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The Texas Health and Human Services Commission has proposed eliminating the state-funded Children’s Autism Program in its 2028-29 budget request. If lawmakers approve the proposal, services would continue through August 2027, but families and advocates say the program fills gaps left by insurance and Medicaid coverage.
The Texas Health and Human Services Commission has proposed eliminating all state funding for the Children’s Autism Program, which offers reduced-cost applied behavior analysis therapy to eligible children. The proposal is part of the agency’s 2028-2029 budget request and would need approval from the Legislature; if approved, current services would continue through August 2027.
The Children’s Autism Program (CAP) contracts with 16 providers across Texas to provide focused ABA therapy at a cost adjusted for family income and insurance coverage. Eligible children can receive up to 720 hours over their lifetime. The program began in 2008 and is funded entirely by the state, according to the report.
Texas spent $13.7 million over the past two years on CAP. In fiscal year 2026, the program funded treatment for 583 children, while contractors reported at least 1,000 more children on statewide waitlists. This year, the state expanded eligibility to people up to age 21 and removed an annual-hours cap, the report said.
HHSC’s budget request acknowledges that demand for autism services exceeds the supply of qualified providers, particularly in rural areas, and says that insurance coverage does not mean providers are available everywhere. The agency’s summary of its 3% budget reduction effort said it focused cuts on areas with the lowest direct impact on clients and sought to limit effects on federal funding. Officials did not provide a specific explanation for selecting CAP for elimination in response to questions, according to the report.
Families Could Lose a Route to Therapy
CAP serves families who may have difficulty obtaining ABA therapy through other routes, including some who have insurance but cannot find a provider willing to accept it. Medicaid coverage alone may not secure access, advocates told MedpageToday, citing low reimbursement rates and limited provider availability. Self-funded insurance plans are also not required to cover ABA therapy, while families without insurance may face additional barriers.
The proposal could therefore affect more than the amount families pay: if the program ends, some could lose access to a provider or face longer waits. The scale of that effect is not established, but the reported waitlist and provider shortages point to existing limits on availability. Disability rights and autism advocates argue that eliminating a state-funded option could leave children without timely services, while the state has not published a detailed account of how affected families would be served instead.
Parents interviewed for the report described the practical role of CAP-supported services. Elizabeth Solis said therapy helped her nonverbal son communicate using pictures. Emily Pena said she struggled to find a provider for her daughter despite the child’s Medicaid coverage, before finding a CAP-funded program. These accounts illustrate individual experiences; they do not establish what the program’s proposed elimination would mean for every family.
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Budget Cuts and Coverage Gaps
In July, Gov. Greg Abbott, Lt. Gov. Dan Patrick and House Speaker Dustin Burrows directed state agencies, appellate courts and universities to reduce spending by 3% in the next biennium. HHSC cited its reduction summary when asked about its budget decisions. Disability Rights Texas policy specialist Jeff Miller told MedpageToday that CAP’s status as a solely state-funded program may have made it appear to be a less complicated target than programs involving federal matching funds. That is his assessment, not a stated explanation from HHSC.
Medicaid began covering ABA therapy for people age 20 and younger in 2022, which may have made the state program seem duplicative. But advocates say Medicaid and private coverage do not eliminate provider shortages or cover every family’s situation. CAP’s income-adjusted services have remained a separate option for some families who encounter those gaps.
The proposed cut comes after Texas expanded the program’s eligibility and removed its annual-hours limit. The budget request would reverse that trajectory if lawmakers accept it, even as the agency’s own request describes unmet demand and limited provider availability.
“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?’”
— Elizabeth Solis, parent of a child receiving CAP-supported services
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Legislators Have Not Decided
The proposal is not a final budget decision. The Legislature must decide whether to approve the elimination as part of the 2028-2029 biennial budget. The available report does not specify how lawmakers will respond, whether a revised funding level will be considered, or whether HHSC has identified an alternative service arrangement for children currently relying on CAP.
It is also unclear how many families would lose access to therapy if funding ends. The reported 1,000-plus figure refers to children on contractor waitlists, not a count of all children who would be affected by elimination. The state has not provided a breakdown of families who could obtain services through Medicaid or private insurance, or how provider capacity would change.
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Budget Debate Sets the Timeline
The next major step is the Legislature’s consideration of the 2028-2029 budget. Until lawmakers act, the proposal remains a request from HHSC rather than an enacted cut. Families, service providers and advocacy groups are likely to press legislators to retain or restore funding, but the report does not identify a specific hearing date or a final vote schedule.
If lawmakers approve elimination, HHSC said children would continue receiving services through the end of August 2027. The agency and Legislature would still need to clarify what happens after that date, including whether other programs can serve affected children and how families who cannot find Medicaid- or insurance-covered providers could obtain care.
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Key Questions
Has Texas already ended the Children’s Autism Program?
No. HHSC has proposed eliminating the funding in its 2028-2029 budget request. The Legislature has not yet made a final decision.
What services does the program provide?
CAP contracts with 16 providers to offer focused applied behavior analysis therapy at a cost adjusted for family income and insurance coverage. Eligible children can receive up to 720 hours over their lifetime.
When would services stop if the proposal is approved?
HHSC said services would continue through the end of August 2027 if lawmakers approve eliminating the program. The report does not describe a replacement program after that date.
Does Medicaid coverage mean families can easily find ABA therapy?
Not necessarily. Advocates say low reimbursement rates can make it difficult to find providers who accept Medicaid, and some self-funded insurance plans are not required to cover ABA therapy. Provider availability varies, including by location.
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