Autism Medicaid Waivers Are Being Cut: What Families Need to Know in 2026
Published June 24, 2026
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7 min read
More than 711,000 people are currently on Medicaid waiver waitlists across the United States. About 73 percent of those waiting have intellectual or developmental disabilities, including autism. For autism-specific waivers, the average wait exceeds five years.
Now, federal legislation is making it harder for states to keep those waitlists from growing longer.
The One Big Beautiful Bill Act, signed into law on July 4, 2025, will cut nearly $1 trillion from federal Medicaid funding over the next 10 years. While the law preserves one key protection for children with autism, it leaves another layer of Medicaid coverage, the one many families depend on most, vulnerable to state-level cuts.
Here is what autism families need to understand about HCBS waivers, what is changing, and what steps to take now.
Two Layers of Medicaid Coverage for Autism
If your child has autism and is covered by Medicaid, they likely have access to two different types of programs. Understanding the difference between them matters more than ever in 2026.
EPSDT: The Protected Layer
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is a federal mandate that requires states to cover medically necessary services for all Medicaid-enrolled children under the age of 21. ABA therapy falls under EPSDT, which means states cannot simply cut ABA coverage for children who need it on medical grounds.
The One Big Beautiful Bill Act preserved EPSDT. ABA therapy coverage for children under 21 is not at immediate risk under this law.
HCBS Waivers: The Vulnerable Layer
Home and Community-Based Services (HCBS) waivers are different. These are optional state programs, approved by the federal government under Section 1915(c) of the Social Security Act, that fund a broader range of supports beyond what standard Medicaid covers. For autism families, HCBS waivers can fund things like:
- Respite care for caregivers
- Supported employment and day programs
- Transportation to and from services
- Assistive technology and communication devices
- Home modifications for safety and independence
- Case management and service coordination
- ABA therapy for adults who no longer qualify for EPSDT protections
Because states are not required to provide HCBS waivers, they are among the first services states cut when facing budget pressure. And in 2026, that pressure is significant.
How the 2025 Federal Budget Law Affects Waiver Programs
The One Big Beautiful Bill Act reduces the federal contribution to Medicaid for certain programs. States receive between 50 and 83 cents of every dollar they spend on Medicaid from the federal government. When that federal match is reduced, states face a funding gap they must either fill with state revenue or offset by cutting services.
HCBS waivers are not protected by the same federal mandate as EPSDT. When states face budget shortfalls, waivers are frequently targeted first. According to the Kaiser Family Foundation, at least 11 states have already announced plans to cap waiver enrollment or spending for fiscal year 2026.
Disability advocates have been direct about the risk. Zoe Gross, director of advocacy at the Autistic Self Advocacy Network, has noted that because states are not required to provide HCBS to everyone who needs them, states facing a large loss of federal funding will cut HCBS first, leaving people without the supports they need to stay in their communities.
States Already Cutting Back
The federal budget law is amplifying cuts that began before the bill was signed, as states grappled with explosive growth in Medicaid spending on autism therapy over the past decade.
- Indiana paused new ABA provider enrollment in June 2026 and imposed hour caps and new prior authorization requirements on existing services.
- North Carolina proposed sweeping changes to Clinical Coverage Policy 8F that would restrict telehealth access, limit therapy hours, and impose new oversight standards.
- Nebraska cut Medicaid reimbursement rates for some ABA providers by nearly 50 percent.
- Colorado passed new ABA licensing legislation in June 2026, in part to address $77.8 million in identified improper Medicaid payments.
These state-level actions are happening alongside, not solely because of, the federal legislation. The two pressures compound each other.
Who Is Most at Risk
Two groups face the greatest vulnerability when HCBS waivers are cut.
Autistic Adults (Age 21 and Older)
Once a person turns 21, EPSDT protections end. Standard Medicaid for adults does not require coverage of ABA therapy. For adults with autism who need ongoing behavioral support or daily living assistance, HCBS waivers are often the only pathway to funded services.
Adults currently receiving waiver-funded services may see those services reduced. Adults on waitlists, where the average wait for autism-specific waivers already exceeds five years, may wait even longer as states limit new enrollment.
Families on Waitlists
Nationally, more than 519,000 people with intellectual or developmental disabilities are waiting for HCBS waiver services. In some states, including Texas and Florida, that wait can stretch from five to fifteen years or more. When states cap enrollment or freeze new applications, families already waiting find themselves frozen in place with no path forward.
A New Waiver Category, But Not Until 2028
The One Big Beautiful Bill Act did create a new HCBS waiver category designed for people who do not meet the traditional institutional level of care threshold. This expansion could eventually help families who do not qualify for existing waivers.
There is a significant catch: this new waiver category does not take effect until July 1, 2028, and the initial federal funding is extremely limited. Meaningful relief through this provision is years away. Families navigating the current system cannot count on it for near-term access.
What Families Should Do Right Now
If your child or family member relies on HCBS waiver services, or if you have not yet applied, these steps can help protect your family's access to services.
- Apply for waiver services immediately. In most states, your application date determines your place on the waitlist. Waiting even a few months can mean waiting additional years. Do not wait until your child is older or until the situation feels urgent.
- Apply to multiple waiver programs. Many states have more than one HCBS waiver that people with autism may qualify for, including general developmental disability waivers in addition to autism-specific programs. Apply to every one your child may qualify for.
- Obtain strong medical necessity documentation. A detailed letter from your child's diagnosing physician or developmental pediatrician documenting functional limitations and support needs will strengthen both your waiver application and any future appeals.
- Use EPSDT-covered ABA therapy now. While your child is under 21, EPSDT protections apply. Use this window to establish an ABA therapy program, document progress, and build the clinical record that will support waiver applications as your child approaches adulthood.
- Connect with your state disability advocacy organization. State advocacy groups often have the most current information about waitlist status, new waiver openings, and application timelines. Organizations like The Arc, state autism societies, and the Autistic Self Advocacy Network can help.
- Contact your state legislators. Waiver funding decisions are made by state legislatures and Medicaid agencies. Constituent voices matter. Many state autism advocacy organizations run active legislative campaigns and can connect you with advocacy opportunities.
The Bigger Picture for Autism Families
The convergence of federal budget cuts, state-level spending concerns, and a growing population of autistic children aging into adulthood is creating real pressure on the HCBS system. Families most affected are often those who rely most heavily on public funding, because private insurance does not cover the full range of services that waivers fund.
EPSDT protections mean that ABA therapy for children under 21 has a legal floor that states cannot easily remove. But HCBS waivers, which support family caregivers, autistic adults, and children with needs beyond ABA, have no such federal guarantee. The time to act is now, not after waitlists grow longer or waiver slots disappear.
Find ABA Therapy Providers Near You
While federal and state policies continue to evolve, connecting with a qualified ABA provider is one of the most concrete steps families can take today. ABA Navigator's directory lists thousands of verified ABA therapy providers across the United States, searchable by state, city, and insurance accepted.
