HHSC proposes ending the Texas Children’s Autism Program, which funded ABA for 583 children in FY 2026, to meet a 3 percent cut. Lawmakers decide in 2027.
Key Takeaways
- A zeroed-out line item: HHSC’s 2028-29 budget request funds the Children’s Autism Program at $0, ending $6.8 million a year in state-only ABA grants. The program funded treatment for 583 children in fiscal 2026.
- The 3 percent directive: The cut helps HHSC meet a $330.8 million reduction target set under a July order from state leaders. Medicaid and CHIP were exempt, and the agency says it chose reductions with the lowest direct impact on clients.
- Overlap and gaps: HHSC says 68 percent of the 655 children the program served in fiscal 2025 had Medicaid or CHIP coverage, and nearly 89 percent had some coverage. Texas Medicaid’s ABA benefit does not reach CHIP enrollees, families on self-funded plans, or the uninsured, and the program now serves 21-year-olds, a year past the Medicaid age limit.
The Legislature decides in 2027: None of HHSC’s 38 add-on budget requests names the program, leaving any restoration to lawmakers writing the 2028-29 budget. If the cut stands, HHSC says services continue through August 2027.
In April, the Texas Health and Human Services Commission proposed rewriting the rules for one of its smaller programs, a grant-funded effort that pays local providers to deliver applied behavior analysis to autistic children. The changes, adopted in August and effective August 25, opened eligibility to anyone younger than 22, where the program had previously served children ages 3 through 15. They removed a ceiling of 180 service hours a year and a 24-month limit on time in the program, and, after comments from professional associations, added Nurse Practitioners and Physician Assistants to the clinicians who can make a qualifying diagnosis. The agency’s rulemaking notice said the age change “fills a significant gap in the availability of autism services for children and young adults.”
HHSC’s budget request for the next biennium leaves that program unfunded. In its Legislative Appropriations Request for fiscal years 2028 and 2029, submitted September 4, the agency requests $0 for the Children’s Autism Program in each year. The proposal drew statewide attention after The Texas Tribune reported on it October 12, and the Associated Press distributed the story nationally. Jacquie Benestante, Executive Director of the Autism Society of Texas, told the Tribune that the request was “just blank where the line item should be.”
The request is a proposal, not a law. Texas agencies submit appropriations requests as opening positions, and the 90th Legislature, which convenes in January, will write the budget that takes effect in September 2027. Still, it puts a program that has operated since 2008 on the table, with consequences for its contracted providers, for nearby operators serving Medicaid and commercial patients, and for families on its waitlists.
What the Texas Children’s Autism Program Funds and Who It Serves
The Children’s Autism Program began as a pilot in fiscal 2008, serving children ages 3 through 8, according to HHSC. It now works through grant contracts with 16 providers across the state, according to the Tribune, which deliver focused ABA aimed at one or more specific skill deficits or behaviors. Families pay a monthly cost share scaled to adjusted gross income and household size, and some pay nothing. The program is a payer of last resort: when a family has insurance that covers ABA, the contractor bills the insurer first, and the family owes the lower of the HHSC fee schedule amount or its deductible, copayment, or coinsurance.
The rules adopted in August kept a lifetime limit of 720 service hours; at 20 hours a week, a child would reach it in 36 weeks. How much treatment children need remains a live question among providers. Parents must attend training sessions at least twice a month, and children must attend at least 85 percent of scheduled sessions.
HHSC’s request shows the program spent $5.15 million in fiscal 2025, when it served 655 children, according to the agency, and is budgeted at $6.83 million in each of fiscal 2026 and 2027, about $13.7 million for the biennium. In fiscal 2026 it funded treatment for 583 children over the course of the year, according to the Tribune, and served an estimated average of 253 in a given month, at an estimated annual cost of about $6,958 per child, according to HHSC. The agency had budgeted for an average of 625 children a month in fiscal 2027, the first full year under the expanded rules, before setting both years of its new request to zero. Contractors have reported at least 1,000 more children on waitlists, a figure the Tribune cited from the Legislative Budget Board’s 2026 Strategic Fiscal Review. At the University of Houston-Clear Lake’s Center for Autism and Developmental Disabilities, a contractor since the program’s first year, the program served 41 families last year with about 200 more waiting, Director Dorothea Lerman told the Tribune. She said the center lacks the infrastructure to bill Medicaid or private insurance and would have until August 2027 to find another source of funding if the elimination takes effect.
