Leaked documents show UnitedHealth is working to reduce the number of children with autism who receive important therapy, Applied Behavior Analysis (ABA), in an effort to save money. ABA is a proven treatment that helps children with autism develop basic skills. Many children, like Benji, are covered under Medicaid, a government program for low-income patients.
ProPublica obtained internal reports from Optum, the mental health arm of UnitedHealth. These documents show that Optum is limiting access to ABA therapy, even though it is considered the best treatment for children with autism. As autism diagnoses have increased, Optum wants to cut costs by restricting therapy hours and removing some providers from its network.
One major target of these cuts is children covered by Medicaid. The strategy is based on a financial model where insurers like UnitedHealth can keep leftover funds if they spend less on patient care. This could explain why they are reducing necessary treatments, despite evidence that children need ongoing support.
Benji’s mother, Sharelle Menard, is one of many parents affected. Her son, diagnosed with severe autism, made progress with over 30 hours of ABA therapy each week. But recently, Optum denied additional hours of treatment that his therapists said he needed. Despite the clear benefits, the company said Benji wasn’t improving enough to justify more therapy, a decision that confuses autism experts.
ABA therapy has no set end date for many children, as autism is a lifelong condition. Experts say denying therapy for kids like Benji could lead to worse outcomes, including more difficult behavior and limited progress. This raises serious legal concerns, as federal law requires that mental health treatment be treated the same as physical health care.
UnitedHealth, which made $22 billion in profits last year, is using strict measures to reduce ABA therapy costs. One strategy is limiting which providers can join their network, which might force families to find new, often more expensive, providers.
In Benji’s case, the reduction in therapy led to regression. His behavior became more challenging, and his mother was forced to pull him from school after repeated incidents. The decision to limit his therapy could have long-lasting negative effects on his development. Despite this, Optum refuses to approve the additional hours Benji needs.
Advocates argue that cutting therapy for vulnerable children will harm them in the long run. The cuts are not just a financial issue; they also disregard the complex, long-term nature of autism. As one expert put it, if children don’t get the right treatment now, they may require more expensive services as adults.
For now, Benji continues to receive the therapy he needs, but his family is caught in a legal battle with Optum to make sure the treatment is covered. Other families face similar struggles, and the demand for ABA therapy is only growing. The need for these services is clear, but whether insurance companies like UnitedHealth will provide them remains uncertain.
