The Centers for Autism and Related Disorders (CARD), one of the largest autism service providers in the United States, has announced it is shutting down—or has already halted—operations in 10 states. This move significantly reduces CARD’s national presence and has immediate implications for families, employees, and the broader autism services community. The closures are part of a broader trend of autism service providers closing locations across the country.
Backed by private equity firm Blackstone, CARD had been a major force in autism care. At the end of 2021, the organization operated in 24 states with 221 centers. Following the recent closures, CARD will maintain operations in only 14 states, marking a notable contraction in its national footprint.
The affected states include Oregon, Georgia, Maryland, Massachusetts, Michigan, Missouri, New Mexico, New Hampshire, Rhode Island, and Wisconsin. In Oregon alone, the closure of 10 centers over the summer resulted in 156 layoffs, according to state documentation. These closures highlight a growing pattern of autism service providers closing centers in response to staffing, reimbursement, and economic pressures.
CARD’s Response to Operational Changes
Jeffrey Cho, vice president of field operations at CARD, shared the organization’s reasoning for these closures in a statement to Behavioral Health Business:
“CARD regularly reviews and evolves our operating footprint to ensure our centers have adequate capacity, staff, and reimbursement rates to provide outstanding care to patients. We are proud to continue to play a leading role in the overall well-being of our patients, their families, and the entire autism community as we continue to deliver high-quality care and services to our patients nationwide.”
While CARD frames the closures as strategic, they are a reminder of the larger trend of autism service providers closing locations across multiple states. Families and staff in affected areas face immediate challenges finding alternatives and adjusting to new care networks.
About CARD
Founded in 1990, CARD specializes in applied behavior analysis (ABA) therapy, a one-on-one treatment approach that focuses on improving specific behavioral skills in individuals with autism. ABA therapy is widely recognized as an evidence-based intervention that can significantly improve communication, social, and adaptive skills for people on the autism spectrum.
In addition to ABA, CARD provides a variety of services, including center-based services, specialized outpatient programs, remote clinical services, and training programs that support families and professionals working with individuals with autism.
Blackstone Acquisition and Expansion Strategy
CARD’s rapid growth in recent years was fueled in part by its acquisition by Blackstone, a major private equity firm. Blackstone’s investments in the healthcare and technology sectors include virtual behavioral health provider Ginger and consumer genomics company Ancestry. With Blackstone’s backing, CARD expanded quickly to increase its market share and negotiating leverage with insurance payers.
However, rapid growth has also presented challenges. Staffing shortages, inconsistent reimbursement rates across states, and regional economic pressures have made it difficult to sustain operations in all markets. These pressures have contributed to the wave of autism service providers closing centers in certain regions.
Leadership Changes
CARD’s reduction in operations coincides with significant leadership changes. In February, Jennifer Webster was appointed CEO, succeeding Tony Kilgore, who resigned for undisclosed reasons. Leadership transitions often trigger strategic reassessments, and Webster’s appointment appears to have influenced the company’s operational restructuring.
Industry-Wide Closures
CARD is not the only provider scaling back. Across the autism services sector, aggressive expansion fueled by private equity has collided with economic realities. In many cases, national platforms that initially aimed to capture market share had to recalibrate. Over the summer, 360 Behavioral Health laid off 503 employees in California, according to the state’s Worker Adjustment and Retraining Notification (WARN) report. These examples illustrate a wider trend of autism service providers closing centers to balance growth and sustainability.
Growing Demand for Autism Services
Despite closures, demand for autism services continues to rise sharply. The Centers for Disease Control and Prevention (CDC) reports that roughly 1 in 44 children are diagnosed with autism spectrum disorder (ASD), up from 1 in 69 children in 2012. This growing prevalence underscores the critical need for care and the importance of maintaining access, even as some autism service providers are closing physical locations.
Private Equity and the Autism Market
While some providers reduce their footprint, investment activity in autism services remains strong. According to The Braff Group, there were 46 autism-focused private equity deals in the first half of 2022, a 15% increase year over year. Investors continue to see long-term potential in the autism market, even as autism service providers closing locations highlights operational challenges.
Implications for Families and Providers
CARD’s closures underscore several important points:
- Access challenges: Families in affected states may face longer wait times or travel distances for therapy.
- Workforce impact: Employees affected by closures may find themselves navigating a tight job market in autism services.
- Private equity influence: Investors shape operational decisions, balancing growth and patient care.
- Continued demand: Rising prevalence ensures the need for high-quality autism services remains strong.
The trend of autism service providers closing centers reflects both economic realities and the challenge of delivering consistent, high-quality care nationwide.
Looking Ahead
As CARD consolidates, it emphasizes its commitment to high-quality care in the states it continues to serve. Families will need to explore alternatives in affected areas, from local clinics to telehealth options. The broader autism services market continues to evolve, with private equity shaping growth, consolidation, and operational strategies.
For the autism community, the closures offer a cautionary tale: while rapid expansion can increase access in the short term, sustainability, staffing, and reimbursement rates ultimately determine long-term availability of services. Even as autism service providers close centers, the rising prevalence of autism ensures that the need for ABA therapy and specialized care will remain urgent.
