(The Center Square) – State Auditor Dave Boliek, a first-term Republican, has hired an auditor to direct a team that will examine Medicaid spending in North Carolina with a significant focus on spending for autism therapy.
“Previous engagements by the State Auditor’s Office have already exposed some questionable spending and decisions surrounding Medicaid,” Randy Brechbiel, spokesman for Boliek’s office, told The Center Square on Monday morning.
In the 2025 fiscal year, North Carolina spent $25 billion in federal funding on Medicaid, which accounted for more than half of all the state’s federal grants, the state said. State funds covered $6.17 billion of the costs.
A review of 40 sample payments as part of a state audit released late last year uncovered a payment of $170,042 to a Medicaid provider that should not have been paid because it was submitted 29 months after the medical service was provided.
“We’re currently looking at a rise in spending on Applied Behavior Analysis therapy in North Carolina’s Medicaid program,” Brechbiel said.
ABA is a therapy for autism.
A new report by the Cato Institute found that Medicaid spending for autism therapy has increased from $347 million to more than $2.2 billion in recent years.
In Minnesota, a state that has recently gained national attention for accusations of fraud in federal spending, Medicaid autism therapy has increased from less than $700,000 in 2018 to $342 million in 2024, the Cato study found.
The number of people diagnosed with autism has also increased dramatically, Cato found.
Before 2000, fewer than 1 in 150 people had autism according to the U.S. Centers for Disease Control and Prevention. In 2025, the number had increased to 1 in 31, Cato said.
“The American health care system’s structure of open-ended reimbursement, subjective diagnostic criteria, and fee-for-service billing creates powerful incentives for psychiatric overdiagnosis across every condition,” Cato said. “Nowhere have those incentives produced more dramatic consequences than in Medicaid-funded autism therapy.”
Medicaid dollars spent on autism centers has jumped in North Carolina, Boliek told a legislative panel.
“There has been a tremendous spike in the amount of money that Medicaid spends in that particular arena,” Boliek told the joint Legislative Oversight Committee on Health and Human Services. “Our team has begun a detailed look at that. That is one area that we identified that needed a really, really, really close look.”
North Carolina expanded its Medicaid program in late 2023, becoming the 40th state in the nation to do so. U.S. Senate candidate Roy Cooper, the former two-term Democratic governor, hails it as a signature achievement.
A fraud probe would loom as an albatross to a campaign already weighted down by his failed North Carolina Office of Recovery and Resiliency following Hurricanes Matthew (2016) and Florence (2018); and the release of 3,500 prisoners including 51 on death row in a litigation settlement with the NAACP and ACLU.
As a result of the expansion, more than 600,000 people gained coverage, the state said at the two-year anniversary of the expansion last December.
“Medicaid expansion is a perfect example of what we can accomplish when we come together and put the well-being of North Carolinians first,” first-term Democratic Gov. Josh Stein said in a statement last December.
