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For families who depend on Medicaid to access Applied Behavior Analysis (ABA) services, stability is everything. Consistency matters in therapy, and it matters in funding. But lately, stability is in short supply. Across the U.S., states are rolling out new Medicaid cuts , payment delays, and administrative changes that put pressure on providers and limit access for families.
In just the past year, we’ve reported on how Florida ABA providers struggled with Medicaid payment delays , how North Carolina practices faced reduced rates , and how Nebraska’s cuts left families...
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fearing lost access to care. Now, new developments in **Idaho Medicaid** and **Colorado Medicaid**, along with a **Sunshine Health ABA** enrollment pause in Florida, are adding to the growing uncertainty.
The Bigger Picture: Why Medicaid Cuts Keep Happening
Medicaid is one of the largest expenses in state budgets—often second only to education. When states face budget shortfalls, Medicaid becomes an easy target for savings. The recent wave of changes isn’t random; it reflects broader financial and political pressures, including:
- Budget shortfalls caused by slowing revenue growth and inflation.
- The end of pandemic-era federal Medicaid funding that temporarily boosted state budgets.
- Competing priorities like higher education, infrastructure, and public safety that also demand resources.
For ABA Practice Owners , the impact of these changes is immediate. Staff wages are rising, compliance requirements are expanding, and recruiting qualified RBTs and BCBAs remains difficult. Even small changes in reimbursement or enrollment policy can disrupt your ability to pay staff, plan for growth, and provide consistent care for families.
Idaho: A 4% Medicaid Rate Cut
According to KTVB, the Idaho Department of Health and Welfare has proposed a 4% across-the-board cut to Medicaid provider rates to help manage a $252 million state budget shortfall. While 4% may not sound like much on paper, it can mean a lot in practice.
For ABA agencies, which already operate on thin margins, a 4% reduction makes it harder to pay competitive wages to RBTs and BCBAs. In a state like Idaho, where recruiting staff is already a challenge—especially in rural areas—this kind of cut could lead to increased turnover, fewer available services, and longer waitlists for families. In some communities, it could even mean providers closing their doors, leaving children without access to critical ABA therapy.
This proposal has not yet been finalized, but it’s a clear example of how quickly state budget decisions can create challenges for providers and families who depend on Medicaid-funded care.
Read the full Idaho & Colorado Medicaid Cuts Analysis
Colorado: Budget Cuts, Oversight, and a Short RBT Extension
Colorado is facing even more significant financial challenges. On August 28, 2025, Governor Jared Polis announced $252.2 million in budget reductions, with Medicaid and higher education taking major hits, according to CPR News. A letter from the Governor’s Office of State Planning and Budgeting, shared by Polsinelli, outlines that healthcare providers will absorb $89.5 million in cuts across Medicaid and other programs [oai_citation:0‡colorado-budget-cuts-hit-home-for-medicaid-providers.pdf](file-service://file-8TZCFpRVzU4LPzHyyMnRmy).
The changes include:
- A planned 1.6% increase to Medicaid reimbursement rates for FY 2025–26 has been canceled.
- Pediatric behavioral therapy codes are being reduced to 95% of benchmark rates.
- All pediatric autism therapy codes will be subject to pre- and post-claim reviews, with $7 million in projected savings.
- Outpatient psychotherapy and definitive drug testing now require prior authorization, with $7.7 million in additional projected savings.
On a more positive note, Colorado Medicaid has granted an extension on the RBT certification requirement until October 31, 2025. This gives providers more time to get staff through the certification process, which may help with staffing continuity. Still, many ABA leaders worry that a short extension won’t be enough to prevent disruptions to care once the pause and cuts take effect.
Provider Voices in Colorado
In online communities, providers have expressed concern about what these changes mean for their practices and families. Comments include:
- “Will our rates revert back on October 1st?”
- “Pre- and post-claim reviews for autism codes will delay payment.”
- “Going back to 95% of benchmark rates hurts us when costs keep rising.”
- “This will push small practices out. Only PE-backed companies can survive this.”
