PROVIDENCE, R.I. [Brown University] — Private equity firms have acquired more than 500 autism therapy centers across the U.S. over the past decade, with nearly 80% of those acquisitions occurring over a four-year span, according to a new study from researchers at the Brown University Center for Advancing Health Policy through Research.
Study author Yashaswini Singh, a health economist at Brown's School of Public Health, said the work highlights how financial firms are rapidly moving into a sensitive area of health care without much public scrutiny or data on where this is happening or why.
"The big takeaway is that there is yet another segment of health care that has emerged as potentially profitable to private equity investors and it is very distinct from where we have traditionally known investors to go, so the potential for harm can be a lot more serious," Singh said. "We're also dealing with children who are largely insured by Medicaid programs, so if private equity increases the intensity of care, what we're really looking at are impacts to state Medicaid budgets down the road."
The findings of the analysis were published in JAMA Pediatrics and offers one of the first national assessments of private equity's growing role in autism therapies and services. Autism diagnoses among U.S. children have risen sharply in recent years, nearly tripling between 2011 and 2022, and the condition has been in the national spotlight amid political debate falsely linking autism to childhood vaccines.
The researchers, Singh said, did not evaluate the impacts of private equity ownership on access to treatment, quality of care or the experience of families seeking services. The findings do suggest that investment has been concentrated in states with higher rates of autism diagnoses among children and states that have fewer limits on insurance coverage.
The researchers identified a total of 574 autism therapy centers owned by private equity firms as of 2024, spanning 42 states. Most of those centers were acquired between 2018 and 2022, the result of 142 separate deals. The largest concentrations of centers were in California (97), Texas (81), Colorado (38), Illinois (36) and Florida (36). Sixteen states had one or no private equity-owned clinics at the end of 2024.
States in the top third for childhood autism prevalence were 24% more likely to have private equity–owned clinics than others, according to the study.
The scale and speed of acquisitions underscore the growing trend of private equity's entry into the market. According to Singh, researchers were prompted to investigate after hearing anecdotal reports from families and health providers about changes following private equity takeovers.
The primary concern is private equity firms putting money over families, said Daniel Arnold, a senior research scientist at the School of Public Health.
"It's all about the financial incentives," Arnold said. "I worry about the same types of revenue generating strategies seen in other private equity-backed settings. I worry about children receiving more than the clinically appropriate amount of services and worsening disparities in terms of which children have access to services."
To establish a baseline of where private equity firms are investing and why, the team used a mix of proprietary databases, public press releases and manual verification of archived websites to track changes in ownership. Unlike public companies, private equity firms and private practices are not required to disclose acquisitions, making data collection challenging and labor-intensive.
The team is now seeking federal funding to examine how private equity ownership affects outcomes, including changes in therapy intensity, medication use, diagnosis age or how long children stay in treatment. They will determine whether these investments are helping meet real needs or are primarily a way to make money.
"Private investors making a little bit of money while expanding access is not a bad thing, per se," Singh said. But we need to understand how much of a bad thing this is and how much of a good thing this is. This is a first step in that direction."
This study received funding from the National Institute on Aging (R01AG073286) and the National Institute on Mental Health (R01MH132128).
