As Arizona’s Medicaid ABA market convulses, the Phoenix autism nonprofit SARRC is expanding adult services, training its own BCBAs, and scaling statewide.
Key Takeaways
- Arizona’s Medicaid ABA market has been destabilized over the past year by managed care contract terminations and rate cuts that hit two of the state’s largest providers. Families have filed suit, and the state Medicaid agency is preparing a broader policy overhaul.
- The Southwest Autism Research & Resource Center, a Phoenix nonprofit founded in 1997, says its track record of high-quality services, community-based model, and diversified payer mix have largely insulated it from that pressure. SARRC also helped pass 2025 legislation that, by its account, removed the age and dollar caps from Arizona’s autism insurance law.
- SARRC centers its clinical model on Pivotal Response Treatment, runs an inclusive preschool, identifies risk of autism in infancy, and trains most of its behavior analysts in-house. Its programs for teenagers and adults address employment and independent living, areas most ABA organizations do not serve.
- Chief Executive Dr. Daniel Openden frames the current scrutiny of ABA as an opening for quality-focused providers to distinguish themselves. SARRC is now scaling toward a statewide footprint by 2030, opening new campuses and pressing to expand services across the lifespan.
Arizona’s autism therapy market has been in upheaval for the past year. Between October 2025 and early 2026, three of the state’s Medicaid managed care organizations moved against two of its largest applied behavior analysis (ABA) providers, families filed lawsuits, and the Arizona Health Care Cost Containment System (AHCCCS) signaled a sweeping policy review. The contract terminations and rate cuts that reshaped Arizona’s Medicaid ABA market became the story in the state’s autism sector.
Dr. Daniel Openden wanted to talk about a different story. In an interview with Acuity, Openden, President and Chief Executive Officer of the Southwest Autism Research & Resource Center (SARRC) since 2013, argued that the moment is an opening as much as a threat. “This is the time for quality providers to step forward,” he said. “There is so much negativity in the ABA world. How about we talk about what some of the really good groups are doing out there to make a difference in people’s lives and build a better community for all of us at the same time?”
Now approaching its 30th anniversary, SARRC advances research and delivers ABA primarily in homes, schools, and community settings rather than in clinics, and serves people with autism across the lifespan. How it has weathered the past year says something about which providers the current upheaval rewards.
An autism preschool built on inclusion, not isolation
SARRC’s primary center-based program looks nothing like a conventional ABA clinic. The SARRC Community School embeds an ABA program inside an inclusive preschool, where half or more of the children are typically developing, and the rest are on the spectrum.
“If you came in and looked in the windows or stepped into the classroom of one of our preschools, it would look to you like a high-quality preschool with children smiling, laughing, playing, and learning alongside their peers,” Openden said. “And it absolutely is. But at the same time, we are providing an intensive ABA treatment program that looks dramatically different than your traditional ABA clinic.”
The staffing model inverts the usual ratios. Where a typical preschool might run two teachers for 18 to 23 children, Openden said, the Community School runs roughly one teacher for every three to four, all of them registered behavior technicians supervised by board-certified behavior analysts (BCBAs). SARRC operates four Community School campuses, in Tempe, Phoenix, Scottsdale, and Mesa, each serving children ages 15 months to 5 years on an extended day from 8 a.m. to 5 p.m., with tuition for full-time typically developing children set at roughly $900 a month and prorated for reduced schedules.
“At the heart of what autism is, is a social disorder,” he said. “Having kids with autism only around other kids with autism doesn’t seem to be as beneficial as having them around social experts: kids without autism who have stronger language, communication, appropriate social skills.”
The arrangement also seeds a more inclusive community, he argues, since the typically developing children grow up to be classmates, coworkers, and employers. In 2011, the Centers for Medicare & Medicaid Services named the inclusive preschool among the most promising practices in autism services.
Pivotal Response Treatment: A Naturalistic, Play-Based Form of ABA
SARRC centers its clinical model on Pivotal Response Treatment (PRT), a naturalistic, play-based form of ABA developed by Robert and Lynn Koegel at the University of California, Santa Barbara, where Openden earned his doctorate and trained at the Koegel Autism Center, and by Laura Schreibman at the University of California, San Diego. PRT builds instruction around a child’s own motivation rather than a fixed curriculum.
He likes to tell a story about it. Walking the halls one day, he found a therapist covered head to toe in shaving cream. Inside was Max, a four-year-old so uninterested in toys that his parents had stopped buying them, but who loved the feel of textures. The therapist had paired the shaving cream with pushing a toy car across a table, and by the end of the session, Max had played with a car for the first time. “Fun was had, skills were learned,” Openden recalled her saying.
