Two Truths and a Wake-Up Call: Medicaid Cuts, Treatment Intensity, and the Future of ABA
Join us live to discuss these two topics - 8 AM Eastern-Click the link here-
1. Medicaid Cuts & The ABA Squeeze
Let’s be real—what’s happening with Medicaid isn’t just a policy shift. It’s a wake-up call. States like New York are proposing deep cuts to Medicaid funding—$30 million over two years just for behavioral services. Indiana’s been through a major federal audit, triggering a chain reaction of policy updates that have left ABA providers scrambling to figure out what “compliance” even means anymore....
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The impact? Small ABA companies are at risk. Not because they’re doing anything wrong—but because they’re doing everything right with limited support and now face a storm of funding uncertainty, tighter documentation rules, and rising administrative pressure. If you’re a solo owner or small group trying to stay true to your values, this moment can feel overwhelming.
And the families? They’re caught in the middle. Medicaid isn’t a luxury for many—it’s the only reason therapy is accessible. If these cuts go through, access narrows. Kids miss sessions. Progress slows. Burnout rises. This isn’t hypothetical. It’s already happening.
In this piece, we break down what’s going on—not with fear, but with facts. We look at the federal and state-level trends, what they could mean for access, and why smaller providers are most at risk. We don’t offer panic. We offer a plan.
Because this is survivable—but only if you prepare. That means tightening up your documentation systems, ensuring your team knows how to defend treatment intensity with data, and building internal processes that don’t fall apart under audit pressure.
And if you don’t know where to start? We do. We’ve helped over 500 ABA practices get through audits, prep for policy shifts, and stay anchored to their mission while navigating compliance. This moment is hard, but you don’t have to go through it alone.
2. Quality Is a Choice (And So Is Chaos)
Here’s a question no one wants to ask but most BCBAs have thought: If funders didn’t control what we do, would we still recommend the same number of hours?
A 2025 study by Hustyi & Yingling shows what many of us have felt for years—treatment intensity recommendations vary wildly across providers. Not based on clinical needs, but based on habit, preference, or sometimes... whatever number fits the billing target.
That’s not judgment. That’s reality. And it’s a problem.
This article takes that study and flips the conversation. It’s not just about treatment hours—it’s about who we are as providers. It’s about getting clear on our “why.” Because if our decisions are based on staffing constraints, utilization goals, or just trying to keep the wheels from falling off, then something’s out of alignment.
And that’s where the chaos comes from.
In this piece, we unpack what quality actually means in an ABA company—and how to anchor your planning process in clarity and ethics, not just survival. We break it down into real questions:
- Would you still do this if funders weren’t involved?
- Are your staff able to act in alignment with your company’s values?
- Are you building a system that protects your clinicians and your clients?
If the answer to any of those is “no” or “I’m not sure,” that’s not failure. That’s a signal. It’s time to revisit your values and make sure your systems match.
At 3 Pie Squared, we help busy BCBAs and overwhelmed company owners get out of reactive mode and build intentional, scalable, and ethical systems. Because quality isn’t some shiny goal—it’s a choice you make every day, every session, every hire.
And if you’re ready to make that choice more intentional?
