ATLANTA, GA — A sharp Medicaid payment cut is putting autism therapy for Georgia foster children at risk just as some children are making important early gains. Families, clinics and advocates say the 30% reduction could force providers to stop accepting new patients, reduce existing caseloads or shut out children who need treatment during a critical window.
Krystina McQueen, a foster parent in Hall County, said her severely autistic foster son had already started to make progress in specialized behavior therapy when the provider called to warn that it may not be able to keep treating him at the new rate. He turns 3 soon, and the therapy is meant to help him build basic skills while he is still very young.
Amerigroup’s new rate structure starts drawing pushback from clinics
Georgia Medicaid uses private insurers to manage care, and for foster children that work is handled by Amerigroup, part of the Elevance family that also includes Anthem Blue Cross Blue Shield of Georgia. Clinics say a letter arrived in August saying the lower payment rate for applied behavior analysis, or ABA, would begin Sept. 1.
Amerigroup said the change is meant to better align reimbursement across autism services. In an email to state officials obtained by the Georgia Recorder, the company said it would increase rates for parent-training work instead, describing that approach as more targeted and clinically defensible.
Therapy advocates do not dispute the value of parent coaching, but they say trained clinicians cannot be replaced by caregivers alone. Amerigroup has said medically necessary services remain covered and that families should continue appointments and follow treatment plans.
Providers say the cut could force them to turn away foster children
For many clinics, the change is already affecting how they plan to serve Medicaid patients. Dr. Michelle Zeanah, who runs a clinic in southeast Georgia, said the size of the cut was hard to believe until her office began receiving September benefit statements showing payments reduced by 30%.
Zeanah said the numbers do not work for her practice. She also pointed to the shortage of providers in rural parts of the state, where many families have few alternatives and some children depend on one clinic for all of their ABA services.
The provider network concern is not just about one child being dropped. Clinics say lower payments can lead to fewer staff members, shorter waiting lists for others and less willingness to accept new foster children at all, even if commercial patients covered by Anthem plans are unaffected.
Lawmakers and state officials are watching the fallout
State Rep. Lee Hawkins, a Gainesville Republican who chairs the House health committee, said he has heard from both Amerigroup and clinic operators. According to the industry representatives he has spoken with, 75% of the clinics surveyed expect they will have to reduce services or stop serving foster children within three months if the rate remains in place.
Hawkins said more than 90% said they would cut back or stop taking new patients. Those changes could ripple through already strained systems, leaving fewer therapists available for children who are often difficult to place.
Georgia Medicaid spokesman Stuart Portman said the state’s review happens mostly after the fact, though officials are trying to engage early to ensure beneficiaries still receive care. State spokeswoman Lauren Williams also said that if an in-network provider is unavailable, Amerigroup must arrange out-of-network services for the individual patient.
ABA therapy remains central to autism treatment debates
Applied Behavior Analysis is designed to teach practical skills in carefully structured steps, often through one-on-one work over hours-long sessions. Supporters say it can be especially helpful for children with severe autism, even though it does not work equally well for every child on the spectrum.
Dr. Nathan Call, clinical director for the Marcus Autism Center in Atlanta, said research supports the therapy for some children and that early treatment often leads to better outcomes. He also said many families are referred to ABA right after a diagnosis, which has helped fuel demand for the service.
The rapid growth has also raised national concerns about fraud and overbilling. The U.S. Centers for Medicare and Medicaid Services said this summer that ABA spending in the program rose 421% between 2021 and 2025 and issued a toolkit encouraging states to strengthen oversight.
Families say early progress could be lost if therapy is interrupted
Anna Bullard, who helped push Georgia to cover the therapy through “Ava’s Law” in 2015, said she worries the latest cut could undo years of work to expand access. Her daughter, Ava Bullard, is now 22 and works as a surgical neurophysiologist in Florida after receiving ABA therapy as a child.
Anna Bullard said the state has long fought to make sure access to care does not depend on income, race or whether a child is in foster care. She said the payment change makes those protections feel uncertain, especially if families cannot find providers willing to keep going at the lower rate.
Katie White, a foster parent and guardian ad litem, said her adopted son lost services after only about six weeks. She said she is trying to continue the home exercises she learned, but she also worries about other foster families who do not have the time or flexibility to fill in the gaps themselves.
What the rate change could mean for foster children in Georgia
The long-term concern is that children could lose valuable progress if therapy is interrupted during the years when ABA tends to work best. Advocates say children who miss that window may face greater needs later, which could create larger challenges for families, schools and support systems.
McQueen and other parents say they have not received clear alternatives from Amerigroup. That uncertainty is especially difficult for foster children, who already have little control over their lives and often move through systems that are hard to navigate.
For now, clinics are weighing whether they can absorb the lower reimbursement or whether they will have to reduce care. Families say the answer will shape how much autism treatment remains available to some of the state’s most vulnerable children.