The Biggest ABA Market in the Country Is Deciding Whether to Cap How Many Months a Child Gets Treatment

Florida spent $6.57 billion on applied behavior analysis between 2023 and 2025 — more than any other state, and roughly four times the next two combined. Indiana came second at $1.65 billion. North Carolina third at $1.53 billion.

Those figures come from Shena Grantham, Florida's deputy secretary for Medicaid policy and quality, presenting to a blue-ribbon panel in Tallahassee this month. Her summary of the numbers was six words long:

"There's something unusual happening … that deserves a closer look."

What the task force is

The Applied Behavior Analysis Task Force was created by the Legislature through HB 5003-E in the fiscal 2026-27 budget. It has 10 members and is chaired — non-voting — by AHCA Secretary Shevaun Harris. Its inaugural meeting was held in mid-August.

Its charge is to review how ABA is delivered under Florida Medicaid so care stays high-quality and family-centered, the program stays financially sustainable, and current recipients do not lose access. It must report to the Governor, the Senate President and the House Speaker by December 31, 2026. Harris has suggested finishing the bulk of the recommendations by the end of October, while noting the schedule is "not set in stone."

The six things it must examine

• Clinical care models for therapy at appropriate ages
• Transitions across developmental, educational and community settings
• Quality metrics for ABA services
• Limits and use controls on the length of service authorizations
• Potential caps on months of ABA services
• Enhanced Medicaid provider enrollment and billing standards

Item five is the one without precedent at this scale. States have capped weekly hours — Nebraska at 20 without prior authorization since July 1, Indiana with a 4,000-hour lifetime ceiling. A cap on months is a different instrument: it puts an expiry date on a course of treatment regardless of clinical progress, and Florida is the largest market that has ever seriously considered one.

The number driving the scrutiny

About 55,000 children aged 20 and under receive ABA through Florida Medicaid, at roughly $2.3 billion a year. The statistic that will be quoted in every hearing from here is this one: approximately 25 percent of children receiving Medicaid-covered ABA — roughly 13,698 — have no autism spectrum disorder diagnosis.

That figure deserves care rather than a headline. ABA is not diagnostically restricted to autism, and under EPSDT a state must cover medically necessary services for a range of conditions. A quarter of recipients lacking an ASD diagnosis is not by itself evidence of fraud. But it is the kind of number that shapes a task force's assumptions before the first witness speaks, and providers should expect to be asked to explain their own diagnostic mix.

What Florida has already tried

This is not the state's first attempt at cost control. Prior efforts included pilot programs and a moratorium on ABA provider enrollments. Costs went up anyway. That history is why the task force is looking at structural limits rather than another round of screening.

Families are already reporting the friction. Nicole Grabner, a disabled veteran and mother of two autistic children, told the panel about service disruptions:

"These disruptions are kind of concerning, especially now that we are getting into the new school year, when consistency is most critical."

Why this matters outside Florida

CMS handed states a 173-page ABA toolkit on August 4 and told them to tighten authorization controls and measure outcomes. Florida is the first large state to convene a formal body to do exactly that, on a public clock, with a report going to a Governor and Legislature that have already shown they will act on it.

Whatever Florida writes by December 31 will be the most detailed state-level answer to the toolkit in existence. Other states will not have to invent their own.