Abigayle Hosking says she was once told to wake a sleeping 3-year-old. The girl, who has autism, had rested her head on a stuffed toy and shut her eyes. She still had four hours of therapy left that day at a Centria Healthcare clinic in Michigan. Hosking's account opens Thursday's Page One investigation by Anna Wilde Mathews, Christopher Weaver and Tom McGinty. Centria says waking a child that way would have broken its rules, and no such incident was recorded.
Medicaid and private insurers often set the ceiling near 40 hours a week. Time a child spends asleep isn't supposed to count. The Journal studied Medicaid billing records for five of the largest chains backed by private-equity firms. Their average weekly hours per patient ran 29% above competitors' in 2024. Four of the five billed more than local rivals. In Arizona, Centria billed 94% more hours a week per patient. In Colorado, Action Behavior Centers billed 81% more. When 69 Arizona Medicaid patients switched to Centria, their hours went from about 13 a week to 24. Medicaid's autism-therapy bill hit $10 billion last year, five times the roughly $2 billion of 2021. A doctor who was briefly Centria's chief medical officer called it "simple business math."
All five companies say each child's needs set the hours, not money. The four higher-hour chains say the analysis ignored how severe their patients' autism is. Centria says three-quarters of its patients fall into its higher severity tiers. Action calls the comparison "not apples-to-apples." The fifth chain, Learn Behavioral, billed fewer hours than rivals. Technicians often earn about $20 an hour, while Medicaid pays the companies about $60. Private insurers can pay closer to $90, by one health-tech firm's count. New federal Medicaid guidelines say more hours don't bring better outcomes, which Action disputes.
What one family did
LaDeana Thompkins's son was scheduled for about 40 hours a week at an Action site near Phoenix. In July she asked to cut that about in half so he could start kindergarten. The next day, she and her husband say, a staffer said he wasn't ready and proposed delaying school. They say they were warned he might land on a waiting list if he left. "It felt like we just fell off a cliff," she said. Action says it supports families who choose school. It also says the family's refusal to let it share his records calls their account into question. The boy, now 6, gets about 25 hours a week after school from another provider, paid for by her employer plan. She says kindergarten is going well.
Our read
This is a Health Costs story, and Insurance M11 is the lever. A child's weekly hours come from a behavior analyst's recommendation, and the insurer then approves them. The paper's data say the big chains bill more hours than their neighbors. The chains say sicker kids explain it. Both can be partly true, and a parent can't tell which from outside. What a parent can do is ask. Our verdict is watch. No public company is in this story, and the money is taxpayers' and employers'.
Here's the connection to your own family. If a child or grandchild you help is in autism therapy, ask for the written treatment plan this week. Ask who set the weekly hours, what the goals are and when the hours should come down. Ask what happens to the slot if school cuts the hours. Then ask the insurer what it approved. The same questions apply if your employer plan pays. If the answers don't line up, bring them to a review.