CareSource Partially Reverses Georgia Therapy Rate Cut, Leaving Access Uneven

A Reversal That Does Not Reach Everyone

ATLANTA, GEORGIA — CareSource has begun reversing its 20 percent reimbursement cut for some pediatric therapy providers. Still, the change does not settle the crisis that families and clinics have been warning about for months.

CareSource sent rescission letters in July to certain providers, allowing them to remain under their previous reimbursement terms. The Georgia Department of Community Health said those letters were targeted to communities where an ongoing network analysis identified a provider shortage.

That means the outcome now depends in part on geography. Some clinics have returned to a normal Georgia Medicaid fee schedule. Others remain subject to the lower rate, and some providers that rejected the amendment have already been terminated from the CareSource network.

The bigger picture is that a partial reversal can protect access in one community while leaving another family with the same problem. A child does not experience network adequacy as a statewide percentage. A family experiences it as whether a qualified therapist is nearby, accepting patients, and able to continue care.

How Georgia Reached This Point

The dispute began after CareSource mailed providers a Notice of Material Amendment on March 27. The notice lowered reimbursement to 80 percent of the state Medicaid fee schedule, effective May 11, according to Breaking News ABA and local reporting.

Providers had 45 days to object. Those who stayed silent were treated as accepting the change, while those who objected risked termination from the network. For independent therapy practices, the choice was not simply about earning less. It was whether they could continue treating Medicaid patients without destabilizing the rest of the clinic.

Local reporting soon showed what that pressure looked like. Atlanta News First reported that 40 of Georgia’s 159 counties already had no CareSource speech, physical, or occupational therapy providers. Its later analysis found the original reimbursement change could affect at least 71 percent of the state’s pediatric Medicaid therapy network.

CareSource said the adjustment reflected rising health care costs and the need to manage Medicaid resources responsibly. At a public meeting, a company executive also described an oversaturation of therapists and said CareSource planned to move toward a performance-based incentive model in 2027. Providers questioned how the network could be oversaturated when families were already facing long drives and waitlists.

Lawmakers Put Access at the Center

The issue moved from provider meetings into the Georgia General Assembly on June 23. Lawmakers questioned whether a health plan paid a fixed amount per member should respond to growing demand by reducing provider reimbursement.

State Rep. Scott Hilton said he had no tolerance for anyone hurting some of Georgia’s most vulnerable children. State Rep. Jesse Petrea argued that every effort should improve services for people with disabilities rather than reduce them.

CareSource’s own executives did not speak at the hearing. Jesse Wethington, CEO of the Georgia Association of Health Plans, spoke on the company’s behalf and said overall therapy utilization had risen about 62 percent from 2018 to 2025, with autism-related utilization rising by about 300 percent. He argued that members could move to other willing providers if a clinic rejected the lower rate.

That answer brought the central disagreement into focus. CareSource described a system that could redirect patients inside its network. Providers and families described a network that already had empty counties, long waitlists, and clinics preparing to leave.

The New Question Is Who Qualifies for Relief

CareSource now says it is having targeted conversations with providers to preserve access in individual communities. DCH has also said managed care organizations must maintain adequate networks and that the agency is monitoring access.

However, neither the public reporting nor the state statement explains the full formula used to decide which clinics receive rescission letters. Providers still need to know what evidence defines a shortage, how often the analysis is updated, whether a termination can be reversed, and what happens when a county has a provider on paper but no open appointment in practice.

The distinction matters for ABA providers as well as for speech, occupational, and physical therapy clinics. A directory may show that a service exists, but that does not mean the provider has capacity, treats the child’s needs, or is within a realistic driving distance.

Georgia is also tightening oversight of ABA. In April, DCH proposed additional prior authorization requirements, claims-based RBT oversight ratios, geographic limits on remote supervision, and new capacity expectations for larger agencies. Those changes reflect the state’s focus on program integrity, but they arrive while providers are also navigating reimbursement uncertainty.

Ultimately, CareSource’s partial reversal shows that provider shortages can force a payer to reconsider a rate decision. It also leaves Georgia with a difficult question. If full reimbursement is necessary to preserve access in one part of the state, what protects children in communities that have not yet crossed the official shortage threshold?

AT A GLANCE

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