Saturday, March 28, 2026

In Charts: Audits Spotlight Unusual Trends in Medicaid Spending for Autism Care (Connecting the Dots: Autism Speaks, Medicaid, Minnesota & The Carnegie/Soros Network)

 In Charts: Audits Spotlight Unusual Trends in Medicaid Spending for Autism Care (Connecting the Dots: Autism Speaks, Medicaid, Minnesota & The Carnegie/Soros Network)

Spending on autism therapy services is dramatically outpacing overall Medicaid spending, prompting state and federal scrutiny.

The Epoch Times

By Sylvia Xu

March 27, 2026

Updated:

March 27, 2026

https://www.theepochtimes.com/article/in-charts-audits-spotlight-unusual-trends-in-medicaid-spending-for-autism-care-5997375?ea_src=frontpage&ea_med=section-1

One in 31 U.S. children has an autism diagnosis. Among Minnesota’s Somali community, that number jumps to one in 12.

That discrepancy made headlines last fall when the Department of Justice charged a Somali woman with netting millions in fraudulent autism services. Now, state and federal investigators are putting autism spending in the spotlight.

The September 2025 federal indictment alleged that a therapy center—run by 28-year-old Asha Farhan Hassan—recruited Somali children for an autism services program that was then reimbursed by Medicaid.

The White House pointed to the indictment on March 16 in an executive order announcing the creation of a federal task force to eliminate fraud.

“The staggering fraud and waste in Minnesota alone is a case in point,”  the order reads.

“There is also strong reason to believe that similar problems exist in other States, including California, Illinois, New York, Maine, and Colorado.”

US Medicaid Spending Increase Rate, 2018 to 2024

Click on link to view charts. 

Chart: The Epoch TimesSource: Statista, U.S. Department of Health and Human Services Open DataCreated with Datawrapper

Nationwide, Medicaid spending for autism therapy services increased by over 200 percent between 2018 and 2024—nearly four times the rate of overall Medicaid spending. In some states, the increase was much higher.

The surge is linked to what Health and Human Services Secretary Robert F. Kennedy Jr. has called an autism epidemic, including “an alarming escalation in case severity, and increasingly stark disparities across racial and ethnic groups.”

However, investigators say the rise in spending can’t be explained by the increase in diagnoses or escalation in severity alone.

Meanwhile, a series of federal audits has drawn attention to four states where auditors found millions in “improper” or incorrectly billed payments for Medicaid-funded autism services.

Here is a look at states that have uncovered higher-than-usual Medicaid spending for autism services.

Minnesota

Since 2018, Minnesota has spent more than $18 billion on 14 Medicaid programs considered “high risk” for fraud, Assistant U.S. Attorney Joe Thompson said in December.

More than $9 billion of that money went to fraud, Thompson estimated, announcing another autism related indictment.

The state’s Early Intensive Developmental and Behavioral Intervention program, which treats children under 21 with autism spectrum disorder, is under particular scrutiny.

It’s the coverage framework for services like applied behavior analysis, a major part of the program.

Applied behavior analysis is a widely used behavior therapy, primarily used with children who have been diagnosed with autism or other developmental disorders. It can include teaching children to follow directions or practicing communication or social skills. Registered behavior technicians usually administer the therapy, supervised by more highly trained behavior analysts.

On March 17, Minnesota released the results of its own audit investigating allegations of kickbacks in the state’s autism services program.

Chairman Rep. James Comer (R-Ky.) (C) speaks during a House Oversight and Government Reform Committee hearing at the U.S. Capitol on March 4, 2026. The committee held the hearing to examine the alleged misuse of federal funds intended for Minnesota Medicaid programs. Anna Moneymaker/Getty Images

For over 30 years, the report said, the state’s definition of “fraud” has not included kickbacks.

“While DHS could have acted at any time to revise its rules, it has permitted the error to stand since 1995, limiting its authority to address kickbacks,” the report said.

Meanwhile, the cost of the state’s autism early intervention service increased nearly 1,600 percent from 2019 to 2024, according to a March report from the House Committee on Oversight and Government Reform.

Enrollment ballooned by more than 620 percent during those years.

Autism Rate Among Children in Minnesota

Click on link to view charts. 

Source: Minnesota Autism and Developmental Disability Monitoring

A state-commissioned report from United Health Group’s Optum division found Minnesota could have saved more than $1 billion in autism early intervention costs between January 2022 and October 2025, if officials had clarified ambiguous policies. An addendum to the January report revised that number to $703 million.

An investigation revealed patterns of claims that didn’t match clear policies or procedures.

