Alabama Autism Families Deserve Transparency, Not Consolidation

Guest Opinion by Catey Hall

Alabama autism families need to understand what is happening right now as a result of Senator Chris Elliott’s handling of SB113.

Over the last several days, I have reviewed correspondence from the Alabama Behavior Analyst Licensing Board, letters from the Alabama Department of Mental Health (ADMH), both versions of SB113, and transcripts from multiple legislative hearings. What is unfolding is not a minor administrative adjustment. It is a shift in control over how ABA providers are regulated in this state. And families have reason to be concerned.

In September, during a Joint Interim Sunset Committee hearing, ADMH acknowledged that the Board had administrative deficiencies. The department also acknowledged that those deficiencies were tied to its own failure to meet statutory obligations to support the Board. The Board had been operating without adequate staffing because the required administrative support had not been fully provided. ADMH presented a corrective action plan and publicly committed to stabilizing the Board. The Board itself was described as important and necessary.

Within months, instead of allowing that corrective plan to take effect, the bill originally introduced simply to extend the Board was substituted on the Senate floor to eliminate its independence and place licensure authority under ADMH.

There was no separate public hearing focused on that structural change. Sunset legislation typically extends or dissolves boards; it does not ordinarily restructure governance on the floor. Yet that is what occurred.

During House consideration, Representative Leigh Hulsey introduced what was described as a “friendly amendment.” That amendment defined autism spectrum disorder and  involved the Department of Rehabilitation Services in some capacity. At the time of writing, I have not been able to review the final amendment language in full. Any clarification that autism is not a mental health diagnosis is welcome. However, definitional changes do not alter the core structural shift in this bill: the independent Board becomes advisory, and regulatory authority rests with ADMH.

It is also important to address statements made during floor debate. Representative Hulsey characterized the situation as one in which families are not receiving needed services because of the Licensing Board. That assertion is false and harmful. 

Access challenges in our state stem primarily from workforce shortages, geographic disparities, reimbursement rates, and longstanding underinvestment—not from clinical failure or misconduct by this seven-member peer board. Long waitlists existed before this sunset review and will not disappear because governance authority changes hands.

Families are reacting strongly because we remember the history.

Autism has been recognized in the DSM for decades. But access to ABA therapy in Alabama did not materialize because ADMH proactively built a system. It materialized because parents organized and demanded insurance coverage. Insurance carriers required licensure before paying claims. Families fought for that framework in 2017 through HB284.

In a recent hearing, the committee chair referenced the late Representative Jim Patterson and noted that he risked his political career to carry that legislation. In a Republican supermajority, championing access to therapy for autistic children was considered politically risky, and vem for a well respected Republican colleague. That reality shaped the system we have today.

On January 1, the Licensing Board formally requested an Attorney General opinion to clarify whether it is legally independent or subject to the direction of the ADMH Commissioner. That request stemmed from a disagreement over who held final authority—not from refusal to comply. The Board sought clarification through the proper legal channel. Before that question could be resolved, Commissioner Kimberly Boswell submitted her January 8 letter to the Sunset Committee characterizing the situation as compliance concerns. The legal dispute was never allowed to play out before structural consolidation was pursued.

The legal question had not been resolved. The corrective plan had not been given time to stabilize the Board. There was no finding of patient harm and no evidence of clinical misconduct. These were administrative compliance issues.

Instead of extending the Board as originally proposed and requiring ADMH to fulfill its statutory obligations, the Legislature pursued consolidation.

Supporters argue that licensure will continue. That is true. But control shifts. In a state already struggling with provider shortages and long waitlists, workforce confidence matters. Peer-regulated boards are the standard in healthcare professions for a reason. Independence can influence whether professionals choose to practice in a state.

Families deserved broader stakeholder engagement before such a structural change occurred.

I am not writing as a lobbyist. I am writing as a parent who remembers how hard it was to build this framework. We were not handed access to ABA therapy. We fought for it. We fought for insurance coverage. We fought for licensure because insurers required it. We fought for recognition that this therapy is medically necessary.

When the governance structure that grew out of that fight changes quickly, families do not forget the past.

We are not opposed to accountability. We are not opposed to improvement. But consolidation was not the only option, nor was it the best option. Extension, enforcement of statutory support requirements, and time for corrective action were available paths.

Those paths were not taken.

Autism families in Alabama are not dramatic. We are protective. We know what it took to get here. And we are paying attention.

The full text of SB113 as engrossed may be found HERE.

Catey Hall is an advocate, mother, small business owner, entrepreneur, and amateur writer and podcast host. She became involved in grassroots advocacy during Alabama’s 2017 fight for Alabama autism insurance legislation and now creates content spanning a broad range of topics, from disability policy, criticism of public-facing figures and often uses inappropriate humor. Her work is rooted in lived experience, independent research, and a willingness to ask uncomfortable questions. Follow her here: http://www.linktr.ee/CateyHall

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