Judge temporarily halts NC Medicaid cuts for autism treatment

RALEIGH, N.C. (WTVD) — As state lawmakers have stalled coming up with a budget, some of the most vulnerable North Carolinians have been caught in limbo.

After the General Assembly couldn’t come up with a budget that would include enough funding for Medicaid, ABA, or behavioral therapy for autism was facing a steep 10% cut for Medicaid reimbursement, higher than other programs facing a 3% cut.

After a lawsuit a judge issued an injunction to keep that funding going, but for families caught in the middle it’s still a difficult road ahead.

Marissa Scheetz from Franklinton, says her son Charlie has been through a lot by the age of 5.

“We kind of suspected about two years old that he did have autism. He wasn’t kind of meeting his milestones and that sort of thing,” she says.

Diagnosed with autism and non-verbal, ABA therapy was a gamechanger.

“He’s really come a long way. He’s starting to be able to communicate his emotions, which is really big from where he came from,” she says.

It’s sometimes been a maze of waitlists, and finding the right fit, and working with Medicaid, but now amid cuts, she’s worried he could lose the breakthrough care that finally helped him open up his world.

“I’m scared for my child. I’m scared that, you know, maybe it won’t necessarily lose all of the services, but it is a potential that he could start receiving cuts,” she says.

DHHS cut Medicaid reimbursements in October, including ABA by 10%, prompting 21 families to file suit to stop the cuts. A judge granting a temporary order.

Former U.S. Attorney Michael Easley, Jr. who worked on the case, says it’s about making sure valuable progress isn’t lost.

“Every month that those kids don’t receive that care is a month that these patterns and habits associated with their autism begin to calcify and can result in them not being able to speak or interact in a way that can allow them to be self-sufficient and productive members of society,” Easley says.

But it’s only temporary and other DHHS cuts are still in effect, until lawmakers can sort out a budget.

State Representative Zack Hawkins (D-Durham) has two sons with autism himself, and is calling on lawmakers to come to the table.

“And so, again, this this injunction is, again, a time to me to pause and just see sort of where we are, what we need and allow so that the department and legislators and others to think about and understand just how critical these services are to families across North Carolina who desperately need care,” says Hawkins.

DHHS did respond in a statement, saying:

“The North Carolina Department of Health and Human Services will comply with the temporary restraining order related to provider rate reductions for Research Based Behavioral Health Treatment Services. At this time, we are still awaiting the written order to be issued by the Court.

This order makes the need for the General Assembly to fund Medicaid even more urgent. Any reinstatement or reversal of the provider cuts without additional funding from the General Assembly means the program will run out of funding sooner, putting the entire state Medicaid system at risk.

Without additional funding and implementation of the October 1 rate cuts, North Carolina could run out of NC Medicaid funds as early as April 2026. If the NCGA fully funds NC Medicaid, the Department will reevaluate all cuts and take action to reverse or modify cuts to ensure NC Medicaid can operate within the appropriated budget.

We understand these provider rate cuts are devastating to people, providers and communities that rely on NC Medicaid. NCDHHS did not want to take this extremely difficult step of making these significant reductions for NC Medicaid services, however without additional funding from the General Assembly, it was unavoidable.”

As it stands right now, Medicaid rebates are only guaranteed to be funded through April.

Meantime, the next hearing in this lawsuit it set for Monday.