A mother in Palm Beach County has bruises on her arms. Another one said her daughter is biting her now. A third watched her son go from nonverbal to speaking in full sentences, and then watched it start slipping backward.
All three told a reporter the same thing. Their kids lost ABA therapy, and nobody explained why.
The story ran last week, and the headline said Florida cut Medicaid coverage for autism therapy. I understand completely why it got written that way. That is exactly what it feels like from inside a family. But it is not what happened, and the difference matters more than almost anything else I could tell you today.
Because if we say it wrong, the state gets to issue a one line correction and walk away. And if we say it right, somebody has to answer a much harder question.
Florida did not cut ABA. Florida cannot cut ABA.
Here is the part almost nobody is reporting.
In 2012, a federal judge ordered Florida Medicaid to cover applied behavior analysis for eligible children with autism. The state fought it and lost. In 2013, a federal appeals court backed that judge up. The case is called Garrido v. Dudek, and the order it produced has never been dissolved. It still stands today.
Florida is under a federal court order to cover medically necessary ABA for kids on Medicaid under 21. A blanket cut is not a thing the state is legally allowed to do.
So the benefit is still on the books. It is the access that broke.
I want to be careful here, because this is where it gets genuinely important. That same appeals court, in the same ruling, preserved one thing for the state. It said Florida can still make medical necessity determinations case by case, one child at a time.
Hold onto that. It explains everything that follows.
What Florida actually did
Three things changed, and none of them was a cut.
February 1, 2025. Florida moved ABA into managed care. Nine private insurance companies took over prior authorization, provider contracting and payment. Before that, the state's own review organization handled approvals. Now nine companies do, each with its own rules, its own paperwork, and its own portal.
February 10, 2025. Nine days later, the coverage policy tightened. A doctor's order used to be enough to start. It is not anymore. Families now need a full comprehensive diagnostic evaluation performed by a licensed practitioner, plus two specific assessments scored and submitted with the authorization request. And every six months, you do the reassessment and prove it all again.
March 13, 2026. A state senator had filed a bill in January that would have stopped insurance plans from freezing ABA providers out of their networks, forced them to use one standardized credentialing process, and barred them from making providers submit the same documents to multiple portals. It was called SB 1648. It died in committee. It never got a floor vote.
Four months after that bill died, families in Palm Beach County started losing care.
The part where I tell you what is mine and what is not
Everything above is documented. The dates, the rule change, the bill, the court order. You can look all of it up, and I hope you do.
What comes next is my opinion, and I am labeling it as opinion because I think you deserve to know which is which.
When a blanket cut is illegal but denying children one at a time is not, handing that decision to nine insurance companies and raising the paperwork bar is how you get the result without the cut. Nothing gets repealed. Nobody votes on anything. The benefit stays right there on the books where anyone can point to it. And the kids stop going.
Somebody is going to ask me whether I think that is the point. Whether it was designed that way.
Maybe. I am not going to guess. I have been doing this long enough to know that the second you start assigning motive you have handed the other side an easy way to dismiss you, and I would rather keep the harder question in front of people.
About the fraud, because it is real
I am not going to pretend the other side has no argument. It does, and I want to give it fairly.
Federal auditors have confirmed 197.9 million dollars in improper Medicaid payments for ABA across four states, and they have recommended those states refund roughly 123 million of it. In one state, yearly ABA spending went from about 4.6 million dollars to about 85.6 million in four years. Those are not small numbers and they are not made up.
Prosecute every one of them. I mean that without a single qualifier. Anybody who billed Medicaid for therapy a child never received stole from disabled kids, and I have no interest in defending them.
But two things need saying right after that.
The first is that Florida is not one of those four states. Florida has never been audited on ABA. There is no federal audit finding against Florida. The reporter who broke this story filed a public records request asking what Florida actually spends on ABA, and as of this writing it is still pending, which means nobody outside the agency knows.
The second is what those audits actually found. Overwhelmingly, it was documentation. Session notes that did not record what was done.
Credentials that were never verified. Treatment plans that did not support the hours billed. That is a paperwork failure, by clinics and by state agencies that had never once run a post payment review before the federal government showed up. It is not a finding that the children did not show up.
