North Carolina ABA Therapy 2026: New Medicaid Rules, Hour Caps, and What Families Need to Know

North Carolina parents of children in ABA therapy have been navigating significant uncertainty in recent weeks. Governor Josh Stein signed House Bill 696 on April 30, 2026 — a budget legislation package that included sweeping new restrictions on ABA therapy reimbursement under NC Medicaid. On May 14, 2026, North Carolina’s Department of Health and Human Services (DHHS) released draft changes to Clinical Coverage Policy 8F, with a public comment period open through June 14.

If your child receives ABA therapy in North Carolina through Medicaid, here is what you need to know right now.

Why Is North Carolina Changing Its ABA Therapy Rules?

The short answer: cost. NC Medicaid spending on ABA therapy has grown dramatically — from $121.7 million in fiscal year 2022 to a projected $1.1 billion by 2027, an increase of roughly 425%. By 2025, combined state and federal Medicaid spending on ABA in North Carolina had already surpassed $505 million.

Lawmakers began scrutinizing this growth earlier in 2026. In November 2025, DHHS attempted a 10% reimbursement rate cut for ABA providers, but a court injunction temporarily blocked enforcement after families challenged it as discriminatory. That legal challenge did not stop the legislative effort. HB 696 codified a new set of restrictions signed into law by the Governor.

The Autism Society of North Carolina published a detailed policy update on May 19, 2026, outlining concerns about several provisions — particularly the 16-hour cap and the new monthly reauthorization requirement.

What HB 696 Changes: The Key Provisions

HB 696 introduced several significant changes to how ABA therapy is delivered and reimbursed under NC Medicaid:

1. A 16-Hour Weekly Cap on ABA Services

The most direct impact for many families: Medicaid will now cap ABA therapy at 16 hours per week. Children who have been receiving intensive programs of 30, 40, or more hours weekly will face reductions in their authorized hours. The Autism Society of NC has raised concerns about this cap, noting that clinical guidelines for intensive early intervention often recommend higher dosages.

2. Out-of-State Provider Restrictions

ABA providers licensed out of state can no longer bill NC Medicaid unless they are physically located within 40 miles of the North Carolina border. This effectively ends fully remote therapy from out-of-state providers for most NC Medicaid patients.

3. Telehealth Restrictions

Telehealth assessments are no longer reimbursable under NC Medicaid. In-person assessment is now required. For supervisory sessions, no more than 10% may be conducted remotely — and exceptions require written justification subject to post-payment review and audit.

4. Monthly Treatment Plan Reauthorization

Treatment plans must be updated and reapproved by an MCO or DHHS every month. Previously, authorizations typically ran for several months. This new requirement adds significant administrative burden for providers and may create delays in continuity of care.

5. Strengthened Credentialing Requirements

Behavior technicians must now hold national RBT (Registered Behavior Technician) certification. Additionally, the law blocks new BCBAs and Qualified Autism Services Practitioner Supervisors (QASPs) from newly enrolling as NC Medicaid providers — a restriction that could limit provider capacity over time.

6. Conflict-of-Interest Rule (Phase 2 — December 2026)

A second phase of reforms, targeted for December 2026, will prohibit providers from diagnosing autism and then directly referring patients to their own ABA services. The provision addresses concerns that the financial incentive to diagnose can influence referral patterns.

The DHHS Draft Policy 8F Update

On May 14, 2026, DHHS released its draft update to Clinical Coverage Policy 8F, which governs ABA therapy coverage under NC Medicaid. The draft implements Phase 1 of the HB 696 restrictions, with a target effective date of August 1, 2026.

Public comments are being accepted through June 14, 2026. Families, providers, and autism advocates can submit formal comments to DHHS. This is an important window for families to weigh in — particularly if your child currently receives more than 16 hours per week of ABA therapy or depends on telehealth delivery.

The Autism Society of North Carolina is encouraging affected families to engage with the comment process.

What This Means for Families Currently in ABA Therapy

If your child currently receives ABA therapy through NC Medicaid, take these steps now:

• Talk to your BCBA today. Ask how many hours per week your child is currently authorized for and how the 16-hour cap will affect their treatment plan. Some children may already be under 16 hours; others will face significant reductions.
• Contact your MCO. Your managed care organization handles prior authorization. Ask about the new monthly reauthorization process and what documentation will be required.
• Know your private insurance rights. The 16-hour cap and telehealth restrictions apply to NC Medicaid reimbursement. If your child has private insurance coverage, those rules are separate. Under federal mental health parity law (MHPAEA), private insurers generally cannot impose caps or limits on ABA therapy that they would not apply to comparable medical services.
• Submit public comments before June 14. If the proposed changes to Clinical Coverage Policy 8F concern you or your family, DHHS is accepting comments through June 14, 2026. Your voice matters in shaping the final policy.

Is North Carolina Alone in Cutting ABA Coverage?

No. North Carolina is part of a broader national trend. Indiana implemented new hour caps and rate cuts effective April 1, 2026. Behavioral Health Business reported in January 2026 that multiple states are introducing age limits, hour caps, and rate reductions as Medicaid spending on ABA grows nationwide. States are under pressure to balance access to care with budget sustainability — a tension that has directly affected families in North Carolina and elsewhere.

At the same time, advocates point out that restricting ABA access can have long-term consequences. Early, intensive ABA therapy is associated with meaningful improvements in communication, adaptive behavior, and independence — outcomes that reduce long-term costs for individuals and families alike.

Find ABA Providers in North Carolina

Despite the changes, many qualified ABA providers in North Carolina continue to accept Medicaid and are actively helping families navigate the new rules. Use the ABA Navigator directory to find licensed ABA therapy providers in North Carolina who are currently accepting patients.

Whether you’re seeking a provider that accepts NC Medicaid, looking for in-person options after the telehealth changes, or trying to find a BCBA who can help you appeal a reduced authorization, ABA Navigator connects you with qualified professionals in your area.

Find ABA therapy providers in North Carolina →

Note: This article reflects information available as of May 2026. NC Medicaid policies are actively evolving. Contact your MCO or a qualified ABA provider for guidance specific to your child’s situation.