“If you are doing PRT, you have got to take a step back and see what motivates the child and build the instruction around the child’s motivation and interest,” Openden said. “So automatically, right away, it is an individualized approach, and we have less risk of getting too cookie-cutter.” SARRC stays flexible, pivoting to other evidence-based practices such as discrete trial training or a picture exchange system when PRT is not working.
That emphasis sharpens his critique of the practices that are drawing negative headlines. He pointed to a widely circulated New York Times photograph of a clinic with children in cubicle-like spaces, which he said looked like it was built to maximize patients per square foot. To Openden, the cramped setting and one-size-fits-all programming are two faces of the same problem: care organized around the business rather than the child. “Some children with autism will require 40 hours per week ABA programs, but when you have lots of kids who are all on the same treatment program and all receive the same number of hours of treatment per week, that is a business plan, not a treatment plan,” he said. It is a pointed entry in a live industry debate over treatment hours and settings.
Early autism identification, starting in infancy
The lifespan model starts in infancy. SARRC screens and monitors babies, then coaches parents in a technique from the Early Start Denver Model called “stepping into the spotlight”: getting into a baby’s line of sight and stripping away distractions so the child learns to attend to faces before formal instruction begins. Chief Clinical Officer Rachel Anderson has described working with babies who had made eye contact only once or twice.
Diagnosis is its own national bottleneck, and SARRC says it provided 213 free diagnostic evaluations last year through philanthropy, clearing waitlist, insurance, and, by telemedicine, geographic barriers.
Why SARRC says the Medicaid reimbursement squeeze has not hit home
The pressure on Arizona’s market is real and contested. AHCCCS spending on ABA climbed from roughly $260 million in fiscal 2024 to $371 million in fiscal 2025. Mercy Care terminated contracts with both Centria Autism and Action Behavior Centers; Arizona Complete Health and UnitedHealthcare Community Plan each dropped Action Behavior Centers alone, with the changes taking full effect in early March 2026. The moves are part of a national wave of rate cuts and tightening billing rules that has also driven MCO disputes in states such as Georgia. One class action estimated up to 1,000 children could lose access, a number AHCCCS disputes. Insurers call the changes a fiscal necessity. Families and providers call them a threat to care. And some autistic self-advocates question parts of ABA itself. SARRC, for its part, runs a self-advocate advisory board that advises the organization on its programs, services, and communications.
Openden told Acuity that SARRC has largely stayed out of that storm. He points to a payer mix weighted toward commercial insurance rather than Medicaid, unlike providers “building their businesses on the Medicaid portion,” and to nearly three decades of local roots.
“We didn’t move here from out of state to set up shop,” Openden said. “We have been in this market long before there was any kind of insurance reimbursement to pay for services, and our bottom line is always going to be outcomes for the people we serve.” He credits the entry of private equity into autism therapy, which has consolidated much of the sector, with teaching nonprofits like SARRC to run leaner, even as he holds to what he calls a “thick red line” on quality.
Openden casts that as a defining choice. SARRC, he says, built its programs around quality first and a business around them second, rather than building a business and then working to ensure quality. “We led with quality,” he said.
Building BCBAs in-house amid the workforce shortage
SARRC’s staffing runs counter to a sector strained by a national shortage of board-certified behavior analysts. Openden said it employs about 250 people, including 36 BCBAs, most of them trained in-house. SARRC has tapped fundraising and endowment dollars to pay for employees to earn their master’s degrees and on-the-job certifications.
He casts the bad publicity around ABA as, oddly, a recruiting advantage. “This is not a field therapists and BCBAs entered to become super wealthy,” he said. “This is a field where people want to come in, and they want to make a difference in people’s lives, and we are seeing an increase in BCBAs interested in working at SARRC because they know we are an ethical, high quality provider.” Further, thirty-six employees have stayed a decade or more, a group SARRC has taken to calling “SARRC legends.”
Autism adult services, employment, and the services cliff
Where SARRC departs most sharply from the rest of the ABA industry is in its service to teenagers and adults. Most providers concentrate on young children, where billable hours are easiest to rack up. Adult services, Openden says, are exactly the work a nonprofit should take on.
“What a nonprofit should really do is provide services within a place for which there is no market,” he said. “There’s no market for adults with autism. That’s the biggest reason why you’re not seeing it. What nonprofits do is address gaps in the market and often help create a market.”
Every age is treated as a step toward independence. “At SARRC, we look at a three-year-old and ask what they are going to look like at 33, not six,” Openden said. In a spread-out city, that means transportation goals: teaching teenagers to use the autonomous-vehicle service Waymo or the light rail, and teaching younger children to ride a bike, which Openden called “medically necessary on the path to living independently.”
