ABA is a data-driven, goal-oriented therapy that uses positive reinforcement to build skills and manage challenging behaviors. The therapy style has gained popularity among children with autism and other behavioral health diagnoses for its one-on-one personalized approach that Malhotra said she believes can’t always be accessed within special education classrooms.
“I realized there were many more people who were struggling the same way as I struggled,” Malhotra said. “And if you think, back then there were very little resources. So that’s when I started my journey.”
Although more than two dozen ABA centers have opened in Sugar Land and Missouri City since 2017, local providers said demand continues to exceed capacity, underscoring persistent gaps in autism care.
Additionally, families—especially those relying on Medicaid—still face long waitlists of up to a year to receive ABA care and high out-of-pocket costs, said Dana Harris, founder of Missouri City’s first ABA center Spectacular Kids.
How it works
What's happening
When Malhotra’s son was diagnosed with autism in the early 2000s, the nationwide prevalence was approximately 1 in 150 children, according to the U.S. Centers for Disease Control and Prevention. Since then, CDC data shows 1 in 31 children had autism spectrum disorder in 2022. Texas has higher rates, with an estimated 1 in 28 children receiving the diagnosis.
Meanwhile, Texas Education Agency data shows a rise in the number of Fort Bend ISD students receiving behavioral health services.
“I really think [the increase in diagnoses] has a lot to do with how we’re defining autism,” said Charlotte L. Carp, University of Houston clinical assistant professor. “Now autism is defined as a spectrum disorder so it includes a wide range of experiences and support needs.”
Digging deeper
Since 2022, Medicaid has covered ABA for those under 21, expanding access beyond private insurance, which began covering it in 2015. For 10% of children with autism who never received ABA, insurance was cited as a key barrier in a 2023 study from the Cureus Journal of Medical Science.
However, Behavioral Innovations officials said they accept Medicaid and report no waitlist at the Missouri City location.
Zooming out
Local community organizations are working to provide autism support as well.
Fort Bend County nonprofit Hope For Three provides monthly assistance and free programs for families who are struggling with financing all medical expenses, including ABA, Family Assistance Director Rowena Laine said.
Behavioral Innovations refers clients in need of financial assistance to the nonprofit as well as FACES Autism, Masonic Children & Family Services of Texas, and UnitedHealthcare Children’s Foundation, said Ashly Joys, senior director and marketing brand experience.
Some clinics also offer in-house scholarships, including Spectacular Kids, Harris said.
Texana Center, the county’s nonprofit partner for mental health, provides external help for children ages 3 to 17, including ABA and developmental therapies in clinical, residential and community settings, said Dr. Forrestine Knowles, a Texana Center psychiatrist.
Moving forward
Every Little Star in Missouri City, like other smaller clinics, doesn’t accept Medicaid. Owner Shimin Bao said this is due to the clinic offering higher pay to retain staff.
Spectacular Kids joined Medicaid’s network at the end of last year, Harris said. Now, about one-third of Spectacular Kids’ clients use Medicaid’s network.
“I don’t think we’re even close to keeping up with the demand. ... The people who carry Medicaid who need services are a huge amount," Bao said.