“If the pre-payment system being developed now had been in place at the time, these items would have been flagged for further review and payments paused, until additional investigation was completed,” John Connolly, deputy human services commissioner and state Medicaid director, said in February.

“This is not a measure of fraud, waste and abuse, but it shows us where we need to do more work to understand why these claims are raising red flags,” Connolly said in a statement.

Minnesota Autism Services Medicaid Spending and Enrollment

Click on link to view charts. 

*Data for 2025 remains partial through September 30.

Source: House Committee on Oversight and Government Reform

Nebraska

Nebraska’s Medicaid spending for applied behavior analysis increased notably over a similar time period. It grew by 1,700 percent from 2020 to 2024, according to a report last fall from the state’s Health and Human Services department.


The Holland Center, an autism treatment center for children and adults, in Minnetonka, Minn., on Feb. 11, 2026. In Minnesota, an estimated one in 12 eight-year-old Somali children allegedly has autism spectrum disorder, which is double the overall state average of one in 28. Adam Hester/The Epoch Times

The number of companies providing applied behavior analysis services nearly quadrupled, growing from 10 to 38 over the four years.

The number of behavior analysts and technicians billing for autism services in the Cornhusker State rose by 761 percent from 2019 to 2024—higher than Minnesota’s rate of growth in that area, which was 646 percent, according to a December report from Trilliant Health, a health care analytics company. 

Nebraska Applied Behavior Analysis Services: Increase in Medicaid Spending and Providers

Click on link to view charts. 

Source: Nebraska Department of Health and Human Services

The payment rates in Nebraska were the highest in the nation, according to the Nebraska Department of Health and Human Services.

“We found that Nebraska’s rates for these services have been significantly higher, some more than twice as high, as those of other state Medicaid programs,” said Drew Gonshorowski, Medicaid and long-term care division director for the department.

A behavior technician in Nebraska earned $36.11 per 15-minute unit in 2024. That’s slightly more than $144 an hour, and 130 percent higher than the national average.

Behavior technicians typically undergo 40 hours of training and must have a minimum of a high school diploma.

In August 2025, the state agency reduced Medicaid payment for a behavior technician by 48 percent, bringing the rate from $36.11 to $18.70 per 15-minute unit, or $74.80 per hour.

The “Light It Up Blue” autism awareness celebration is held at the Chicago Children’s Museum in Chicago on April 8, 2017. Medicaid spending for autism therapy services increased by more than 200 percent between 2018 and 2024—nearly four times that of overall Medicaid spending. Daniel Boczarski/Getty Images for Autism Speaks

North Carolina

In North Carolina, spending on autism therapy is projected to exceed $1 billion over the next two years.

Medicaid spending on applied behavior analysis in the state grew by 347 percent from 2022 to 2025, North Carolina Medicaid deputy secretary Melanie Bush reported in a joint legislative oversight committee meeting March 10.

“Nothing here can answer the question of where that growth rate is coming from,” state Sen. Ralph Hise said during the meeting.

Spending growth was concentrated among a small number of providers and far outpaced growth in new provider enrollment, according to a report from the North Carolina Department of Health and Human Services.

Utilization growth also increased faster than the autism diagnoses, the report said.

While total Medicaid enrollees receiving applied behavior analysis services grew by 249 percent over the four years, the number of 15-minute service increments increased even more, by 305 percent.

“Utilization growth far outpaces increases in Autism Spectrum Disorder (ASD) diagnosis,” the report said, adding that it’s “unlikely that this level of growth can be explained by increased access alone.”

North Carolina Applied Behavior Analysis Services: Increase in Medicaid

Spending and Enrollment

Click on link to view charts. 

*Data for 2026 and 2027 are projected.

Source: North Carolina Department of Health and Human Services 

Massachusetts

MassHealth, the Medicaid and children’s health insurance program for Massachusetts, overpaid autism service providers $17.3 million in 2024, according to an audit report from the state’s Office of the Inspector General.

The state’s spending on autism services rose 36 percent between 2021 and 2023, according to the 2024 report.

A slide outlining details of an autism service fraud scheme is displayed during a news conference by the U.S. Attorney’s Office at the U.S. District Court in Minneapolis on Dec. 18, 2025. Kerem Yucel/Minnesota Public Radio via AP

State rules require that a licensed applied behavior analyst provide at least one hour of supervision for every 10 hours of therapy given by a technician.

Nearly $16.8 million was overpaid because the therapy provided was over that ratio and should not have been billed, the audit found.

Further, from 2018 to 2022, behavior technician roles in the state grew at twice the pace of licensed supervisor positions, at 129 percent and 52 percent, respectively.

