Across Nevada, many families raising children with autism are asking hard questions about the cost — and the business — of therapy.

In recent months, parents have shared stories about dramatic increases in the price of care. Insurance approvals come through, but new billing policies and changing clinic structures leave families on the hook for thousands of dollars in unexpected costs.

In one news report, Nevada parents describe the shock of discovering that therapy for their child could suddenly cost more than their monthly mortgage, even with insurance coverage.

For many families, the question isn't whether therapy is valuable. It's why the system delivering it suddenly feels so expensive and opaque.

Behind these stories is a trend that has quietly reshaped health care across the country: the rapid expansion of private equity investment in medical and behavioral health services. 

Autism therapy is the latest frontier.

From water to mining, Nevada has a long history of extractive industries that squeeze enormous profits from vulnerable systems. So when I read reports that private equity firms have quietly acquired nearly 600 autism service delivery sites across the United States over the past decade — with nearly 80 percent of those buyouts happening between 2018 and 2022 — my reaction wasn't just academic curiosity. It was recognition.

Private equity investment has expanded rapidly across the American health care system. That means hospitals. Emergency physician groups. Nursing homes. Behavioral health clinics.

And increasingly, autism therapy providers. Across the country, investors have been buying or building large networks of clinics offering Applied Behavior Analysis (ABA), the most commonly prescribed therapy for autism, which makes it a multibillion-dollar market.

The model is attractive for many reasons. Demand is high, services are billed hourly, treatment plans can involve 20 to 40 hours per week per child and insurance reimbursement is predictable.

Translation? Steady cash flow.

Harvard Medical School research has already linked private equity acquisition in hospitals to worsened patient outcomes, including increased mortality. But we've paid far less attention to what happens when financial models that prioritize cost-cutting enter developmental and pediatric care.

It's happening in Nevada. Our state already faces serious challenges in autism and developmental services, such as long waitlists for therapy, workforce shortages, limited rural access and complicated insurance systems.

At the same time, large investor-backed companies are rapidly expanding autism therapy networks across the country.

Some of the biggest players include BlueSprig Pediatrics, backed by private equity giant KKR; Action Behavior Centers, backed by Charlesbank Capital Partners; and the Center for Autism and Related Disorders, formerly the largest autism therapy provider in the U.S., acquired by Blackstone before closing more than 100 clinics and filing for bankruptcy in 2023.

More recently, venture-backed companies are experimenting with new models.

One example is Forta Health, which trains parents to become Registered Behavior Technicians (RBT) so they can deliver therapy to their own children under remote supervision. The company raised $55 million in venture funding in 2024 to expand the model nationally. (In Nevada, Forta absorbed autism provider Collaborative Autism Resources and Education as part of an acquisition in 2022.)

Supporters consider parent-led therapy an example of innovation. But many clinicians see something different: the financialization of disability services in which companies publicly celebrate raising tens of millions in funding while failing to provide evidence that their care models meet the standards of the very profession they operate within.

In July 2023, the Behavior Analyst Certification Board issued an ethics reminder that the RBT parent-as-provider model conflicted with professional ethics standards. 

For families, these structural changes don't show up as policy debates. They show up as confusion, unexpected bills, changing providers, new expectations placed on parents and, perhaps most troubling, a quiet transfer of responsibility. Responsibility for delivering care. Responsibility for navigating systems. Responsibility for determining what's working — without always having the clinical training to do so.

At the same time, decision-making power increasingly shifts away from clinicians and toward corporate health care systems.

This isn't about attacking clinicians, individual therapists, behavior analysts or families seeking help. Most clinicians working in autism services are deeply committed professionals trying to support children in an imperfect system.

The real questions are structural: Who decides what care looks like? Who determines how much care is needed? Who benefits financially from those decisions? Increasingly, the answer is investors.

Private investment in health care isn't automatically harmful. But evidence from other sectors shows it can create incentives that prioritize revenue growth over patient outcomes.

Nevada policymakers should approach the rapid expansion of investor-backed therapy companies with caution.

At a minimum, Nevada should consider transparency requirements for ownership of pediatric therapy providers, outcome reporting for large therapy networks, stronger interdisciplinary care standards and protections ensuring clinical decisions remain clinician-driven. 

We would not be starting from scratch. States such as Massachusetts and Oregon have passed health care transaction review and ownership transparency requirements designed to monitor consolidation and protect patient access. Similar policies in California increase scrutiny of corporate ownership structures and reinforce clinician-led care. Nevada could build on these models while tailoring safeguards to the state's autism and developmental services landscape.

Because once health care markets become consolidated, reversing course becomes much harder.

Transparency matters. Oversight matters. And vulnerable communities deserve protection. Children with developmental disabilities are not a growth market. They are human beings who deserve thoughtful, ethical, community-centered care. Nevada should make sure the people shaping that care are clinicians and families, not executives and investors.

Matthew Brandenburg is a licensed occupational therapist based in Nevada who works with children and families in developmental services.