NCSA Hill Brief: Requesting a GAO Investigation into Housing for Adults with Severe Autism — 2025
Hill Brief | 2025
To: U.S. Congress
Re: Addressing the Critical Housing Needs of Adults with Severe/Profound Autism — Requesting a GAO Investigation
ADDRESSING THE CRITICAL HOUSING NEEDS OF ADULTS WITH SEVERE/PROFOUND AUTISM
SUMMARY
National Council on Severe Autism (NCSA) urges Congress to initiate a Government Accountability Office (GAO) investigation to evaluate housing options for adults with severe/profound autism, identify regulatory barriers, and propose actionable solutions.
THE CHALLENGE
One in 31 children have autism spectrum disorder (Shaw et al., 2025), with 26.7% classified as having profound autism (Hughes et al., 2023). As these children become adults, our nation faces an unprecedented housing crisis. Despite the surging demand for specialized housing solutions, current options remain severely limited, leaving families without viable alternatives for long-term care.
BACKGROUND
Adults with severe/profound autism require specialized housing and support that existing models fail to provide. The problem is compounded by conflicting federal regulations:
The HUD Section 811 Supportive Housing program, while well-intentioned, creates unintended barriers. Its extremely low-income requirements (30% of Area Median Income) and restrictions on specialized group living arrangements often exclude individuals with severe autism who require 24/7 support (HUD, 2025).
The CMS Home and Community-Based Services (HCBS) Settings Rule, while aiming to promote integration, has created significant limitations for adults with severe autism. According to research published in the Journal of Intellectual and Developmental Disabilities, the rule's implementation has created barriers to specialized residential settings that many individuals require for their health and safety (Friedman, 2020).
These regulatory conflicts between HUD and CMS policies create a fragmented system that restricts innovation in housing development. Families bear unsustainable caregiving burdens due to the lack of appropriate housing options.
WHY CONGRESSIONAL ACTION IS NEEDED
Current federal regulations, while intended to protect vulnerable populations, have created unintended barriers to effective housing solutions. Without congressional intervention, we face: increased reliance on costly hospital care and emergency services; growing strain on family caregivers; inefficient use of existing federal resources; and limited development of innovative housing models.
A Government Accountability Office (GAO) investigation would provide the data-driven insights needed to improve and optimize these systems.
CALL TO ACTION
We urge Congress to take immediate action by initiating a Government Accountability Office (GAO) investigation. Specifically, we request:
1. Initiate a GAO Investigation — Direct GAO to evaluate current housing options, identify regulatory barriers, and propose optimized housing solutions for adults with severe/profound autism.
2. Update Regulatory Framework — Use GAO findings to align HUD and CMS policies to eliminate conflicts; modernize Section 811 requirements to better serve individuals with severe autism; enhance HCBS Settings Rule to ensure it accommodates necessary specialized residential settings.
3. Enable Innovation — Support public-private partnerships and community-based initiatives that maximize existing resources while meeting specialized care requirements.
EXPECTED OUTCOMES
Improved quality of life for individuals with severe/profound autism; reduced burden on emergency services and hospitals; enhanced workforce participation among family caregivers; broader economic growth and social stability for families; more efficient use of existing federal resources; development of sustainable, scalable housing solutions.
SOURCES
Friedman, C. (2020). The Impact of Home and Community Based Settings (HCBS) Final Settings Rule Outcomes on Health and Safety. Intellectual and Developmental Disabilities, 58(6), 486–498.
Hughes, M. M., et al. (2023). The Prevalence and Characteristics of Children With Profound Autism, 15 Sites, United States, 2000-2016. Public Health Reports, 138(6), 971–980. https://doi.org/10.1177/00333549231163551
Shaw KA, et al. (2025). Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years — Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR Surveill Summ 2025;74(No. SS-2):1–22.
Mandell, D. S. (2017). A house is not a home: The great residential divide in autism care. Autism, 21(7), 810-811.
