ABA Therapy Medicaid Cuts in 2026: Which States Are Cutting and What Families Need to Know

If your child receives ABA therapy through Medicaid, 2026 is bringing significant changes you need to understand. Across the country, states are grappling with surging costs — and many are responding with rate cuts, hour caps, and age limits that could directly affect your family's access to care.

This guide breaks down the latest ABA therapy Medicaid coverage changes state by state, explains why this is happening, and outlines what families can do to protect their child's access to treatment.

Why States Are Cutting ABA Therapy Coverage

ABA therapy spending through Medicaid has grown at a pace that has alarmed state budget officials. The numbers are striking:

• North Carolina is projected to spend $639 million on ABA therapy in FY 2026 — up from $122 million in FY 2022, a 423% increase in just four years.
• Nebraska saw a 1,700% increase in ABA spending over recent years.
• Indiana experienced a nearly 2,800% rise in Medicaid ABA costs.

These increases have caught the attention of state budget managers, and federal pressure is amplifying the problem. President Trump's proposed budget legislation could reduce federal Medicaid contributions significantly. Combined with federal audits uncovering billing irregularities in several states, state officials are moving quickly to contain costs — and families are caught in the middle.

State-by-State Breakdown of ABA Medicaid Changes in 2026

Georgia: 20% Rate Cut from CareSource

Effective May 11, 2026, CareSource Georgia — a Medicaid managed care organization — is reducing reimbursement for certain ABA therapy provider organizations by 20%. This rate cut applies to organizations submitting ABA claims under specific billing codes. Families covered by CareSource Georgia Medicaid should contact their ABA clinic directly to understand how this affects their child's services.

Nebraska: Cuts of 28–79% and a 30-Hour Weekly Cap

Nebraska implemented sweeping ABA Medicaid reductions, with cuts ranging from 28% to 79% depending on the service code — among the most severe in the country. The state also introduced a 30-hour weekly cap on ABA therapy services.

These changes have forced many Nebraska families to significantly reduce their child's therapy hours, and several providers have exited the Medicaid program as a result. Families in Nebraska who have been receiving more than 30 hours per week should speak with their provider and consider an appeal if the reduction is clinically inappropriate.

New York: Proposed 680-Hour Annual Cap and 25% Rate Cuts

New York is considering two major changes that would dramatically limit ABA access for Medicaid families:

1. Assembly Bill A03896 proposes an annual 680-hour cap on ABA therapy — roughly 13 hours per week. This is far below what many children with moderate to severe autism currently receive.
2. A proposed 25% Medicaid rate reduction, phased as two 12.5% cuts, has alarmed providers. A survey of New York ABA providers found that 72% would exit Medicaid if the full cuts are implemented.

These proposals are still legislative — families and providers in New York have an important opportunity to contact their legislators now to oppose these changes.

Indiana: New Age Limits, Hour Caps, and Rate Cuts Effective April 1, 2026

Indiana implemented major ABA Medicaid changes on April 1, 2026, including:

• A 6% rate reduction for non-group ABA therapy services
• Coverage now limited to individuals through age 21
• A lifetime hour cap of 4,000 hours of ABA therapy

For families whose child is approaching 4,000 lifetime hours or age 21, it is critical to begin planning alternative or supplemental supports now.

North Carolina: 423% Spending Increase Prompts Ongoing Policy Review

North Carolina attempted a 10% ABA payment cut earlier in 2026 but faced significant pushback from providers and families. The state continues to review ABA authorization criteria and medical necessity standards as part of broader cost containment. Families in North Carolina should be prepared for stricter authorization reviews and should ensure their child's clinical documentation is thorough and up to date.

Colorado: Federal Audit and Pending Rate Review

A federal Medicaid audit found significant overpayments for ABA therapy in Colorado, leading to pressure on the state to implement rate adjustments and tighten billing compliance requirements. Colorado families should monitor developments closely, as rate changes may follow.

States Expanding or Protecting ABA Coverage in 2026

Not every state is cutting. Some are taking steps to protect or expand access:

Washington State: Wait Time Protections

Washington's HB 2331 prohibits the state from cutting ABA reimbursement rates if average wait times exceed 30 days. This is a meaningful protection — it acknowledges that if rates drop too far, providers leave and families wait longer. Washington is also requiring that ABA services include a distinct rate layer above the base Medicaid rate.

Hawaii: Removing Age Caps and Annual Benefit Limits

Hawaii's HB 1670 would eliminate the current age 13 cap on ABA coverage mandates and remove a $25,000 annual benefit limit. If passed, this would significantly expand access for older adolescents and adults with autism who need continued behavioral support.

What Should Families Do Right Now?

If your child receives ABA therapy through Medicaid, here are concrete steps you can take to protect their access to care:

1. Contact Your ABA Provider Immediately

Ask your current clinic whether they are continuing to accept your Medicaid plan, and whether any changes are coming to your child's authorized hours. Do not wait for a notice to arrive — be proactive.

2. Request Thorough Clinical Documentation

If hour caps are being introduced, ask your provider to document the full medical necessity of your child's current therapy level. A detailed clinical record — showing specific goals, progress, and the functional impact of therapy — is your strongest tool in an appeal.

3. Know Your Right to Appeal

If Medicaid denies or reduces your child's ABA therapy authorization, you have the right to appeal. Contact your state Medicaid office or a disability rights organization in your state for guidance on the appeals process.

4. Engage with Advocacy Organizations

Organizations like Autism Speaks, the Autism Society of America, and the Association for Behavior Analysis International (ABAI) are actively tracking and opposing harmful Medicaid cuts. Joining parent advocacy networks and contacting your state legislators can make a real difference.

5. Search for All Available Providers in Your Area

As some providers exit Medicaid, access to care can become more geographic than ever. Use ABA Navigator's provider directory to find all ABA therapy providers near you — including those currently accepting Medicaid patients.

The Federal Budget Wildcard

The biggest unknown for ABA therapy coverage in 2026 and beyond is federal Medicaid funding. Proposed federal budget legislation could reduce federal Medicaid contributions, forcing states to either cut services, increase their own spending, or both. ABA therapy — with its dramatic spending growth — is a likely target in any restructuring.

Families and providers should stay engaged with advocacy organizations, monitor state legislative sessions, and share their personal stories with elected officials. Families who have seen their children thrive with ABA therapy are the most powerful voices in these policy debates.

Find ABA Therapy Providers Near You

As the Medicaid coverage landscape shifts, finding a qualified provider who accepts your insurance and is currently accepting new patients is more important than ever. ABA Navigator's provider directory lists ABA therapy providers across all 50 states, searchable by location and insurance accepted.

Search the ABA Navigator directory to find ABA therapy providers in your area →