The flagship adult effort is the First Place Transition Academy, a two-year residential program where SARRC provides clinical services at First Place-Phoenix, the housing community built by its sister nonprofit, First Place AZ. Residents have their own bedrooms, take an independent-living curriculum at GateWay Community College, and hold community jobs. It started about a decade ago as private-pay and later picked up some Medicaid and commercial insurance coverage. Employment services cannot be billed to insurance, so SARRC funds that work through state vocational rehabilitation dollars and philanthropy; it also published a free online safety manual after finding some participants were being financially exploited online.
The numbers SARRC cites are concrete. Nationally, by the figures Openden uses, only about 14 percent of autistic adults are employed; SARRC says it added 17 employment partners in 2025 and 86 percent of the adults in its employment programs were competitively hired. Those partners run from a local art studio to Fine Timepiece Solutions, a watchmaking company that hires neurodiverse technicians and asked SARRC to help adapt a hiring process built around a written test.
What those services aim for shows up in self-advocates like Vin Peterson. He entered SARRC’s Community School at two and a half; at 19, he sits on the organization’s self-advocate advisory board and public policy committee. A self-described flag and civics obsessive, Peterson testifies at the Arizona Capitol, hosts a politics podcast, and drafted a bill to standardize the state’s Blue Envelope Program, which helps drivers on the spectrum communicate with law enforcement. It did not clear the committee this session, and he plans to bring it back. He is headed to Arizona State University to study political science, with an eye on running for the legislature one day.
Pushing Steven’s Law and Arizona autism insurance toward parity
SARRC has paired the service push with advocacy. Arizona’s autism insurance law, known as Steven’s Law and passed in 2008 as House Bill 2847, has long capped covered behavioral therapy at $50,000 a year for children under nine and $25,000 a year for ages nine through 16. Arizona was, by Openden’s account, the fourth state to pass an autism insurance mandate thanks largely to parents of children with autism.
In May 2025, Governor Katie Hobbs signed SB 1590, which SARRC helped pass after roughly 18 years of advocacy. By Openden’s account, the bill removes Steven’s Law’s age and dollar caps and, for the first time in Arizona, guarantees coverage for adults with autism. Independent summaries emphasize different changes: an update of the statutory autism definition to align with current criteria in the Diagnostic and Statistical Manual of Mental Disorders, and a bar on denying coverage solely because of an autism diagnosis. The caps had also long been seen as unenforceable under the federal Mental Health Parity and Addiction Equity Act.
“At a time when it feels like lots of people are concerned about losing services,” Openden said, “SARRC is actually expanding services, particularly for teens and adults with autism.” The need, he says, is bigger than any one provider. “There are limited options for autistic adults to receive ABA services, mostly due to funding,” he said. “We need more high-quality providers to help as well.”
Building Community
He has taken that message national. In an April 2025 op-ed responding to Health and Human Services Secretary Robert F. Kennedy Jr., who that month called autism an epidemic in remarks that drew criticism from many advocacy groups, Openden invited Kennedy and others to come to Arizona to see the work. With roughly 1 in 31 children in the United States now diagnosed with autism, he argued, the debate should shift from the hunt for a single cause to how to support people now. His refrain, and the op-ed’s title: “possibility lives here.”
SARRC’s ambitions extend beyond its own clients, making an impact in the surrounding community. “We are as committed to improving the behaviors and skills of people with autism as we are to improving the behaviors and skills of the communities in which they live,” Openden said, describing work with schools, restaurants, sports leagues, and employers. In 2016, a PBS NewsHour series, “A Place in the World,” produced with SARRC, First Place AZ, and dozens of other organizations, dubbed Phoenix “the most autism-friendly city in the world.”
Now he wants to take that model statewide. At SARRC’s annual community breakfast, a gathering it has hosted each spring for nearly three decades, he set a goal of putting effective services within reach of every Arizonan by 2030, scaling toward nine sites statewide. SARRC opened its fifth location, the Kathryn G. Bosco Campus in Mesa, in January 2025, plans a sixth in central Tucson in early 2027, and recently completed its A-to-Z and Everywhere in Between Capital Campaign, exceeding its $13 million goal for additional locations in North Phoenix, northern Arizona, and the West Valley, the last seeded by a lead gift from the Arizona Cardinals.
The clearest sign of that community, Openden said, is that breakfast, themed Hope Happens Here this year, which drew about 1,500 people two weeks before this interview, most of them business leaders, educators, legislators, and officials with no personal stake in autism. That base, he argues, is what lets SARRC take on work that does not pay for itself.
“I am one of these bleeding-heart behavior analysts who would tell you that I firmly believe ABA can change the world,” Openden told Acuity. “But we have got to start first with making sure that the quality of what we do is our guiding light, and then build everything else around that.”
