From Tommy: Medicaid Impacts Everyone in ABA - Both Clients and Staff

The Hidden Cost of Medicaid Rate Cuts in ABA Therapy: The Impact on Behavior Technicians and Quality of Care

In the shadow of every policy decision is a child whose future will be shaped by it.

Medicaid’s proposed reduction in reimbursement rates for Applied Behavior Analysis (ABA) services isn’t happening in isolation—it’s part of a larger pattern of policies that are quietly dismantling access to care. These changes are being justified under the claim of “controlling costs,” but in reality, they’re doing the opposite: driving up the cost of providing quality care while cutting the resources that make quality possible.

Providers are already absorbing new administrative and compliance burdens that have nothing to do with direct care. Chief among them is the state’s new credentialing requirement for Behavior Technicians, which now requires a similar level of credentialing to that of physicians. These are entry-level, frontline professionals who provide critical, hands-on support under the supervision of Board Certified Behavior Analysts (BCBAs). They are not independent medical doctors. Yet they are being held to increasingly complex and time-consuming credentialing processes that were never designed for their role.

This change adds layers of bureaucracy, months of delay, and thousands of dollars in administrative costs for providers—costs that Medicaid does not reimburse. Meanwhile, the very people expected to meet these new demands, the Behavior Technicians, are being pushed toward lower wages as reimbursement rates fall. It’s an impossible equation: more requirements, less pay, and less time for the work that truly matters: helping children and families.

In my experience, Behavior Technicians have one of the most demanding roles in healthcare. Their job requires immense mental stamina, focus, and intelligence. They manage complex behaviors, follow detailed treatment plans, and maintain compassion through emotionally and physically draining situations every single day. The people pushing for Medicaid rate cuts will never sit with our children through their hardest moments. But Behavior Technicians do—every single day. Their work is far more difficult and impactful than that of the agencies now deciding to cut their funding.

In fact, I believe they deserve to be invested in. Today’s Behavior Technicians may be tomorrow’s Board Certified Behavior Analysts.

These professionals deserve to be valued, not burdened.

The quality of ABA services will inevitably decline, not because the science has changed, but because the system has made it unsustainable to practice it. A year from now, ABA will not be the same as we know it today even though it will still be called the same thing. The name will remain, but the quality will not. For us parents, that means that the Behavior Technicians that work with our children will have less hands-on training and will find their positions less sustainable. One of the things Autism parents know all too well is that consistency is crucial, and we are already straining due to societal cultural changes in this primarily young work force.

If Medicaid truly wants to control costs and protect access, it should cut waste—not care. There are clear opportunities to do so:

• End wasteful spending such as paying for Telehealth ABA, where meaningful outcomes were never realistic. The idea of providing hands-on behavior intervention through an iPad defies common sense.

• Stop funneling state dollars out of state by limiting the expansion of national corporations that send profits back to their home offices rather than reinvesting locally.

• Reduce red tape for Behavior Technicians by simplifying credentialing and documentation so they can focus on clients, not paperwork.

• Streamline authorization and claims processes to eliminate the excessive administrative time spent appealing denials, chasing partial authorizations, and disputing unpaid claims week after week.

• If the amount of therapy must be reduced, it should be done flexibly and thoughtfully—without red tape and without cutting reimbursement rates themselves. Cutting rates doesn’t just reduce access; it undermines the entire workforce that delivers care.

Smaller, family-owned, and locally grown organizations—like Partners in Autism—will be hit hardest. Unlike large, out-of-state corporations with deep pockets and administrative teams, local providers operate on tight margins and community commitment. We’ve already seen several local ABA providers close in recent years, while large national companies have flooded into Fort Wayne and surrounding areas, drawn by Medicaid’s previous fee schedule, where not all providers were paid the same. That uneven structure gave many out-of-state corporations a financial advantage that local providers could not match. Now, those same corporations will weather the cuts more easily, while smaller providers who built trusted local relationships will struggle to survive.

Worse yet, large, profit-driven corporations are typically more willing to sacrifice quality to maintain their margins. Smaller, community-based providers often began their work because they themselves once needed these services—for their own children or family members. That personal connection drives higher quality, deeper relationships, and genuine investment in client outcomes. When the market shifts toward corporate ownership, the personal element disappears, and with it, the consistency and compassion that families depend on.

Local and smaller providers see the faces of the children and families affected by these decisions every single day. They know their names, their stories, their progress, and their struggles. They see the impact in real time. For the large, out-of-state corporations and the politicians that support these cuts, those same children and Behavior Technicians become little more than numbers in a spreadsheet—faceless and nameless, just as they are to Medicaid and other insurance companies. Every child deserves care from someone who sees them, not someone who just bills for them. Our children deserve better than the cheapest version of care.

Medicaid says it wants to cut costs. If that’s truly the goal, it should start by addressing the waste within its own system—streamlining inefficiency and bureaucracy—rather than reducing reimbursement for those who deliver the direct care: the Behavior Technicians.

As these decisions unfold, we all have a responsibility to pay close attention.

• Remember which politicians supported these cuts and the layers of administrative burden placed on our Behavior Technicians and providers.

• Remember who is steering us back toward institutional care—the very system we worked for decades to move beyond—and away from the community-based future our children were promised.

• Remember which advocacy organizations are now celebrating these changes or declaring any level of victory when you’re asked to donate or attend their fundraisers. Real advocacy stands with families and the people doing the work—not with policies that strip away care under the guise of cost savings.

Every child deserves care from someone who knows their name - and those people deserve to be supported in return.