A Year of Change for Minnesota Autism Providers

In July 2025, headlines across Minnesota focused attention on concerns involving Medicaid-funded autism services. News stories about fraud investigations, provider oversight, and government accountability sparked important conversations about how public funds are managed and how vulnerable individuals are protected.

Nearly one year later, Minnesota’s autism service system continues to feel the effects of those events.

In response to concerns identified by the federal government, Minnesota Department of Human Services (DHS) implemented a series of significant program integrity initiatives affecting providers across the state. These efforts included increased audits, enhanced oversight activities, prepayment reviews, provider licensing requirements, and a statewide Medicaid revalidation process for providers serving Medical Assistance recipients.

For families, providers, and community members, the amount of information, and misinformation, can be overwhelming. As we reflect on the past year, it is helpful to understand what these changes were designed to accomplish, how they have affected providers, and what organizations like MAC Midwest are doing to continue supporting children and families throughout the process.

What Happened After the Autism Fraud Investigations?

The concerns raised in 2025 prompted policymakers, regulators, and oversight agencies to examine how autism services and other Medicaid-funded programs were being monitored.

While nearly all providers were not accused of wrongdoing, the events highlighted the need for stronger systems to ensure that public funds are used appropriately and that services are delivered in accordance with federal and state requirements.

As a result, DHS implemented a number of reforms designed to strengthen program integrity, including:

• Increased provider oversight and screening
• Enhanced Medicaid enrollment requirements
• Expanded auditing and monitoring activities
• New licensing requirements for EIDBI providers
• Prepayment review initiatives
• Revalidation of Medicaid provider enrollment

These changes affected providers across Minnesota regardless of whether they had ever been the subject of an investigation or allegation.

What Is Provider Revalidation?

One of the most significant changes has been the statewide provider revalidation process.

Medicaid provider revalidation is a federally required process through which providers periodically demonstrate that they continue to meet enrollment requirements and remain eligible to participate in Medicaid programs.

The process typically includes review of:

• Ownership information
• Managing employees and authorized agents
• Business operations
• Physical service locations
• Policies and procedures
• Background studies and screening requirements
• Other documentation required by state and federal regulations
• Unannounced site visits by DHS screeners

For many providers, revalidation involved substantial administrative work and extensive communication with regulatory agencies. It has also presented significant operational challenges for providers navigating new requirements, evolving guidance, and increased scrutiny.

Many providers have expressed concern that the implementation of these oversight efforts has been hindered by DHS administrative backlogs, delayed reviews, and inconsistent communication. While strong oversight is essential, effective oversight also requires DHS to process applications, conduct screenings, and issue determinations in a timely and consistent manner. When those systems fall behind, the burden often shifts to providers and families who are left navigating uncertainty despite making good-faith efforts to comply with evolving requirements.

Why Are Some Minnesota Providers Facing Disenrollment?

According to public reporting, 3,411 of the 5,583 Medicaid providers that underwent revalidation were notified of disenrollment.

Disenrollment does not mean fraud occurred.

In many cases, disputes involve questions regarding documentation, enrollment records, screening requirements, administrative processes, or interpretation of regulatory requirements.

Federal and state law provide appeal rights precisely because reasonable disagreements can occur regarding enrollment determinations.

The appeals process allows providers to present evidence, clarify information, and seek review of agency decisions through established administrative procedures.

How Has This Impacted Children and Families?

However, the most important question is not about paperwork or regulations, it is about people.

Children, teens and young adults receiving autism services often rely on consistent routines, established therapeutic relationships, and ongoing treatment plans developed over months or years. Any uncertainty within the provider system can create understandable concern for families.

Every month, every year, that a child is unable to access medically necessary autism services represents developmental opportunities that cannot simply be recovered later. Early intervention is designed to address challenges during critical periods of development, when gains in communication, social interaction, daily living skills, and independence can have the greatest long-term impact.

When access to care is delayed, the effects often compound over time. Children may require more intensive supports later in life, resulting in greater challenges to independence and increased long-term costs to public systems. Research and clinical experience consistently demonstrate that timely intervention can improve outcomes, strengthen family stability, and reduce the need for more restrictive or costly services in the future.

It is important to understand that Medicaid-funded autism services through Early Intensive Developmental and Behavioral Intervention (EIDBI) are not custodial care or babysitting services. These are medically necessary treatments that must be recommended by qualified professionals and authorized through Minnesota’s Medicaid program.

For providers, the challenge has been balancing compliance obligations with the responsibility to continue delivering high-quality care to the families who depend on those services.

MAC Midwest’s Experience with Revalidation

Like many providers throughout Minnesota, MAC Midwest participated in the statewide revalidation process and submitted applications for all service locations.

To date, 8 of our 17 centers have successfully completed revalidation and remain fully enrolled.

Nine centers received disenrollment determinations despite our belief that the required documentation and information were submitted appropriately, accurately, and in good faith.

Because we believe these determinations warrant further review, MAC Midwest has exercised its appeal rights and is actively participating in the administrative appeals process.

We remain committed to working collaboratively and professionally with DHS as these matters move through the established review process.

What MAC Midwest Is Doing Today 

Throughout the past year, our focus has remained centered on the children and families we serve. 

While regulatory processes continue, our leadership team has been actively engaged in several key areas: 

Advocating for Continuity of Care 

Our highest priority is ensuring that individuals receiving services experience as little disruption as possible. We continue to evaluate every available option to preserve access to medically necessary care. 

Supporting Our Workforce 

The professionals who provide autism services are the foundation of our mission. We remain committed to supporting our clinicians, behavior technicians, therapists, and support staff as they continue serving families during this period of uncertainty. 

Engaging with Policymakers and Stakeholders 

We continue to participate in industry discussions regarding Medicaid policy, provider oversight, program integrity, and the long-term sustainability of autism services in Minnesota. 

Looking Ahead

One year after the events that prompted widespread changes across Minnesota’s autism service system, the work of balancing accountability with access continues.

Strong program integrity is important. Families deserve confidence that services are delivered ethically, appropriately, and in compliance with all applicable requirements.

At the same time, children and families also need stable access to care, continuity of services, and providers that can continue fulfilling their mission within an increasingly complex regulatory environment.

For nearly 30 years, MAC Midwest has been privileged to serve Minnesota families affected by autism and related needs. That commitment has not changed.

As the appeals process continues, we will remain focused on the values that have guided our organization for decades: integrity, quality, accountability, and above all, the well-being of the individuals and families we serve.

We are grateful for the trust our families place in us and for the dedication of our staff, community partners, and supporters. We look forward to continuing this work for another 30 years.

Article by :  Jennifer Diederich, Chief Compliance Officer at MAC Midwest.