Published September 2026
Autism services spending has outpaced patient growth by more than 2x, with Medicaid and CHIP ABA spend rising 5.2x to $10.1 billion between 2021 and 2025 against 189% growth in patients served.
That divergence has brought the sector into a reform cycle. States including Nebraska, New York, Indiana, Colorado, and Arizona have cut rates or imposed hour caps, CMS has published its first federal cross-state rate benchmark alongside a recommended weekly intensity range, and payors are tightening medical-necessity and documentation standards.
The underlying fundamentals remain exceptionally strong:
- A large and growing addressable market. Measured prevalence has risen 4.8x since 2000 to 3.2% of children, against a $98 billion addressable market.
- Sticky, recurring demand. Treatment runs two to four years on average, and more than 80% of revenue comes from scheduled weekly therapy hours.
- A highly fragmented base. Roughly 7,000 providers serve the market and 70% operate fewer than five centers.
- Acquisition as the cheaper path to scale. Reform raises the cost and risk of building de novo, pushing growth toward M&A and regional density.
Deal activity reflects it. The sector has seen 378 transactions since 2015, including more than 120 sponsor-backed platform creations. 2025 was the most active year in our tracked history, with 47 deals. Multiples have held near 13x through the reform cycle with no compression yet visible. Returns now turn on utilization and realized hours, documentation quality, and payor diversification rather than center count, and platforms that can evidence those things continue to clear the top of the range.
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