By Dr. Amanda Kelly
Autism insurance mandates passed across all 50 states between 2001 and 2018, requiring that insurance companies cover treatment for individuals with an autism diagnosis, with Applied Behavior Analysis (ABA) emerging as the dominant covered modality. Rapid industry growth followed via an explosion of ABA companies and national chains, with Medicaid billing scaling in tandem. By 2026, widespread audits in states across the country are surfacing serious problems: improper payments, fraud, and unethical billing practices. The issues reflect a dynamic that emerged when fast-moving insurance mandates created significant Medicaid revenue opportunity without proportionate oversight infrastructure. The billing incentives created by rapid scaling rewarded volume over quality, and bad actors took advantage. That said, the evidence does not point to all providers. The majority of providers operate ethically and the therapy itself remains medically necessary for many families. The goal of reform should be closing the regulatory and oversight gaps that allowed problems to take root while preserving access to necessary care.
Colorado is currently navigating both sides of the accountability and access-to-care challenge. Earlier this year, an Office of Inspector General (OIG) audit identified $77 million in questioned Medicaid payments to Colorado ABA providers. That finding accelerated a statewide effort to close regulatory gaps. The result is pending legislation establishing two new requirements: state licensure for Board Certified Behavior Analysts (BCBAs) by July 2028, adding a Colorado-specific license to the national certification already required through the Behavior Analyst Certification Board (BACB), and ABA clinic licensure to follow in late 2029.
Firefly Autism has operated under state licensure since its founding in the early 2000s, first as an early childhood education center and later as a day treatment center. That history means Firefly has always functioned within a framework of state oversight, documentation standards, and compliance requirements. Firefly also established early on that all clinicians working directly with learners would hold full Registered Behavior Technician (RBT) certification via the BACB, regardless of Medicaid rules that permitted behavior technicians to bill without this nationally recognized certification. New staff complete 30 to 90 days of supervised training before working independently, to ensure the absolute highest quality of individualized care. This also ensures that every staff member feels fully supported with the training and tools they need to be maximally effective. Training and continuing education is paramount, with a strong focus on trauma informed and assent based care.
The proposed changes in Colorado are, on balance, a step in the right direction. The question is how ABA clinic licensure requirements will be structured in 2029 and whether they will be calibrated in a way that strengthens accountability without creating barriers that reduce provider capacity and limit family access. Because Firefly has operated within a licensed framework from the start, we are well positioned to contribute meaningfully to that conversation as a leader in the field.
