Applied Behavior Analysis therapy has become a major source of support for hundreds of thousands of American families, offering children with autism help in developing communication, social and daily living skills.

At the same time, Medicaid spending tied to the therapy has grown into the billions, bringing new scrutiny over fraud allegations and the way public money is being used.

The debate is now exposing a partisan divide over how states should respond to the rapid expansion of the treatment option. Republican led states such as Florida have emphasized fraud enforcement and tighter oversight, while discussions in Georgia have focused on reimbursement rates and protecting access to care.

The Trump administration has also made eliminating fraud, waste and abuse across federal programs, including Medicaid, a central policy priority during Trump's second term. Supporters of stronger oversight argue that money lost to fraud cannot be used for children and families who rely on Medicaid covered autism therapy.

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According to Department of Health and Human Services Medicaid provider spending data, Medicaid paid more than $5.15 billion between 2018 and 2024 under one of the primary billing codes used for Applied Behavior Analysis therapy.

The same data shows that three providers received roughly $685 million in Medicaid reimbursements during that period. Those figures have intensified questions about how spending is monitored as the therapy sector grows.

Applied Behavior Analysis, often called ABA therapy, is one of the most common treatments for children with autism. It uses structured, one on one sessions to help build communication, social and daily living skills.

Much of the therapy is provided by Registered Behavior Technicians, known as RBTs. They are entry level workers who complete a 40 hour training program and work under the supervision of Board Certified Behavior Analysts, who design and oversee treatment plans.

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As spending has climbed, fraud concerns have also drawn attention from prosecutors and news investigations. In May, federal prosecutors charged two Minnesota autism clinic operators with allegedly billing Medicaid $46.6 million for services prosecutors say were unnecessary or never provided.

Those allegations included claims tied to children with allegedly fraudulent autism diagnoses. Earlier this year, another Minnesota woman pleaded guilty in a separate $14 million Medicaid autism fraud scheme.

Investigations by The Wall Street Journal and The New York Times have also documented allegations involving providers that billed for services that were never provided. The investigations also reported allegations of inflated therapy hours and aggressive expansion as Medicaid spending surged.

The Medicaid data also shows examples of providers receiving unusually large reimbursements under the ABA billing code. Some claims equated to hundreds of dollars per minute of therapy based on a standard 15 minute billing unit.

The data alone does not explain why those reimbursements were so high. Billing experts say unusually large payments can reflect several factors, including claim adjustments or other administrative processes.

The Centers for Medicare & Medicaid Services, the federal agency that oversees Medicaid with states, told Fox News Digital it has observed "significant growth" in Medicaid spending on ABA therapy in recent years.

"While access to medically necessary services remains a priority, rapid program growth also underscores the importance of ensuring services are clinically appropriate, delivered by qualified providers, and supported by strong program integrity safeguards," a CMS spokesperson said.

States have taken different approaches as concerns have grown. Florida says it recovered more than $72 million in improper Medicaid payments over the past year and prevented hundreds of behavior analysts from participating in Medicaid because of documented fraud concerns.

Last month, Republican Florida Gov. Ron DeSantis announced a statewide Medicaid Integrity Initiative. The effort is aimed at strengthening provider screening, enhancing fraud detection and increasing oversight to protect taxpayer dollars.

Georgia has taken a different focus. Lawmakers there recently questioned a Medicaid managed care organization's decision to reduce ABA reimbursement rates by 20%.

At the same time, industry representatives testified that use of autism therapy services had increased by more than 300% in recent years. The dispute reflects the tension between efforts to root out fraud and the push to preserve access to therapy that many families describe as life changing for children with autism.