Texas Health Agency Proposes Eliminating Children's Autism Program

— Move threatens free therapy for low-income families left with few other options

For years, 7-year-old Israel Solis couldn't communicate with the world around him. Born with autism and nonverbal, he would bite and scratch himself in frustration when someone couldn't understand his needs. Therapy through a state-subsidized program gave him a voice: Using a picture system he's learned from his providers in Houston, he's now able to convey his desires.

But Texas wants to eliminate the state program, which allows some families to pay nothing for services, because of state budget cuts. In its budget request to the Legislature for the 2028-2029 bienniumopens in a new tab or window, the Texas Health and Human Services Commission (HHSC) proposed eliminating funding for the Children's Autism Programopens in a new tab or window (CAP) entirely, stunning advocates, providers, and parents.

"If the doors just completely close to access that at all, you just feel like it's all caving in on you, like 'how am I going to get some help?'" said Israel's mother Elizabeth Solis, who has another son who obtains services through a CAP-funded program at the University of Houston-Clear Lake's Center for Autism and Developmental Disabilitiesopens in a new tab or window; she pays nothing for their services.

CAP, which started in 2008, contracts with 16 providers across Texas to provide focused applied behavior analysisopens in a new tab or window (ABA) therapy to autistic children at a reduced cost based on their families' incomes and insurance coverage. Children are eligible for up to 720 hours of ABA therapy, which advocates consider the gold standard for autism treatment, over their lifetime.

Over the last 2 years, the state spent $13.7 million on the program, and this year even expanded the program, extending eligibility to those up to 21 years old and removing a cap on yearly hours. In fiscal year 2026, the state autism program funded treatment for 583 children, but contractors report there are at least 1,000 more childrenopens in a new tab or window on waitlists statewide.

"We were really shocked to see nothing, and it's just blank where the line item should be," said Jacquie Benestante, executive director of the Autism Society of Texas. "We're used to having to fight for funding, but to actually have a program just slashed and canceled is pretty shocking."

In July, Gov. Greg Abbott (R), Lt. Gov. Dan Patrick (R), and House Speaker Dustin Burrows (R) directed state agencies, appellate courts, and universities to cut spending by 3%opens in a new tab or window in the next biennium. In response to questions about why HHSC chose to eliminate the program, officials pointed to HHSC's 3% budget reduction summaryopens in a new tab or window, which says the agency "focused reductions on the lowest direct service impact to clients and minimizing impacts to federal funding."

But, in HHSC's budget request proposing to axe the program, officials explicitly acknowledged the acute need for autism therapy. "The demand for services exceeds the availability of qualified providers especially in rural parts of the state," per the request. "While private and public insurance now provide coverage for treatment services there are often not providers available in all parts of the state."

If the Legislature agrees to eliminate the program, children would still receive services through the end of August 2027, HHSC said.

Many of Texas' public programs are funded with federally matched dollars. Jeff Miller, a senior policy specialist at Disability Rights Texas, said CAP, as a solely state-funded program, may have seemed like an easy way to cut costs without endangering federal funding.

Complexities around Medicaid coverage for ABA therapyopens in a new tab or window may also be partly to blame. In 2022, Medicaid benefits started covering ABA therapy for people 20 years old and younger, making the state's autism program appear redundant. But relying solely on Medicaid could still leave many without access to ABA therapy, said Jolene Pohl, advocacy director for the Coalition of Texans with Disabilities.

First, those Medicaid benefits don't apply to families without insurance or who are on self-funded insurance plans, which aren't required to cover ABA therapy. Second, Medicaid, despite the new benefits, is far from a guarantee for accessing ABA therapy: Due to low reimbursement rates, it's difficult to find providers willing to take Medicaid clients. CAP is an avenue for families that fall through these gaps to still access ABA therapy, Pohl explained.

"It would make more sense to increase the funding and get those kids off the waitlist and give them the services that they need," Pohl said, "because eventually it's going to cost the state more if we don't provide the services to these eligible families in a timely manner."

Single mother Emily Pena said that even though her daughter Lila Rodriguez, 5, is on Medicaid, finding a provider still proved difficult. She eventually discovered a CAP-funded program at the University of Houston-Clear Lake's autism center.

Lila was nonverbal when she was first diagnosed and struggled in pre-K. ABA therapy works by using positive reinforcement to encourage desired behaviors. For instance, to help address Lila's meltdowns when tablet time ended, therapists used something fun, like slime, to redirect her so that she associated the transition with a positive outcome. Pena said the center's program, which Lila attended two or three times a week until she graduated in June, allowed her to enjoy "somewhat of a normal childhood."

Over the past 20 years, the number of children diagnosed with autism spectrum disorder has risen 300%opens in a new tab or window, according to researchers at Johns Hopkins University. With autism diagnoses on the rise, ABA therapy is in high demand. In Texas, wait times for CAP-partnered programs are measured in years, not weeks.

The University of Houston-Clear Lake's autism center has worked with the state to offer ABA therapy since CAP launched. Last year, the center's CAP-affiliated programs provided therapy for 41 families, the center's director, Dorothea Lerman, PhD, said, and there's another 200 families on the waitlist. She called the proposal to eliminate CAP "devastating."

"There is no other option for the majority of them, and so they would basically have no services," Lerman said. "It would greatly impact the quality of the whole family's life -- the ability to take your child to the grocery store or out to a restaurant, to function better, and learn better in public school."

Her center doesn't have the infrastructure to take Medicaid or insurance, Lerman said. If the proposed CAP elimination goes into effect, the center would have until August 2027 to find an alternate source of funding before its CAP-affiliated programs shut down.

The proposal has also left Hailey Johnson baffled and frustrated. Her son Micah Ortiz was diagnosed with autism at 18 months; now 3 years old, he attended one of the university's CAP-funded programs for several months and is on the waitlist to return to the program. Johnson said that ABA therapy improved his communication skills and mitigated his meltdowns and aggressive behavior.

"It's already hard enough on families with kids with autism ... We don't have that many resources as it is," Johnson said. "This was a really great one, and they're going to take that away."