Setting the Record Straight: ABA Works, and Accountability Matters
A pair of recent Wall Street Journal articles — "The Boom in Autism Therapy Is Medicaid's Fastest-Growing Jackpot" and "The Medicaid Autism Racket" — have drawn wide attention to billing and oversight problems in the Applied Behavior Analysis (ABA) industry. The reporting is striking, and for families navigating autism services, we imagine it raises questions. We want to address this directly.
At FirstSteps, we believe in transparency. So, let's talk about what the WSJ got right, where the coverage fell short, and why we stand firmly behind the Council of Autism Service Providers' (CASP) response (click to access) to these articles.
What the WSJ Got Right
Fraud, waste, and abuse in Medicaid billing are real. The articles documented cases of ABA providers billing extraordinary amounts in some instances, hundreds of thousands of dollars per child annually, in states with little to no rate guardrails. That is wrong. Bad actors who exploit Medicaid funding for children with autism do lasting harm: to the families they claim to serve, to the public trust, and to every ethical provider in this field.
CASP agrees. Their statement puts it plainly: billing fraud and abuse "must be stopped," and they support the efforts of the HHS Office of Inspector General to identify and remove bad actors from the industry. So do we.
Where the Coverage Missed the Mark
The WSJ articles conflate a compliance crisis with a clinical one and that distinction matters enormously.
Documenting billing irregularities in a subset of providers says nothing about whether ABA therapy works. And it does. Decades of peer-reviewed research establish ABA as an evidence-based treatment for autism spectrum disorder. It is recommended by the American Academy of Pediatrics, endorsed by the U.S. Surgeon General, and covered by Medicaid and most private insurers specifically because the science supports it. That body of evidence does not evaporate because some providers submitted improper claims.
The articles also dismissed ABA's use of play and everyday activities as "glorified daycare." This characterization misunderstands how ABA actually helps kids. When a child with autism learns to request a snack, navigate a social interaction, or communicate a need through structured play, that is not babysitting; that is skill generalization in action, grounded in behavioral science. The families we serve know the difference, and so do the clinicians who deliver this care.
What Needs to Change
CASP's response doesn't circle the wagons. It calls for real, systemic reform, and that's exactly the kind of response the ABA field needs right now.
CASP is urging state Medicaid programs to establish clear coverage policies with defined provider requirements, medical necessity standards, documentation expectations, and robust post-payment audits. They are also calling on ABA providers to strengthen internal compliance, not as a defensive posture, but as a professional and ethical obligation.
We support all of it. The path forward isn't to discredit ABA because some providers behaved badly. It's to build the oversight infrastructure that protects children, holds providers accountable, and ensures that families can trust the services they receive.
Our Commitment at FirstSteps
At FirstSteps, ethical practice isn't a policy document, it's the foundation of everything we do. We are guided by the science, held to rigorous clinical and compliance standards, and accountable to the families who place their trust in us. Our team of Board-Certified Behavior Analysts designs individualized treatment plans rooted in evidence, and we document, audit, and evaluate our work continuously.
It's also worth saying clearly: ABA has evolved. The field looks very different today than it did decades ago, and criticism from autistic self-advocates and families over the years has made it better. Modern ABA is naturalistic, play-based, and built around child assent. This means we honor the child's preferences and requests and always prioritize their comfort and dignity alongside their progress. The goal is never compliance for its own sake. It's helping each child build skills that give them more independence, more connection, and a better quality of life. That is the practice we are committed to at FirstSteps.
We know that when billing scandals make headlines, families wonder whether they can trust their providers. That's a fair question to ask. We welcome it. If you ever want to understand how we operate, what our clinical process looks like, or how we approach compliance, we are an open book.
The WSJ articles are a call to action for the ABA industry, and we hear it. We stand with CASP in demanding accountability from bad actors and better oversight from state Medicaid programs. And we will continue delivering the evidence-based, compassionate care that children with autism deserve.
To read CASP's full statement, click here.
FirstSteps for Kids, Inc. is an ABA therapy provider guided by science and driven by compassion. We serve children with autism and their families across our clinic and community-based programs.