For ABA practice owners , the message is clear: Colorado’s Medicaid system is entering a period of tighter oversight, lower rates, and more administrative burden. That’s a combination that threatens sustainability if practices don’t prepare.
Read the full Idaho & Colorado Medicaid Cuts Analysis
Florida: Sunshine Health ABA Enrollment Pause
Florida ABA providers have already been hit hard by Medicaid challenges. Earlier this year, we covered how payment delays at Florida Medicaid created major financial strain. Now, another hurdle has emerged. On September 3, 2025, Sunshine Health announced it will begin a temporary moratorium on enrolling new ABA practitioners into existing provider groups, effective October 1, 2025. Regions A and B are exempt, but elsewhere in Florida, no new RBTs or BCBAs will be credentialed during the pause. Sunshine Health stated the pause is meant to allow time to process current credentialing requests and ensure accuracy .
For ABA businesses, this creates serious challenges. If you hire new RBTs or promote staff to BCBA during the pause, they won’t be credentialed to bill. That means you may be paying staff you can’t use for Medicaid clients—an unsustainable position when reimbursement delays are already a problem. Families are understandably worried about continuity of care if agencies can’t replace staff quickly.
Provider Concerns in Florida
Providers in Florida have already voiced their frustrations:
- Families may lose access to services if new staff can’t be added to rosters.
- Uncertainty about how Sunshine Health will handle RBTs who become BCBAs after October 1.
- Ongoing delays in removing former staff from rosters, which raises concerns about accuracy.
- Conflicting messages, with providers receiving recruitment emails from Sunshine even as new enrollments are paused.
- Talk of possible legal challenges, as providers worry about families being denied medically necessary care.
These concerns echo the larger challenges we’ve seen across the country, where administrative barriers are compounding the impact of Medicaid cuts and threatening service stability.
Read the full Sunshine Health Enrollment Pause Analysis
What This Means for Providers
Idaho’s across-the-board cuts, Colorado’s new oversight and funding reductions, and Florida’s Sunshine Health pause all point to the same reality: Medicaid’s future is uncertain. For smaller ABA agencies, this uncertainty translates directly into financial strain. For families, it means longer waitlists and disrupted services.
These are moments where preparation matters. By staying plugged into associations, watching state policy developments, and keeping your practice’s numbers clear and organized, you’ll be better positioned to respond. Strong financial systems also matter more than ever. If you’re looking for ways to cut costs without sacrificing quality, our ABA Billing / RCM services at 2.99% can be a great first step toward stability.
Conclusion
From Idaho’s 4% cuts to Colorado’s new requirements to the Sunshine Health ABA pause in Florida, providers are facing challenges that could reshape how Medicaid services are delivered. For ABA practice owners , the priority now is building resilience, keeping your teams supported, and advocating for fair, sustainable funding. These stories are reminders that the landscape is shifting—and the ability to adapt is what will keep your practice thriving.
We’ll keep covering these issues in our ongoing ABA Business News series. For deeper dives, read the full state updates here:
- Idaho & Colorado Medicaid Cuts: https://3piesquared.com/blog/medicaid-cuts-in-idaho-and-colorado-what-aba-providers-and-families-need-to-know_340
- Sunshine Health’s ABA Enrollment Pause: https://3piesquared.com/blog/sunshine-healths-aba-enrollment-pause-what-aba-practice-owners-need-to-know_361
- Florida Medicaid Crisis: https://3piesquared.com/blog/florida-medicaid-crisis-aba-providers-struggle-to-get-paid_354
- North Carolina Medicaid Cuts: https://3piesquared.com/blog/north-carolina-medicaid-cuts-why-aba-providers-must-act-now_350
- Nebraska Medicaid Rate Cuts: https://3piesquared.com/blog/nebraska-medicaid-rate-cuts-what-aba-providers-and-families-need-to-know_340
Want to talk about what these changes mean for your practice? Don’t go it alone. Join us live today at 8 AM Eastern on Facebook: https://www.facebook.com/3piesquared
