Florida Health Agency Puts $1 Placeholder in Budget Request for Autism Therapy Task Force Recommendations

Florida's Medicaid agency has written a $1 placeholder into its budget request for the coming year to pay for whatever a state task force recommends on applied behavior analysis, the costly therapy used for thousands of children with autism, signaling that the state may need to spend money to rein in a program that already costs billions.

The Agency for Health Care Administration included the line in its legislative budget request "to support the final recommendations of the Applied Behavior Analysis (ABA) Task Force concerning the delivery of ABA services," the Florida Phoenix reported on Nov. 11. The task force has not yet voted on any recommendations. It is scheduled to do so at its final meeting on Nov. 17.

What the $1 line means

The placeholder sits in the "Health Care Regulation" section of AHCA's request and is identified as funding for "contracted services." It is listed as a recurring general revenue expense, meaning the agency wants the money appropriated every year in future budgets unless the Legislature specifically removes it, according to the Phoenix.

"The placeholder is intended to support recommendations concerning ABA services developed through the task force's evaluation," the budget document says.

The line amounts to an acknowledgment by the state's top health officials that, as the Phoenix put it, it may take money to save money. Agencies submit legislative budget requests each fall so lawmakers can see their needs ahead of the session. This year the requests will also go to Gov.-elect Byron Donalds, who will use them in preparing his first budget recommendations to the Legislature after taking office in January.

Why Florida created the task force

The Legislature created the 10-member ABA Task Force in Section 40 of House Bill 5003-E in 2026, as part of negotiations over the 2026-27 budget. It is housed at AHCA and chaired by Secretary Shevaun Harris, who cannot vote on its recommendations. Its report is due to the governor, Senate president and House speaker by Dec. 31, 2026, and the panel expires July 1, 2027, according to the agency.

The driving concern is cost. Shena Grantham, an AHCA Medicaid policy official, told the panel in August that Florida spent $6.57 billion on ABA between 2023 and 2025, more than any other state. Indiana ranked a distant second at $1.65 billion, and North Carolina third at $1.53 billion, WLRN reported.

About 60,000 low-income children in Florida receive ABA at a cost of about $2.3 billion, Grantham said, though she did not specify a year. She said that is more than Medicaid spent on hospital care for 966,900 children, prescription drugs for 1.4 million children, or about 1.75 million doctor visits. "There's something unusual happening ... that deserves a closer look," she told the task force.

AHCA data also show about 25% of children receiving Medicaid-covered ABA, roughly 13,698, have not been diagnosed with autism spectrum disorder. ABA is also used for children with ADHD, traumatic brain injuries and intellectual and developmental disabilities.

Florida also tends to deliver the therapy later in childhood than other states. A chart prepared for the task force showed fewer than 25% of Florida's Medicaid ABA services went to children ages 3 to 5, compared with about 40% nationally, while about 45% went to children ages 6 through 10, compared with fewer than 40% nationally, WLRN reported. That pattern bears directly on the panel's charge to define best practices for therapy at appropriate ages.

The policy backdrop has shifted too. Since 2025, Florida has required its Medicaid managed care plans to cover ABA for children, and 99% of those services are now delivered through the plans. Providers who once billed the state directly have had to negotiate contracts with plans in their regions, a change that some parents told the panel has disrupted care.

What the task force must examine

The law directs the panel to look at least at:

• Clinical care models that lead to best practices for therapy at appropriate ages.
• Transitions for children receiving ABA across developmental, educational and community settings.
• Quality metrics for ABA therapy.
• Limits and controls on how long ABA services may be authorized.
• Potential caps on the number of months an enrollee may receive ABA.
• Ways to strengthen Medicaid provider enrollment and billing standards to promote program integrity and fiscal accountability.

Florida Medicaid currently covers up to 40 hours a week of behavior analysis per recipient, as specified in a prior-authorized behavior plan that can run up to six months, according to materials AHCA presented at the panel's Oct. 29 meeting. Those materials noted that some states require extra review for heavier treatment: Virginia requires more documentation for requests over 20 hours a week, and North Carolina requires reauthorization at least every three months for plans over 16 hours.

Ideas on the table

Several ideas surfaced at the panel's Oct. 5 meeting, though the agency's minutes stress they were for discussion and not task-force-approved recommendations. David Harbour, chief executive of Centria Autism, urged the state to license ABA businesses the way it licenses home health agencies, with surveys tied to Medicaid payments. "Failed surveys should carry a Medicaid reimbursement penalty," he said, acknowledging that "no state has done this yet."

Harris said AHCA had been "very intrigued by that concept," noting that providers go "into people's homes of very vulnerable kids" and that the agency's on-site Medicaid enrollment inspections are "not the same as a licensure process." Other ideas discussed included a Florida licensure framework for behavior analysts, minimum attendance expectations for families, and alternatives to ABA such as speech therapy, occupational therapy and the DIR Floortime model used in some states.

Families have pushed back on anything that could interrupt care. Nicole Grabner, a Brevard County mother of two children with autism, told the panel in August that "a short pause in therapy causes devastating developmental regression."

What's next

The task force meets Nov. 17 from 11 a.m. to 5 p.m. at AHCA's offices on Mahan Drive in Tallahassee, with member discussion, a vote on recommendations and public comment on the agenda. Its report is due Dec. 31. Harris had hoped to wrap up recommendations by the end of October, but the schedule slipped.

Once the recommendations are final, the $1 placeholder gives lawmakers and the Donalds administration a ready line to fill in during the 2027 session, if they choose to fund the changes.