Context

ABA (Applied Behavior Analysis) became covered by commercial insurance in 2014, with widespread adoption taking nearly a decade. This slow progression has created significant variability:

• Coverage Gaps: All 50 states offer some form of ABA coverage, but the extent varies dramatically. States like California and Massachusetts have comprehensive mandates, while states like Wyoming lack private insurance mandates but provide Medicaid access.
• Delayed Medicaid Expansion: For example, Georgia only began covering ABA under Medicaid in 2018. Since commercial insurance often mirrors Medicaid, such delays further fragment access to care.

This variability extends beyond coverage, affecting how providers are trained and enter the industry. With no consensus on what constitutes "quality care," families and providers face a patchwork of inconsistent practices and policies.

Adding to this complexity is ABA’s controversial foundation. Developed by Ole Ivar Lovaas, early ABA methods emphasized strict behavioral interventions that have faced criticism over time. Today, there is a stark divide between “old school” proponents of these methods and “new school” practitioners who emphasize patient-centered care. At Camber, we see this tension firsthand, working as a coalition builder trusted to convene even those who may disagree with each other.

Autism Care: The Current State

While ABA is the only commercially covered treatment for autism, this lack of diversity raises concerns. Autism is a complex, lifelong condition requiring multidisciplinary care, yet families often have only one insurance-covered option. This contributes to growing distrust among providers and parents. Emerging treatments, like MeRT (Magnetic e-Resonance Therapy) or private therapies, highlight innovation but exacerbate accessibility challenges.

On the legislative side, however, autism care is a rare bipartisan success. Autism services are universally recognized as medically necessary, a consensus that transcends political divides. Recent legislation, such as the renewal of Autism Cares ACT during the final days of the Biden administration, underscores this commitment.

Industry Challenges: Rates and Labor Retention

Workforce Dynamics (BACB Data)

ABA’s growth has led to a young, rapidly expanding workforce:

• 86% of BACB (Behavior Analyst Certification Board) practitioners identify as female.
• 45% are aged 25–34, and 21% are under 25.
• Licensure growth in the past five years:
  • RBT (Registered Behavior Technician): 211%
  • BCBA (Board Certified Behavior Analyst): 107%
  • BCaBA (Assistant Behavior Analyst): 65%

This rapid growth means many practitioners are inexperienced and poorly trained, creating a “blind leading the blind” dynamic. Combined with rising autism prevalence (1 in 36 children diagnosed, with increasing awareness and education per CDC), providers face burnout and high turnover.

Rates

Rates are another critical issue. Payment variability across state, national, and federal payers adds complexity:

• States like South Carolina have single insurers (e.g., BCBS SC) dominating market share.
• Nationally, UHC (Optum) controls ~15% of the market.