Georgia Medicaid Contractor Amerigroup Cuts Autism Therapy Payments 30% for Foster Children as Clinics Warn of Pullbacks

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The cut took effect Sept. 1, and clinics have recently begun seeing smaller payments for September appointments, according to a Georgia Recorder investigation published Oct. 5.

The stakes are high for foster and adoptive families from metro Atlanta to rural south Georgia. Many other Medicaid members can choose among three insurers (Amerigroup, CareSource and Peach State), but foster children cannot leave Amerigroup, so families have nowhere else to turn.

Timing matters for young children. Dr. Nathan Call, clinical director of the Marcus Autism Center in Atlanta, told the Recorder that research shows “the earlier interventions are delivered, the better the outcome,” adding, “Meaning delays can have a negative impact on outcomes.”

ABA therapy teaches skills to children who do not learn in typical ways, and autistic children make up a large share of patients. A behavior analyst builds a plan for each child, and a trained technician works one-on-one to break tasks such as using the bathroom into small, rewarded steps. Treatment can run several hours a week.

Clinics said a letter announcing the cut arrived in August. In Hall County, foster mother Krystina McQueen said the provider treating her foster son, who is about to turn 3, warned it may not be able to afford his care. She said she was told the provider has already stopped accepting new patients at the lower rate.

Katie White, a guardian ad litem for the state who adopted her 14-year-old son out of foster care, said he was dropped in mid-September. “He lost his services after only being in it about six weeks,” she said. She says Amerigroup has offered no alternatives since then.

Dr. Michelle Zeanah, who runs a clinic in southeast Georgia that serves many rural families, said the math does not work. “From a business perspective, we’ll be too far in the red. I can’t do that. And it breaks my heart,” she said.

The wider warning comes from an industry survey whose sponsor and size were not disclosed. State Rep. Lee Hawkins, a Gainesville Republican who chairs the House health committee, said industry representatives told him 75% of surveyed clinics expect to reduce or stop serving foster children at the new rate within three months. More than 90% said they would reduce or stop taking new patients. MedicalDaily could not independently review that survey.

Amerigroup’s notice to clinics said the change is “intended to better align reimbursement across autism services.” In an email to Georgia’s Department of Community Health obtained by the Recorder, the insurer said it would instead raise rates for clinicians’ time training parents, calling the structure “a more targeted and clinically defensible approach.”

An Amerigroup spokeswoman said medically necessary services are still covered and urged patients to keep appointments. Advocates counter that parents cannot replace trained clinicians.

The cut follows national scrutiny of ABA costs. Federal officials reported this summer that Medicaid and CHIP spending on ABA rose 421% between 2021 and 2025, far faster than the 67% growth in children served, as MedicalDaily reported in its coverage of the federal ABA oversight toolkit. Anna Bullard, who helped pass Georgia’s 2015 autism coverage law known as Ava’s Law, acknowledged fraud concerns in some quarters but objects to the method. “We fought so hard,” she said, adding that “it’s like falling off the cliff backwards.”

The evidence has limits. No public data show how many foster children have lost ABA since Sept. 1, and the survey figures are projections. Research supports ABA for some children, but not every child benefits.

The affected children are enrolled in Georgia Families 360°, which covers about 27,000 children, youth and young adults in foster care, adoption assistance and some juvenile justice programs, according to the state. It is unclear how many receive ABA.

Stuart Portman, a key policy official at Georgia Medicaid, said the state’s options are limited for now. “Our ability to review things is much more on the back end,” he said. “However, we are engaging as early on as we can to make sure that the care to the beneficiaries is being provided.”

Mental health advocate Roland Behm argued that federal law gives the state the power, and the duty, to review network adequacy before a change like this. “You don’t implement a rate cut and then see what happens,” he said.

The clearest protection is a contract rule. Department of Community Health spokeswoman Lauren Williams said that “in those instances where an in-network provider is not available, Amerigroup is required to secure services with an out-of-network provider.” The Recorder noted that whether families know to ask for that remains an open question. Foster parents, adoptive parents, and caseworkers whose child loses a provider can request out-of-network care from Amerigroup in writing.

Families should keep copies of termination notices, the date of the last session, and records of calls with the plan. Regression such as lost words, more aggression, or self-injury is worth raising promptly with the child’s pediatrician or care coordinator, and any child at risk of serious harm needs urgent care.

Few families can pay privately for ABA, and rural families face the steepest gaps because fewer clinics operate outside metro Atlanta.

The program itself is also in flux. The Department of Community Health has extended its current managed care contracts, including Amerigroup’s, through June 30, 2027, while a procurement protest continues. UnitedHealthcare of Georgia was named the apparent successful bidder for Georgia Families 360°, with no start date set.

The cut is real and in effect, though the worst projected losses are not yet confirmed. For now, families should keep current appointments, document any lost services, and press for out-of-network help, which the state says Amerigroup must provide when no in-network provider is available.

What changed for Georgia foster children who receive autism therapy?

Amerigroup, the only Medicaid insurer for Georgia foster children, cut its payment rate for ABA therapy by 30% starting Sept. 1, 2026. Some clinics have stopped taking new foster patients, and at least one family reported that a child was dropped in mid-September.

Children covered by Georgia Families 360°, which includes about 27,000 children, youth and young adults in foster care, adoption assistance and some juvenile justice programs. Only those receiving or seeking ABA therapy are directly affected, and the state has not said how many that is.

Amerigroup said the change is meant to better align payments across autism services. It raised rates for parent training instead, calling that a more targeted and clinically defensible approach, and said medically necessary services remain covered.

Rep. Lee Hawkins said industry representatives told him 75% of surveyed clinics expect to reduce or stop serving foster children within three months, and more than 90% would limit new patients. The survey’s sponsor and size have not been released.

What can families do if their child loses an ABA provider?

Georgia’s Department of Community Health says Amerigroup must arrange out-of-network care when no in-network provider is available. Families can request this from Amerigroup in writing and keep records of every notice and call.

Research supports ABA for some autistic children, and the Marcus Autism Center’s Dr. Nathan Call said earlier intervention leads to better outcomes. It does not work for every child, and some critics have raised concerns about its methods.

Will Georgia Families 360° change insurers?

UnitedHealthcare was named the apparent successful bidder, but a procurement protest is pending. The state has extended current contracts, including Amerigroup’s, through June 30, 2027, and has not set a transition date.