How was 2025? Fair to middling puts it nicely.
Every year, we take a look back at the article that captured our readers’ — and often the wider health care news consumers’ — attention the most. A lot of articles that one would expect to break through did — big-time developments at the federal government, layoff news, major deals and so on. But something is missing. The articles that one could cast as capturing a positive development for the industry simply didn’t break through the noise.
And 2025 was certainly noisy.
The Los Angeles fires wrought destruction in one of America’s most prominent communities. One estimate of the property damage alone puts the financial losses between $76 billion and $131 billion. Pope Francis died, and for the first time in its centuries-long history, an American ascended to the pinnacle of the church’s leadership. The Ukraine War entered its third year and the Israel-Gaza war stretched to its second, continuing to contribute to the instability of the international scene.
However, most major developments across news, the economy, and politics have been shaped by the first year of the Trump administration. Our coverage reflects this; most of the top-read articles focus on the Trump administration directly or on the broader impacts of federal actions.
Our coverage of these events is continuous. The following entries for the top articles of 2025 will include a combination of several specific articles that are related to each other and are facets of a larger whole.
Trump administration came in like a wrecking ball
It didn’t take long for the Trump administration to start enacting its government disruption campaign. There are so many specific developments. However, two early developments caught readers’ attention.
On March 27, the Trump administration announced a merger of the Substance Abuse and Mental Health Services Administration (SAMHSA) into the new Administration for a Healthy America (AHA). Secretary Kennedy ordered the consolidation to reduce federal bureaucracy and cut taxpayer costs.
Other subdivisions of the U.S. Department of Health and Human Services to be consolidated into AHA include the following: the Office of the Assistant Secretary for Health (OASH), the Health Resources and Services Administration (HRSA), the Agency for Toxic Substances and Disease Registry (ATSDR), and the National Institute for Occupational Safety and Health (NIOSH).
SAMHSA is arguably the most important regulatory and policy division to the behavioral health industry. HHS Secretary Robert Kennedy Jr. said the move was meant to streamline the federal government.
At the time of writing of this article the AHA has not been established as a distinct part of the federal government. Efforts in Congress to develop this agency stalled in the summer.
We also reported that the Trump administration’s first budget potentially included cuts to the popular certified community behavioral health center (CCBHC) program. That ultimately did not come to pass. CCBHCs scored a few minor wins in the budget process. However, the tied-at-the-hip nature of the program means that the changes to Medicaid eligibility and funding mechanisms will inevitably challenge these providers of integrated medical-behavioral services.
State Medicaid programs push back on autism therapy utilization
Shoes started to drop in at the intersection of autism therapy and Medicaid in 2025.
After several consecutive years of heightened utilization and ballooning costs, several Medicaid programs took action to hack back costs. In Indiana, elected officials and state officials proposed lifetime and weekly caps on care. Later in the year, Gov. Mike Braun called for a working group to assess other potential solutions.
In November, the working group recommended a 4,000-hour lifetime treatment-hour limit, establishing ratios of technicians to board-certified behavioral analysts (BCBAs), creating a dedicated autism therapy office within Medicaid, and mandating organizational accreditation.
Nebraska announced steep cuts to reimbursement rates. Several autism therapy executives and advocates said that Nebraska, up to this point, had the highest reimbursement rates among state programs to attract more provider organizations and BCBAs to a highly rural state.
Providers in Colorado and North Carolina turned the tables on state officials by punching back on funding cuts they found discriminatory to those with autism. From the perspective of cuts within Medicaid, the Colorado and North Carolina cases highlight the immediate impact of Medicaid funding changes made through the Trump administration’s signature economic agenda item so far: the One Big Beautiful Bill Act.
Economic imbalances lead to layoffs, a national trend
Layoffs at this point have totaled over 1.1 million across the U.S. economy. The data that we have so far show that layoffs are at the same level as the COVID-era employment chaos.
The behavioral health industry was not immune. Anecdotally speaking, it didn’t seem like behavioral health was any more or less impacted than the wider public.
Here are the layoffs we tracked that resonated with our readers:
— Youth-focused Newport Healthcare closed locations and laid off an unknown number of staff.
— Optum Health disclosed plans to eliminate 572 employees in New Jersey.
— Acadia Healthcare (Nasdaq: ACHC) eliminated several locations, impacting about 400 jobs.
There are a few loose similarities among these developments. Each faces the prospect of diminished financial success from a combination of elevated costs and diminished revenue relative to their segment of the industry. For Optum Health, that is the intersection of health care and health insurance. For Acadia Healthcare and Newport Healthcare, that’s residential care settings. Each move lacks finesse — they each represent a total elimination of entities in one area to focus elsewhere. Each has relatively new leadership in key positions.
Ellie Mental Health sells owned clinics, discloses significant distress
Ellie Mental Health has long been on the radar of Behavioral Health Business. The company’s rapid revenue growth, securing private equity investment and developing a franchise model established a public image of a company on the move.
However, 2025 clarified the direction the company was going.
The company sold its “test kitchen” locations in Minnesota to fellow outpatient mental health provider Nystrom & Associates in a deal BHB exclusively reported on in May 2025. These were Ellie Mental Health’s most mature assets and were the basis for assumptions about the potential sustainability of new franchise locations. However, the experience of new mental health clinics is vastly different than those that have reached a meaningful level of maturity — as several Ellie Mental Health franchisees have found out.
Ellie Mental Health and several franchisees are at loggerheads in court and in arbitration processes over what each other are owed following a rapid expansion of franchise operations and the inability of Ellie’s back-office functions to handle it. What’s more, the company’s struggles have become serious enough that it has publicly disclosed that an “auditor’s report on [Ellie Mental Health’s] financial statements expresses substantial doubt about [its] ability to remain in business.”
Payers, ABA Centers of America duke it out in court
Another company that came onto the Behavioral Health Business radar because of its rapid revenue growth. It almost topped the 2024 Inc. 5000 list of fastest-growing companies. It disclosed 7,755% in three-year revenue growth in the same list earlier in the year.
But the mechanism driving this expansive revenue growth has stuck in the craw of those paying for the company’s services.
In August, ABA Centers of America and the supermarket chain Publix sued each other in a fight over what Publix alleges are millions of dollars in fraudulent claims. ABA Centers of America says that Publix and its contracted health plans, Florida and South Carolina Blue Cross and Blue Shield entities, approved its out-of-contract billing approach.
The fight with Publix recontextualizes a lawsuit that ABA Centers of America filed against Point32Health, a Massachusetts-based payer. Initially, the company said that it was not being paid what it was owed for providing services and was being ignored by the payer. More recent filing show that, Point32Health has filed a counterclaim against ABA Centers of America seeking to recover $19 million the plan paid “based on false claims, fabricated documentation, and deceptive
business practices that violated state law, industry standards, and contractual obligations.” Among allegations in the counterclaim, Point32Health paid ABA Centers of America $123,000 for movie screenings that were billed as clinical services. In this case, ABA Centers of America maintains an out-of-network billing strategy.
Further investigation into the practice of out-of-network billing in autism therapy finds that this strategy is unusual. While specific estimates are difficult to suss out, several industry insiders estimate that out-of-network billing accounts for a single-digit percentage of claims payments and is often an administrative and contractual bridge to in-network billing.