The program has faced this question before. Ahead of the 2015 legislative session, Legislative Budget Board staff recommended phasing out what was then the Department of Assistive and Rehabilitative Services Autism Program, and a Senate proposal would have shifted its funding to the Texas Education Agency. The Legislature instead appropriated $14.4 million, phased out comprehensive ABA, and expanded focused ABA with the aim of serving 1,970 children, up from 295 in 2014, according to the Texas Council for Developmental Disabilities.
Why HHSC Listed the Autism Program in Its 3 Percent Budget Cuts
The proposed elimination answers a July 14 policy letter from Governor Greg Abbott, Lieutenant Governor Dan Patrick, and House Speaker Dustin Burrows requiring each agency to reduce its base appropriation request by 3 percent as the starting point for budget deliberations. The letter exempted the Foundation School Program, debt service, the new education savings account program, state pension and employee benefit costs, and amounts needed to maintain benefits and eligibility required by state law for Medicaid, CHIP, foster care, adoption subsidies, and the Permanency Care Assistance program. The Children’s Autism Program is not in those categories.
Those exemptions shaped where HHSC’s cut could land. According to the agency’s summary of its 3 percent reductions, about $32.3 billion of its $43.6 billion general revenue base was set aside for Medicaid and CHIP, leaving roughly $11.2 billion subject to the reduction and an HHSC target of $330.8 million. In the request’s opening statement, Executive Commissioner Stephanie Muth wrote that “Medicaid and CHIP were exempted” and that the agency protected state hospitals, state supported living centers, eligibility operations, and regulatory oversight.
The summary lists the “GR Funded Autism Program (non-Medicaid)” among a dozen client-service programs proposed for elimination, at $6,831,542 in each of fiscal 2028 and 2029, or $13,663,084 over the biennium. That equals roughly 4 percent of HHSC’s target. The summary says the agency concentrated client-service cuts where they carried the “lowest direct service impact to clients” while minimizing effects on federal funding, and that when client services must be reduced, it weighs demand for the service and its effect on the health of Texans. In the request itself, the explanation for the program’s change in funding is a single line: “2028-29 LAR 3% Base Reduction.” In a statement to Acuity, HHSC said it submitted the request in September “as part of the normal legislative process” and that the Legislature will determine the agency’s budget and any changes to the program.
Unlike Medicaid, which draws federal matching dollars, the program is paid for entirely with state general revenue. Jeff Miller, a Senior Policy Specialist at Disability Rights Texas, told the Tribune that its state-only funding may have made it look like an easy reduction that did not put federal dollars at risk.
The request does not dispute the need. Its section on factors affecting the program states that “the demand for services exceeds the availability of qualified providers especially in rural parts of the state,” and that children with higher needs and more intense challenging behavior have fewer providers available to them than younger children with fewer challenging behaviors. It adds that the number of qualified Licensed Behavior Analysts is not sufficient to meet demand, which “creates a challenge for the contractors to ensure performance.”
The August rule changes did not depend on new appropriations. HHSC’s impact statement for the rules projected no change in future legislative appropriations, and the amended text states that the agency may operate the program only if the Legislature funds it. The expansion widened who could be served within whatever money existed; the budget request asks whether that money should exist after August 2027.
Where Texas Medicaid ABA Coverage Leaves Gaps
The clearest argument for winding the program down is its overlap with Medicaid. Since February 1, 2022, Texas Medicaid has covered ABA for members 20 and younger through STAR, STAR Kids, and STAR Health, with managed care organizations administering the benefit under the state’s fee schedule.
HHSC’s enrollment figures put a number on that overlap. Of the 655 children the program served in fiscal 2025, nearly 89 percent had some type of coverage, Jennifer Ruffcorn of the HHS Office of Communications told Acuity in a statement; 68 percent were covered through Medicaid or CHIP. The program, she noted, is a payer of last resort that sets each family’s cost share on a sliding scale and according to available coverage. HHSC’s figure combines Medicaid and CHIP, so it does not show how many of those children were CHIP enrollees, who fall outside the Medicaid ABA benefit.
