LEARN Behavioral Entity Sues to Stop MassHealth Medicaid Recoupment
By Chris Larson | September 28, 2026
A Massachusetts autism therapy provider has sued 10 public officials and entities to stop a Medicaid recoupment effort that local providers have called flawed since this spring. The lawsuit seeks to halt MassHealth’s—the state’s Medicaid program—attempt to recoup millions of dollars from autism therapy providers for services rendered in 2024.
Autism Spectrum Therapies, a unit of LEARN Behavioral, filed the lawsuit on September 23.
"MassHealth’s shortsighted action will drive ABA providers out of business and risks the financial stability of [Autism Spectrum Therapies]," the lawsuit states. "Ultimately, MassHealth will end up harming children suffering from autism who will be unable to access the care they sorely need to thrive."
Providers and advocates in the state previously expressed concerns that:
- At least, this would challenge autism therapy providers' ability to treat Medicaid members.
- At worst, it could threaten the viability of organizations specializing in treating these members.
Representatives of the state, Autism Spectrum Therapies, and the health plans did not respond to a request for comment. This story may be updated.
This lawsuit is significant as it's the first attempt to halt the state’s effort to recoup payments for therapy provided outside the supervision ratio of one hour of master-level clinician oversight for every 10 hours of therapy. The provider claims that MassHealth has pressured its managed care organization (MCO) partners to recoup $943,000 in total.
Defendants named in the suit include:
- Massachusetts Executive Office of Health and Human Services (EOHHS)
- EOHHS Secretary Dr. Kiame Mahaniah
- Medicaid Director and Assistant Secretary for MassHealth Dr. Ryan Schwarz
- Carelon Behavioral Health and four Medicaid entities in Massachusetts it manages behavioral health benefits for: WellSense Health Plan, Fallon Community Health Plan, Health New England, and the Massachusetts Behavioral Health Partnership
- Point32Health (managing Tufts Health plans in the state)