When applied behavior analysis is not properly supervised, it undermines the quality of care for vulnerable children and results in the waste of public funds, the audit concluded.

Massachusetts Applied Behavioral Analysis Services: Increase in Spending, Enrollment, and Service Usage

Click on link to view charts. 

Source: Office of the Inspector General for the Commonwealth of Massachusetts

Federal Audits

At the federal level, the HHS Office of Inspector General is investigating services and billing patterns for Medicaid applied behavior analysis services provided to children with autism.

The audits, which began in 2022, have been completed for four states: Colorado, Indiana, Wisconsin, and Maine. Three other audits remain in progress.

The federal agency estimated nearly $200 million in improper payments and more than $400 million in potential improper payments for these states.

The completed audits found payments that were improper or potentially improper in 100 percent of reviewed claims. That was often due to inadequate records, such as missing progress notes, lack of supervision logs, or billing issues.

However, the audits also uncovered problems that could affect the quality and safety of care, such as criminal convictions for weapons offenses, assault or driving under the influence.

Improper Medicaid Payments for Autism Therapy

Click on link to view charts. 

Table: The Epoch TimesSource: Office of Inspector GeneralCreated with Datawrapper

Connecting the Dots:

Donald M. Berwick was an administrator for the Centers for Medicare & Medicaid Services and is a senior fellow at the Center for American Progress.

Foundation to Promote Open Society was a funder for the Center for American Progress and the Carnegie Endowment for International Peace (think tank).

George Soros was the chairman for the Foundation to Promote Open Society, a supporter for the Center for American Progress and is the founder & chairman for the Open Society Foundations.

Open Society Foundations was a funder for the Center for American Progress and the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Center for American Progress and a supporter for the American Society for Muslim Advancement.

Ted Lieu was honored with the Carnegie Corporation of New York's Great Immigrants Award, has represented California's 36th congressional district in the United States House of Representatives since 2023 and is a member of the Congressional Progressive Caucus.

Astrid S. Tuminez was a program officer at the Carnegie Corporation of New York and is the 7th President of the Utah Valley University (Charlie Kirk Shooting).

Andrew Carnegie was the founder of the Carnegie Corporation of New York and the founder of the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Center for American Progress, the Carnegie Endowment for International Peace (think tank) and a supporter for the American Society for Muslim Advancement.

Foundation to Promote Open Society was a funder for the Center for American Progress and the Carnegie Endowment for International Peace (think tank).

George Soros was the chairman for the Foundation to Promote Open Society, a supporter for the Center for American Progress and is the founder & chairman for the Open Society Foundations.

Open Society Foundations was a funder for the Center for American Progress and the Carnegie Endowment for International Peace (think tank).

Morton H. Halperin  was a senior fellow at the Center for American Progressserved with the Carnegie Endowment for International Peace (think tank), is a senior adviser for the Open Society Foundations, Newsmax’s Mark Halperin’s father and a director at the ONE Campaign.

Mark Halperin is Morton H. Halperin’s son, In 2010, Halperin joined MSNBC, becoming the senior political analyst and a contributor, the founding editor for Bloomberg Politics and is currently a host and commentator for Newsmax TV.

Harold E. Ford Jr. is a political commentator at MSNBC and was an overseer at the International Rescue Committee.

Andrew Robertson is an overseer at the International Rescue Committee and a director at Autism Speaks.

Foundation to Promote Open Society was a funder for the International Rescue Committee.

George Soros was the chairman for the Foundation to Promote Open Society.

International Rescue Committee is a partner with the ONE Campaign.

Bloomberg Politics is a division of Bloomberg LP.

Michael R. Bloomberg is the founder of Bloomberg LP and an advocate for the ONE Campaign.

Michelle Obama was an advocate for the ONE Campaign.

Howard G. Buffett is a director at the ONE Campaign and Warren E. Buffett’s son.

Susan A. Buffett is a director at the ONE Campaign and Warren E. Buffett’s daughter.

Warren E. Buffett is Susan & Howard Buffett’s father and an adviser at the Nuclear Threat Initiative (think tank)

David A. Hamburg was an adviser for the Nuclear Threat Initiative (think tank) and the president emeritus for the Carnegie Corporation of New York.

Carnegie Endowment for International Peace (think tank) was a funder for the Nuclear Threat Initiative (think tank)

Carnegie Corporation of New York was a funder for the Carnegie Endowment for International Peace (think tank) the Nuclear Threat Initiative (think tank) and a supporter for the American Society for Muslim Advancement.