And here is the thing about enforcement that operates through credentialing friction and authorization delay. It does not reach the provider who already got charged and excluded. That provider is gone. It reaches the ones still open, still filing, still trying to get it right.
A Florida mom named Michelle Roselle said it better than I can. She was at a rally in May, and she said this: "If they're so sure that there's fraud going on, go after the people that you're sure of. Don't just shut down everything."
What I know about re-proving your kid
I have been an autism dad for 25 years. Three of my kids are autistic. And if there is one thing I understand in my bones, it is the specific exhaustion of having to prove, over and over, that your child still needs the help they needed six months ago.
You gather the paperwork. You book the evaluation. You wait for the slot. You fill out the forms about the worst days, because the worst days are what qualify you, and you sit there describing your kid at their hardest to a stranger who has never met them.
Then you send it in and you wait, and while you wait the services pause, and while the services pause your kid loses ground. And when you finally get approved again you start counting down to the next time.
Every added step in that process is a family that falls out. Not because they stopped needing it. Because they ran out of road.
That is not an accident of bad design. That is what a paperwork requirement does, and anybody who has ever administered one knows it.
If you are in Florida
You have appeal rights. If your child's ABA was denied or the hours were cut, that decision can be appealed, and you should appeal it. Denials get overturned more often than families expect, and a denial is the beginning of a process rather than the end of one.
Ask your plan for the denial in writing, with the specific reason stated. Ask what is missing. Ask for the deadline to appeal, and write it down. If you switched plans or providers recently, ask specifically about continuity of care, because there are protections that carry your prior authorization forward for a window after a transition.
And if you get told your provider is not in network, that is a different problem than a medical necessity denial, and it gets solved a different way. Make them tell you which one you are actually dealing with.
If you do not live in Florida
Read this one anyway.
Nothing about what happened in Florida is unique to Florida. Any state can move a benefit into managed care. Any state can tighten a documentation standard. Any state legislature can let a bill die in committee in March and not connect it to the families calling in July.
This is the same pattern I wrote about with the DOJ's Olmstead notice and with Texas v. Kennedy. Almost nothing that has happened to disabled families this year happened by repealing a right. It happened by changing who decides, or by declining to enforce, or by adding a step. The law stays exactly where it was. The access moves. If you want the whole arc in one place, I laid it out in the mid-year policy recap.
Once you can see that shape, you stop waiting for the headline that says they took it away. That headline is not coming. The paperwork is the headline.
I also know that seeing it does not make it easier to carry. If this is the third story like this you have read this month and you can feel yourself going numb, that is a normal response to an abnormal amount of news, and I wrote something about how to stay in this without it eating you.
The question
In May, Florida's health agency told a reporter it was closely monitoring ABA access, provider enrollment, and feedback from families.
In July, when families started losing care, it stopped responding. The records request is still pending.
So I have one question, and I think it is a fair one.
What did the monitoring find?
If you want to push on this, there are free scripts for contacting state officials at theautismdad.com/takeaction. And if your family is living this in Florida right now, tell me in the comments. I read them, and the thing agencies respond to is volume.
Sources
WPTV Investigates, "Florida families fight Medicaid cuts to autism therapy, say children lost access without warning," July 27, 2026.
NBC 6 South Florida, "Families say this Florida Medicaid shift is putting autism care at risk," May 22, 2026. Source of the Michelle Roselle quote and the state agency's May statement.
Florida Senate, SB 1648, Access to Applied Behavior Analysis Services. Filed January 9, 2026. Died in Health Policy March 13, 2026.
Florida Medicaid Behavior Analysis Services Coverage Policy, rule 59G-4.125, effective February 10, 2025. Florida Agency for Health Care Administration.
Florida Statewide Medicaid Managed Care behavior analysis carve-in, effective February 1, 2025.
Garrido v. Dudek, 731 F.3d 1152 (11th Cir. 2013), affirming as modified the permanent injunction entered in the Southern District of Florida in 2012.
U.S. Department of Health and Human Services Office of Inspector General, Audits of Medicaid Applied Behavior Analysis for Children Diagnosed With Autism. Reports issued to date cover Indiana, Wisconsin, Maine and Colorado.
Florida Health Justice Project, "Important Change To Behavior Analysis (BA) Therapies for Medicaid Enrolled Children," December 2024. Covers continuity of care and appeal rights.
