • Ongoing workforce shortages and service capacity concerns

  • Increased utilization management and authorization oversight

  • Ongoing waitlist and provider capacity concerns

  • Managed care and network adequacy discussions

Why It Matters

California serves one of the nation's largest populations of Medicaid-funded autism service recipients through Medi-Cal. As state leaders balance budget pressures, workforce shortages, and growing demand for services, discussions regarding reimbursement, utilization management, provider participation, and access to medically necessary care may have national implications. Because California often serves as an early indicator of broader Medicaid trends, policy developments within the state are closely monitored by providers, advocates, and policymakers across the country.

Resources | Last Reviewed: May 2026

While no single policy change currently rises to the level of immediate advocacy action, California's size and influence make ongoing developments important to monitor.

🟡 Florida

Current Developments

  • Provider network and enrollment policy changes

  • Enrollment pauses and participation requirements

  • Increased program integrity and fraud oversight efforts

  • Legislative and managed care policy activity

Why It Matters

Florida has focused on network adequacy, provider enrollment, and managed care oversight while simultaneously increasing scrutiny of provider accountability and program integrity. Efforts aimed at addressing fraud and ensuring quality services may improve oversight but have also raised concerns regarding access and provider participation in some areas.

Resources | Last Reviewed: May 2026

🔴 Hawaii

Current Developments

  • Ongoing federal litigation regarding access to medically necessary ABA services during the school day

  • Allegations that Medicaid-enrolled students continue to face barriers accessing ABA in educational settings

  • Stakeholders have raised concerns regarding coordination between schools and medical ABA providers.

  • Ongoing questions regarding coordination of ABA services delivered during the school day.

  • Workforce shortages and geographic access disparities across islands

Why It Matters

Hawaii remains the focus of ongoing federal litigation regarding access to medically necessary ABA services for Medicaid-enrolled students during the school day. The case raises questions regarding coordination among schools, healthcare providers, and Medicaid programs, as well as broader issues related to continuity of care and access to medically necessary services. The outcome may have implications for policy and practice both within Hawaii and nationally.

Resources | Last Reviewed: May 2026

🔴 Indiana

Current Developments

  • Weekly ABA service caps implemented

  • Prior authorization and utilization management changes

  • Increased oversight and audit activity

  • Provider concerns regarding access and sustainability

Why It Matters

Indiana has implemented changes to Medicaid-funded ABA services, including weekly hour caps and increased utilization review requirements. Families, providers, and advocates have raised concerns about the potential impact on individuals with higher support needs, particularly individuals whose clinical needs exceed newly established service limitations.. Ongoing discussions continue regarding access, medical necessity, cost containment, and service quality.

Resources | Last Reviewed: May 2026

🔴 Massachusetts

Current Developments

  • ACQ/BHCOE accreditation requirements

  • Increased oversight and enforcement activity

  • Program integrity initiatives

  • Quality and accountability standards

Why It Matters

Massachusetts has become one of the first states to require external accreditation for Medicaid ABA providers participating in MassHealth. Following audit findings, fraud settlements, and concerns regarding program integrity, state leaders have increased their focus on quality assurance, accountability, and provider oversight. These changes may influence how other states approach ABA regulation, accreditation, and Medicaid-funded services in the future.

Resources | Last Reviewed: May 2026

Resources | Last Reviewed: May 2026

🔴 New York

Current Developments

  • Proposed Medicaid-funded ABA cuts

  • Reimbursement and rate concerns

  • Provider concerns regarding sustainability and reimbursement

  • Significant advocacy and legal activity surrounding reimbursement changes

Why It Matters

New York has become one of the most visible examples of the tension between cost containment and access to medically necessary ABA services. Proposed Medicaid reductions and reimbursement concerns have prompted significant advocacy efforts from providers, families, and professional organizations.

Resources | Last Reviewed: May 2026

🟡 North Carolina

Current Developments

  • Proposed limitations on Medicaid-funded ABA services

  • Reimbursement and rate reduction discussions

  • Ongoing litigation and policy challenges

  • Provider concerns regarding reimbursement and long-term service capacity

Why It Matters

North Carolina is experiencing many of the same challenges seen in other states as policymakers seek to balance rising autism service expenditures with long-term Medicaid sustainability. Proposed limitations on ABA services, reimbursement discussions, and legal challenges have generated significant concern among families, providers, and advocates regarding continued access to medically necessary care.

Resources | Last Reviewed: May 2026

🟢 South Carolina

Current Developments

  • Increased collaboration between schools and medical ABA providers

  • Policy changes supporting coordination across educational and healthcare systems

  • Continued growth in autism service demand

  • Workforce and service capacity considerations

Why It Matters

South Carolina has recently enacted legislation supporting case-by-case consideration of medically necessary ABA services provided by private medical providers during the school day. The legislation establishes a framework for collaboration among schools, families, healthcare providers, and third-party payors while supporting individualized consideration of medically necessary services. These developments may improve continuity of care, reduce fragmentation between educational and healthcare systems, and serve as a model that other states may monitor as they address similar access-to-care concerns.

Resources | Last Reviewed: May 2026

Emerging Trends

Funding & Reimbursement

States continue to explore reimbursement changes, service caps, utilization management requirements, and other cost-containment strategies aimed at managing Medicaid expenditures while maintaining access to care.

School & Medical Collaboration

Several states are increasingly confronting questions regarding how educational systems and healthcare providers coordinate medically necessary services for students with disabilities. Recent legislation, litigation, and policy initiatives have focused on access to services during the school day, Medicaid-funded supports, provider collaboration, continuity of care, and the intersection of IDEA, Section 504, the ADA, and healthcare systems. Developments in states such as Hawaii and South Carolina reflect growing national attention to the intersection of education systems and medically necessary healthcare services.

Accountability & Oversight

Federal and state agencies have increased focus on program integrity, provider accountability, fraud prevention, documentation requirements, and quality assurance efforts across Medicaid-funded services.

Workforce Challenges

Recruitment, retention, training, and supervision remain persistent challenges affecting service capacity, provider sustainability, and the ability to meet growing demand for services.

Access to Care

Families continue to face concerns related to provider availability, network adequacy, waitlists, geographic disparities, and the impact of policy changes on medically necessary services.

Quality & Accreditation

States are increasingly implementing accreditation requirements, provider qualifications, quality assurance standards, and other measures intended to improve accountability and service quality.

Why State Watch Matters

Policy changes affecting autism and disability services often begin at the state level. Decisions about Medicaid funding, reimbursement rates, provider participation, oversight, workforce development, and service delivery can directly affect access to care for individuals and families. By tracking developments across states, providers, families, advocates, and policymakers can better understand emerging trends, learn from one another, identify potential risks, and support solutions that promote both access and accountability.

🔴 Active Advocacy Needed = Significant proposed or implemented policy changes that may substantially affect access to care.

🟡 Developing Concern = Emerging developments being monitored.

🟢 Monitoring = Notable developments with no immediate action identified.

DISCLAIMER: State Watch is intended for informational and advocacy purposes. Policy proposals, regulations, court actions, and administrative guidance can change rapidly. Readers should consult official state agencies and legal sources for the most current information.