Minnesota Extends Medicaid Freeze on New Autism Agencies Through April 2027

ST. PAUL, MINNESOTA – Minnesota will keep new autism-therapy agencies out of its Medicaid program through April 30, 2027, six months beyond the freeze’s scheduled Oct. 31 end. The Department of Human Services (DHS) told providers in an Oct. 27 notice that the federal Centers for Medicare & Medicaid Services (CMS) had approved the extension, the second since the freeze began Nov. 1, 2025.

The freeze covers Early Intensive Developmental and Behavioral Intervention (EIDBI), the Medicaid benefit that pays for ABA and other therapies for eligible Minnesotans under 21 with autism or related conditions. New agencies still cannot enroll. The notice allows new locations for agencies approved for a provisional license, an interim state license, before Dec. 31, 2026. Individual practitioners can still enroll and affiliate with agencies that are enrolled and provisionally licensed. The freeze does not affect enrollment of people receiving services.

The Oct. 27 notice gives no reason for the extension. In a fact-check entry posted July 6, DHS said it had opened 73 investigations of EIDBI providers and made 25 referrals to law enforcement since October 2024.

Another change is already law. The human services budget law enacted in May sets EIDBI billing limits beginning July 1, 2027, or upon federal approval, whichever is later. Intensive services will be limited to 40 hours per person per week, with separate limits on treatment planning, clinical oversight, and travel. DHS must grant exceptions when additional services are medically necessary. The law makes DHS’s decisions on providers’ exception requests “final and not subject to appeal.”

Licensing Decides Who Can Expand

The new-location restriction ties expansion to provisional licensing. Under the previous moratorium terms, agencies enrolled before Nov. 1, 2025, could add locations. State law required agencies to apply for a provisional license by May 31, 2026, and requires DHS to approve or deny each application by Dec. 31. DHS received applications covering 433 of the 481 sites that could have applied, the Minnesota Reformer reported in June.

For would-be new agencies, DHS’s licensing page adds a hurdle the extension notice does not mention. Agencies must have applied for a provisional license before they can bill, and the page says that application “is closed to new agencies.” It gives no reopening date. Applications for a full license will open after lawmakers approve comprehensive standards and those standards take effect. DHS plans to propose them by Jan. 1, 2027. In a July 14 update, the department said it expected the standards to take effect no earlier than 2028, if passed.

What the Billing Limits Cover

The 40-hour limit matches the upper end of some EIDBI treatment protocols, which “call for up to 40 hours per week,” according to a 2025 DHS report. Arizona and Colorado have proposed thresholds of 25 hours a week or fewer, depending on school status or age, above which providers must justify additional care. Both proposals allow medically necessary services above those thresholds.

The law also limits treatment-plan development and monitoring to 300 billing units a year per person. It caps observation and direction, the clinical direction and oversight of therapy, at 20 hours a week, and travel time at 2 hours a day per person.

The limits came from the governor’s 2026 anti-fraud package, which DHS said would add or modify billing limits “to mitigate risk of overbilling.” The Minnesota House’s fiscal tracking projects that the four limits will reduce state Medicaid benefit spending by about $6.8 million from July 2027 through June 2029, before administrative costs. Most of that projected reduction comes from the limits on treatment planning (about $3.8 million) and observation and direction (about $2 million). The 40-hour limit accounts for about $910,000.

At an April House committee hearing, before the law passed, leaders of the Autism Treatment Association of Minnesota raised concerns about the billing limits then in the bill. “The limits offered today were first presented to us one week ago with no opportunity for public input or scrutiny,” said Eric Larsson, the association’s chair. The association’s president, Jay O’Neill, said, “Placing caps on services may prevent some children from ever reaching their full potential.”

Exceptions and Appeal Rights

To bill above a limit, a provider must apply to DHS for an exception using forms and procedures the department prescribes. DHS’s July quarterly update repeated that requirement but supplied no forms, deadlines, or application steps.

“A determination under this paragraph is final and not subject to appeal.” – Minnesota’s 2026 human services budget law, on EIDBI billing-limit exceptions

The billing-limits provision addresses providers’ exception requests without explaining how its appeal restriction interacts with recipients’ hearing rights. A separate Minnesota law allows Medicaid recipients to request a state fair hearing when services are denied or reduced; providers may assist recipients but cannot request those hearings on their own behalf. DHS’s July update did not address how those rights would apply after an exception denial.

DHS must decide provisional-license applications by Dec. 31, 2026. The enrollment freeze is scheduled to end April 30, 2027, though further six-month extensions are possible with CMS approval.

AT A GLANCE

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