If you’ve felt like the ground keeps moving under your family’s ABA (Applied Behavior Analysis) coverage this year, you’re not imagining it. Between insurers narrowing their provider networks, a long-running fight over military families’ coverage, and legal battles between insurance companies and therapy providers, there’s a lot happening right now that touches families directly — even if most of it plays out in press releases and courtrooms rather than in your living room. Here’s a look at the biggest storylines and what they might mean for you.
When a Provider Gets Dropped From Your Network
Earlier this year, families in Arizona got a hard lesson in how fragile network coverage can be. Sean Markle’s six-year-old son, Jett, is largely nonverbal and has relied on ABA therapy at Action Behavior Centers since he was diagnosed with autism at age 2. Late last year, Markle got a letter from his insurance plan announcing it would no longer cover Jett’s therapy there. Then, in January, UnitedHealthcare announced it was cancelling its own coverage of the same provider — leaving families like the Markles to scramble for a new in-network clinic, often with waitlists stretching six months or longer.
“It feels like we’re a ship at sea and we got holes in the boat, and we’re doing what we can to plug the holes, and we’re not getting anywhere,” Markle told a local news station.
Insurers frame these network changes as routine reviews to “align with state and federal requirements.” For families in the middle of it, though, it can mean an abrupt disruption to a therapy relationship that took months or years to build. If your child’s provider is ever dropped from your network, it’s worth asking your insurer directly what triggered the change and whether you can request a continuity-of-care exception while you transition — many plans have one, even if it’s not advertised.
The Long Fight Over TRICARE
If you’re a military family, you’ve likely already felt the gap between what TRICARE covers and what most civilian insurance plans offer. Every state now requires private insurers to cover ABA therapy, but those state mandates don’t reach federal programs like TRICARE, which has historically imposed tighter restrictions through its Autism Care Demonstration program.
That’s been the subject of a years-long advocacy push. After sustained pressure from military families and groups like Mission Alpha, the National Academies of Sciences, Engineering, and Medicine published an independent 336-page review last fall concluding that the evidence behind ABA is “robust” and recommending it become a basic TRICARE benefit, free of the extra administrative hurdles families currently navigate. Senators have since pressed the Pentagon to act on those findings. So far, TRICARE’s underlying structure hasn’t changed — the Autism Care Demonstration was recently extended only through the end of 2028 — but this is a live issue, and advocacy groups are actively tracking it. If you’re TRICARE-covered, it’s worth following those groups for updates, since a policy shift could meaningfully change how much your family pays out of pocket.
When Insurers and Providers Go to Court
A separate, messier storyline: a fast-growing ABA provider chain, ABA Centers of America, is now tangled in lawsuits with two major payers. Point32Health, a Massachusetts insurer, filed a $19 million counterclaim alleging the company waived family cost-sharing while telling the insurer those payments had been collected — a practice that, if true, would have inflated what the insurer paid out. Grocery chain Publix, which self-insures its employees’ health plan, filed a separate suit reaching for federal racketeering claims. The company has denied wrongdoing in both cases, and Optum has reportedly ended its relationship with the provider amid the fallout.
Stories like this rarely make it into a family’s day-to-day experience directly, but they matter because they shape how skeptical insurers are becoming about ABA billing generally — which trickles down into more prior authorization requirements, more documentation requests, and more scrutiny of hours, even for families and providers who’ve done nothing wrong.
A Quick Note on Medicaid
Federal regulators also released new guidance this month encouraging state Medicaid programs to tighten oversight of ABA billing, following audits that found improper payments in several states. It’s a smaller piece of this year’s story compared to what’s happening with TRICARE and commercial insurers, but if Medicaid is your family’s coverage, it’s worth a quick conversation with your provider about whether anything is changing in your state.
What This Means for Your Family
None of this changes the basic fact that ABA remains a covered, medically necessary benefit in the vast majority of insurance plans. But it’s a good year to be a little more proactive: keep your own file of evaluations, treatment plans, and authorization letters, ask your provider whether they’re seeing any network changes on the horizon, and don’t assume a denial or network change is the final word — appeals exist for a reason, and providers who’ve been through this before can often help you navigate them.
It’s a lot of noise to sift through when all you actually want is consistent, good care for your kid. We’re keeping an eye on all of it, and we’re always happy to help you make sense of what it means for your family specifically.
Sources
- UnitedHealthcare cuts autism therapy provider, impacting Arizona families — AZFamily, January 26, 2026
- This autism therapy is covered by many insurers. Why does the military’s plan restrict it? — NBC News
- TRICARE and ABA — Autism Policy and Politics, June 2026
- Point32Health Files $19M Fraud Counterclaim Against ABA Centers of America — Acuity News
- Feds Urge States To Adopt New Rules For Autism Therapy — Disability Scoop, August 10, 2026
