PALM BEACH COUNTY, Fla. — Palm Beach County parents say their children lost access to a critical autism therapy after Medicaid abruptly stopped covering it — and Florida's health agency has not explained why.
The therapy at the center of the dispute is Applied Behavioral Analysis, or ABA. The Cleveland Clinic describes it as "a research-based behavior therapy for people with autism and other developmental disorders," adding that "many studies have proven the effectiveness of ABA."
Families connected to Reflection Services ABA Therapy in Lake Worth say they received notice that Medicaid would no longer cover their children's treatment. For many, the loss has been immediate and painful.
"It's like a dark hole. Like you don't know what to do," Daura Mabel Sanchez Cano de Fundora said.
Her son David, she said, is classified by his neurologist as level one on the autism spectrum. She described the progress he had made through ABA.
"His vocabulary have been increasingly amazing. He can make sentences. He can understand what is happening," Sanchez Cano de Fundora said. "How you can deny a service that can decide the life of those children and those parents?"
Myrian Suarez, a mother of two boys with autism, described the daily demands of caring for her children without adequate support.
"I have to do everything for them: feed them, bathe them, help them get dressed, comb their hair — everything, everything, everything," Suarez said.
She said ABA gave her son tools to manage his emotions.
"His therapist gives him tools so he can channel the frustration he feels," Suarez said.
Talia Quiroz said her daughter Salma was diagnosed with autism at 2 and a half years old. She described the progress Salma made through ABA therapy.
"She can learn. She can do math. She can learn to read. She can learn to write. In fact, things that years before we're not thinking that will be possible," Quiroz said.
Since the therapy stopped, Quiroz said she has experienced dangerous regressions in her daughter's behavior.
"I cannot show, but I have bites all over me," Quiroz said.
Suarez described similar physical consequences.
"I have bruised arms from (one of my son's) pinching," Suarez said.
She also described the role ABA support plays in her son's school day.
"The ABA registered behavior technician at school helps Dagito stay seated and complete his tasks, but she is also protecting Dagito from other children who are like him and protecting the other children from how Dagito is," Suarez said.
"It just hurts-- not just as a family, but it hurts thinking in the future," Quiroz said. "(The kids) deserve it... The chance to be able to grow up and be part of this society."
A national pattern
Reports of Medicaid cuts to ABA therapy have surfaced in states across the country.
The Health and Human Services Office of the Inspector General audited Medicaid spending on ABA in Maine, Michigan, Wisconsin, and Colorado. Its findings identified roughly $200 million — specifically $197.9 million — in what it considers improper payments among the four states.
A separate audit in Nebraska found yearly Medicaid spending on ABA therapy multiplied 18 times over, across a five-year period.
The Trump administration has said it is targeting waste, fraud, and abuse in government healthcare spending.
"We are not sending Medicaid and Medicare dollars out the door until we have confidence that they are being spent lawfully and appropriately," U.S. Health and Human Services Secretary Robert Kennedy Jr. said during a news conference last week.
Florida has not been officially audited, so it's not immediately clear how much its Medicaid program spends on ABA.
Providers push back
Melissa Moran, a registered behavior technician at Reflection Services ABA Therapy, acknowledged the cost of the services but said the consequences of cutting them must be weighed carefully.
"We know that the services are expensive," Moran said. "(But) the things that may happen in society if they don't have ABA — those are really important. So those are things that we need to take into account when cutting funds."
Moran warned of the societal repercussions of families losing access to ABA, as forcing some parents to supervise their children around the clock.
"So the parents may not go to work, so that affects the economy of this country," Moran said. "Sometimes (the kids) have unsafe behaviors-- physical aggression. They have self-injurious behaviors. All of these kind of behaviors that may put themselves, the other kids, at risk too. So that's something that may affect the rhythm of the class that's at school and in the community.
State has not responded
Questions were sent to Florida's Agency for Healthcare Administration, which runs the state's Medicaid program. The agency has not responded.
A public records request was also filed asking for a detailed breakdown of Medicaid spending on ABA, or any documents that could help explain why the state is no longer paying for the therapy. That request is still pending.
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