Ted Lieu was honored with the Carnegie Corporation of New York's Great Immigrants Award, has represented California's 36th congressional district in the United States House of Representatives since 2023 and is a member of the Congressional Progressive Caucus.

Astrid S. Tuminez was a program officer at the Carnegie Corporation of New York and is the 7th President of the Utah Valley University (Charlie Kirk Shooting).

Andrew Carnegie was the founder of the Carnegie Corporation of New York and the founder of the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Center for American Progress, the Carnegie Endowment for International Peace (think tank) and a supporter for the American Society for Muslim Advancement.

Foundation to Promote Open Society was a funder for the Carnegie Endowment for International Peace (think tank).

George Soros was the chairman for the Foundation to Promote Open Society, is the founder & chairman for the Open Society Foundations and a friend of Michael Douglas.

Open Society Foundations was a funder for the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Carnegie Endowment for International Peace (think tank) the Nuclear Threat Initiative (think tank) and a supporter for the American Society for Muslim Advancement.

Carnegie Endowment for International Peace (think tank) was a funder for the Nuclear Threat Initiative (think tank)

Michael Douglas is a director at the Nuclear Threat Initiative (think tank) and a friend of George Soros.

Ted Turner is a co-chairman for the Nuclear Threat Initiative (think tank), the founder of CNN and the chairman for the Turner Foundation

Cecile Richards was the grant overseer for the Turner Foundation, the president of the Planned Parenthood Federation of America, the president of the Planned Parenthood Action Fund and the founder & president of America Votes.

Bloomberg Family Foundation was a funder for the Planned Parenthood Federation of America.

Open Society Foundations was a funder for the Planned Parenthood Federation of America.

George Soros is the founder & chairman for the Open Society Foundations.

Planned Parenthood Action Fund is a national partner with America Votes.

Kamala D. Harris had a 100% rating from the abortion rights advocacy group Planned Parenthood Action Fund and Tim Walz ran as her Vice President pick in the 2024 vice presidential campaign.

Tim Walz supports a legal right to abortion, has a 100% rating from Planned Parenthoodran as  Kamala Harris’s Vice President pick in the 2024 vice presidential campaign and is governor of Minnesota.

Bloomberg Family Foundation was a funder for the Planned Parenthood Federation of America and the Bill, Hillary & Chelsea Clinton Foundation

Mark Dayton was a funder for the Bill, Hillary & Chelsea Clinton Foundation, is the Minnesota state government governor and Tina Smith is his chief of staff.

Tina Smith is Mark Dayton’s chief of staff and was a VP for the Planned Parenthood Federation of America

Open Society Foundations was a funder for the Bill, Hillary & Chelsea Clinton Foundation, the Planned Parenthood Federation of America and the Alliance for Justice.

George Soros is the founder & chairman for the Open Society Foundations.

Tim Mynett was as a Foundation Manager at the Alliance for Justice, an advocacy group that fights for a fair justice system and is married to Ilhan Omar.

Robert Raben  is a director at the Alliance for Justice, the president of the Raben Group and was a director at the American Constitution Society.

Open Society Foundations was a funder for the Alliance for Justice and the American Constitution Society.

George Soros is the founder & chairman for the Open Society Foundations.

Ramona E. Romero was a director at the American Constitution Society and the general counsel for the U.S. Department of Agriculture.

Supplemental Nutrition Assistance Program (SNAP) is a program at the U.S. Department of Agriculture.

Rajiv Shah was an undersecretary for research, education & economics for the U.S. Department of Agriculture and is a director at the Atlantic Council of the United States (think tank).

Open Society Foundations was a funder for the Atlantic Council of the United States (think tank).

George Soros is the founder & chairman for the Open Society Foundations.

Carnegie Corporation of New York was a funder for the Atlantic Council of the United States (think tank) and a supporter for the American Society for Muslim Advancement.

Ted Lieu was honored with the Carnegie Corporation of New York's Great Immigrants Award, has represented California's 36th congressional district in the United States House of Representatives since 2023 and is a member of the Congressional Progressive Caucus.

Astrid S. Tuminez was a program officer at the Carnegie Corporation of New York and is the 7th President of the Utah Valley University (Charlie Kirk Shooting).

Andrew Carnegie was the founder of the Carnegie Corporation of New York and the founder of the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Carnegie Endowment for International Peace (think tank), the Brookings Institution (think tank) and a supporter for the American Society for Muslim Advancement.

Foundation to Promote Open Society was a funder for the Carnegie Endowment for International Peace (think tank) and the Brookings Institution (think tank).

George Soros was the chairman for the Foundation to Promote Open Society,

John Edward Porter was an honorary trustee at the Brookings Institution (think tank) and is the chair for Research!America.

