Short report: Disparities in hours of applied behavior analysis services for Medicaid-enrolled autistic youth.
Rural autistic kids on Medicaid get eleven fewer monthly ABA hours than city kids, with race playing no role.
01Research in Context
What this study did
Straiton-Webster et al. (2025) dug into Medicaid billing records. They wanted to see who gets how much ABA each month.
The team looked at autistic kids on Medicaid. They compared rural and non-rural youth, plus race, sex, and age.
What they found
Rural autistic youth received about eleven fewer hours of ABA each month. That is roughly one full session lost every week.
Surprise: race, sex, and age showed no difference in dosage. Only geography mattered.
How this fits with other research
Barton et al. (2019) saw Black children start autism care years later than White peers. The new study finds no racial gap in ABA hours once kids are in. Together they hint that entry, not dosage, is the equity choke point.
Mélinia et al. (2026) looks like a contradiction. They found White youth receive more psychotropic meds than Black or Hispanic peers. Straiton-Webster shows equal ABA hours across races. Disparities appear service-specific, not global.
Stainbrook et al. (2019) offers a fix. Their tele-diagnostic program boosted rural referrals. Fewer miles could shrink the eleven-hour gap found here.
Why it matters
If you serve Medicaid clients, check travel time. Long drives may explain low hours even when authorization looks fine. Push for telehealth intake, mobile clinics, or remote supervision. Track monthly dosage by ZIP code and flag rural cases early. Closing the eleven-hour gap could mean faster skill gains and fewer crisis visits down the road.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Sort your active Medicaid cases by address and add one extra hour or tele-session to any rural client this week.
02At a glance
03Original abstract
To date, no studies have investigated whether disparities in hours of applied behavior analysis (ABA) exist in the Medicaid system. We used multilevel modeling to analyze Medicaid billing claims for 1,028 autistic youth under the age of 21 years to examine the extent to which there were disparities in hours of ABA services for Medicaid-enrolled youth based on race/ethnicity and rurality. Although younger children received more hours of ABA, F(1, 964.63) = 118.28, p < .001, there were no statistically significant differences in hours of ABA based on minoritized race/ethnicity status or sex. On average, youth served in rural areas received significantly less hours of ABA per month than those in non-rural areas, F(1, 122.13) = 7.89, p = .006; youth in rural areas received 10.86 less hours per month than those in non-rural areas. Results suggest that publicly funded service systems like Medicaid may reduce ABA service disparities by race/ethnicity. Policymakers should focus on improving service provision for youth in rural areas. We used Medicaid billing claims from 1,028 autistic youth to see if there were differences in hours of applied behavior analysis (ABA) services per month for youth from different racial/ethnic groups, different service settings (rural or non-rural), different sexes, and different ages. We found that younger autistic youth received more hours of ABA per month compared to older youth, and and youth served in rural areas received about 11 hours less per month compared to youth in non-rural areas. There were no differences among different race/ethnic groups or sexes. Policymakers should focus on improving service availability for autistic youth served in rural areas.
Autism, 2025 · doi:10.1177/13623613251392495