When Meghann Mitchell first launched her autism-therapy business in 2019, she took aim at an unlikely source of profit: Indiana’s taxpayer-funded Medicaid program, the public insurance system for the poor. The bet paid off. In 2023, the state paid Mitchell’s company, Piece by Piece Autism Centers, $29 million to provide therapy to just 84 patients—about $340,000 a child—according to a Wall Street Journal analysis of Medicaid billing records. That amount surpassed what Indiana Medicaid typically spends in a year treating a newly diagnosed lung-cancer patient or covering a year of nursing-home care. Piece by Piece became one of Medicaid’s most…

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