Herbert Pardes is a director at Research!America and a director at Autism Speaks.

Susan Dentzer is a director at Research!America and a director at the International Rescue Committee.

Foundation to Promote Open Society was a funder for the International Rescue Committee.

George Soros was the chairman for the Foundation to Promote Open Society.

Andrew Robertson is an overseer at the International Rescue Committee and a director at Autism Speaks.

ONE Campaign is a partner with the International Rescue Committee.

Michelle Obama was an advocate for the ONE Campaign

Howard G. Buffett is a director at the ONE Campaign and Warren E. Buffett’s son.

Susan A. Buffett is a director at the ONE Campaign and Warren E. Buffett’s daughter.

Michael R. Bloomberg is an advocate for the ONE Campaign and the founder of Bloomberg LP.

Mark Halperin was the founding editor for Bloomberg Politics, In 2010, Halperin joined MSNBC, becoming the senior political analyst and a contributor, is currently a host and commentator for Newsmax TV and Morton H. Halperin’s son.

Harold E. Ford Jr. is a political commentator at MSNBC and was an overseer at the International Rescue Committee.

Andrew Robertson is an overseer at the International Rescue Committee and a director at Autism Speaks.

ONE Campaign is a partner with the International Rescue Committee.

Morton H. Halperin is a director at the ONE Campaign, a senior adviser for the Open Society Foundations, Newsmax’s Mark Halperin’s father, was a senior fellow at the Center for American Progress and served with the Carnegie Endowment for International Peace (think tank).

Donald M. Berwick is a senior fellow at the Center for American Progress and was an administrator for the Centers for Medicare & Medicaid Services.

Foundation to Promote Open Society was a funder for the Center for American Progress and the Carnegie Endowment for International Peace (think tank).

George Soros was the chairman for the Foundation to Promote Open Society, a supporter for the Center for American Progress and is the founder & chairman for the Open Society Foundations.

Open Society Foundations was a funder for the Center for American Progress and the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Center for American Progress the Carnegie Endowment for International Peace (think tank), the Nuclear Threat Initiative (think tank) and a supporter for the American Society for Muslim Advancement.

Ted Lieu was honored with the Carnegie Corporation of New York's Great Immigrants Award, has represented California's 36th congressional district in the United States House of Representatives since 2023 and is a member of the Congressional Progressive Caucus.

Astrid S. Tuminez was a program officer at the Carnegie Corporation of New York and is the 7th President of the Utah Valley University (Charlie Kirk Shooting).

Andrew Carnegie was the founder of the Carnegie Corporation of New York and the founder of the Carnegie Endowment for International Peace (think tank).

Carnegie Corporation of New York was a funder for the Center for American Progress the Carnegie Endowment for International Peace (think tank), the Nuclear Threat Initiative (think tank) and a supporter for the American Society for Muslim Advancement.

Carnegie Endowment for International Peace (think tank) was a funder for the Nuclear Threat Initiative (think tank)

Warren E. Buffett is an adviser at the Nuclear Threat Initiative (think tank) and Susan & Howard Buffett’s father.

Michael Douglas is a director at the Nuclear Threat Initiative (think tank) and a friend of George Soros.
Ted Turner
 is a co-chairman for the Nuclear Threat Initiative (think tank), the founder of CNN and the chairman for the Turner Foundation

Jessica Tuchman Mathews is a director at the Nuclear Threat Initiative (think tank), the president of the Carnegie Endowment for International Peace (think tank) and was an honorary trustee at the Brookings Institution (think tank).

Carnegie Corporation of New York was a funder for the Nuclear Threat Initiative (think tank), the Carnegie Endowment for International Peace (think tank), the Brookings Institution (think tank) and a supporter for the American Society for Muslim Advancement.

Carnegie Endowment for International Peace (think tank) was a funder for the Nuclear Threat Initiative (think tank)

Foundation to Promote Open Society was a funder for the Carnegie Endowment for International Peace (think tank) and the Brookings Institution (think tank).

George Soros was the chairman for the Foundation to Promote Open Society,

John Edward Porter was an honorary trustee at the Brookings Institution (think tank) and is the chair for Research!America.

Herbert Pardes is a director at Research!America and a director at Autism Speaks.

Susan Dentzer is a director at Research!America and a director at the International Rescue Committee.

Foundation to Promote Open Society was a funder for the International Rescue Committee.

George Soros was the chairman for the Foundation to Promote Open Society.

Andrew Robertson is an overseer at the International Rescue Committee and a director at Autism Speaks.

ONE Campaign is a partner with the International Rescue Committee.

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