Estimating Network Adequacy of Autism Service Providers in Affordable Care Act Markets

In the past two decades, behavioral health care for children on the autism spectrum has changed considerably. As demand for applied behavior analysis (ABA) services escalated, government policies broadened health insurance coverage and the number of Board Certified Behavior Analysts increased. Yet, the network adequacy of these providers is unknown. Applying new Centers for Medicare and Medicaid Services (CMS) distance standards, we estimated county-level network adequacy in Affordable Care Act plan markets. All states had at least one county estimate out of compliance with distance standards. In 43 states and DC, the median per county estimate of adequacy was less than 50%, and in 29 of these states, it was less than 20%. Only 12 of 3143 (~0.38%) county estimates met CMS standards. Amid new adequacy standards, estimates suggest that the vast majority of ABA provider networks remain inadequate, which may disadvantage autistic enrollees who seek behavioral health services. As policymakers, providers, funders, and consumers work to improve access to autism services nationally, the present study contributes a prototype of measuring adequacy for ABA service providers that can be used in other US health insurance markets.

The online version contains supplementary material available at https://doi.org/10.1007/s40617-025-01103-7.