Federal health officials have released a 173-page guide urging state Medicaid programs to strengthen oversight of applied behavior analysis, the most common therapy for children with autism, after program spending rose 421 percent in four years. The Centers for Medicare and Medicaid Services published the document on August 4, 2026. CMS states the toolkit does not establish new federal requirements, does not reduce EPSDT obligations, and does not direct states to limit medically necessary care. Any change depends on what a state Medicaid agency decides to adopt. State Medicaid offices and disability rights organizations can explain the process.