The overlap is incomplete in four places. Children enrolled in CHIP are not eligible for the EPSDT-based Medicaid ABA benefit, as Acuity detailed in its April breakdown of the Texas Medicaid ABA fee schedule, a gap that Iowa’s CHIP program shares. Families on self-funded employer plans, which federal law exempts from state autism mandates, may have no ABA coverage at all, a point Jolene Pohl, Advocacy Director for the Coalition of Texans with Disabilities, made to the Tribune. Uninsured families have no third-party payer, and by HHSC’s figures, a little more than one in 10 children in the program in fiscal 2025 had no coverage. And since the August rule change, the program reaches 21-year-olds, a year past the Medicaid benefit’s age limit and at the edge of what Acuity has described as the autism services cliff.
Coverage also does not guarantee a provider. Texas Medicaid pays $14.50 per 15-minute unit for technician-delivered treatment under CPT 97153 and $25.10 for Licensed Behavior Analyst-level treatment with protocol modification under 97155, according to the TMHP Autism Services fee schedule effective September 1, 2025. On 97153, that places Texas at the bottom of the seven-state regional comparison Acuity charted for Oklahoma. Autism Learning Partners announced in December 2025 that it would exit Texas in March 2026, citing the state’s rates and authorization processes, and some newer operators have waited years to enroll: Unity Behavioral Services told Acuity in September that its Texas Medicaid application had been open for two and a half years.
Pohl told the Tribune that the Children’s Autism Program is how families who fall through those gaps still reach ABA, and argued that delaying services will cost the state more over time. Emily Pena, a mother interviewed by the Tribune, said her daughter was enrolled in Medicaid, but finding a provider remained difficult until she located a program funded by the Children’s Autism Program.
What Happens Next for the Children’s Autism Program in the 2027 Legislature
The 90th Legislature convenes January 12, 2027, and the budget it passes will run from September 2027 through August 2029. The policy letter lets agencies seek money above their baseline through exceptional item requests. HHSC filed 38, totaling about $6.2 billion in all funds, and none of them names the Children’s Autism Program; lawmakers can still fund it when they write the bill. If they accept HHSC’s proposal, children enrolled in the program would continue receiving services through the end of August 2027 with current funding, HHSC told Acuity.
Three markers will show where the proposal stands. The first is whether the program’s funding appears in the House and Senate base budget bills. The second is how members of the House Appropriations and Senate Finance committees respond during health and human services hearings early in the session, where advocacy groups and contractors can testify. The third is what HHSC tells its contractors about enrolling children from their interest lists between now and August 2027.
For operators outside the program, the effects would be indirect. Contractors that do not bill insurance, such as the Clear Lake center, have no obvious substitute revenue, and children who leave the program with Medicaid or commercial coverage would enter networks that HHSC’s own request describes as short on qualified providers.
For now, the rules HHSC adopted in August remain in force. A 21-year-old in Texas with an autism diagnosis can join a contractor’s interest list today, under eligibility standards the agency described in May as filling a significant gap. Whether there will be money to serve that person after August 2027 is the question the agency has handed to the Legislature.
Sources: HHS Office of Communications, statement to Acuity (October 2026); Texas Health and Human Services Commission, Legislative Appropriations Request for Fiscal Years 2028 and 2029, Volume I, including the 3.A Strategy Request for Strategy 4.1.6 and the 2.E Summary of Exceptional Items Request (September 4, 2026); HHSC, 2028-29 Biennium 3 Percent Reductions summary (revised September 2026); Office of the Governor, LAR Policy Letter (July 14, 2026); Texas Register, Children’s Autism Program proposed rules (May 1, 2026) and adopted rules, 26 TAC Chapter 358 (August 21, 2026; effective August 25, 2026); TMHP Texas Medicaid Fee Schedule, Autism Services (rates effective September 1, 2025); The Texas Tribune (October 12, 2026); Legislative Budget Board, Strategic Fiscal Review (84th Legislature, 2015, and September 2026); Texas Council for Developmental Disabilities; prior Acuity Media Network reporting.
