Recent headlines about Nebraska’s Medicaid reimbursement changes for ABA services have sparked concern—and a lot of confusion—among ABA providers, families, and advocates across the state. If you run an ABA business or rely on these services for your child, here’s what you need to know about what’s actually happening, why it matters, and what comes next.
The Facts: What Are the New Rates?
Starting in August, Nebraska’s Medicaid program will reduce reimbursement rates for ABA therapy. Under the current system, providers are paid $36.11 per 15-minute unit—equal to $144.44 per hour—for services by BCBAs and RBTs. Under the new rates,...
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- Registered Behavior Technicians (RBTs): $18.70 per 15-minute unit ($74.80 per hour)
- Board Certified Behavior Analysts (BCBAs): $22.72 per 15-minute unit ($90.88 per hour)
This represents a 48% decrease for RBT services and a 37% decrease for BCBA services.
For context, these rates are still higher than many Medicaid and even some commercial payers in other states . In fact, providers working with programs like TRICARE often report lower reimbursement for similar services. That said, Nebraska clinics and families are right to be concerned—not just about the rates themselves, but about what rapid change could mean for stability, access, and quality.
Why Are the Rates Changing?
Nebraska’s Department of Health and Human Services (DHHS) says the new rates are based on a recent state-contracted audit and an effort to align reimbursement with “current practice and federal guidelines.” Officials argue that the previous rates were “well above national averages” and that the new rates bring Nebraska in line with other states. However, many ABA business owners and parents worry that this shift could reduce provider participation , limit access for rural families, and disrupt services for hundreds of children who rely on Medicaid-funded ABA.
The Real-World Impact
For ABA businesses, these cuts are not hypothetical. At $18.70 per 15 minutes for RBTs, providers must cover not just payroll, but also payroll taxes, professional liability insurance, mileage reimbursement, ongoing training, supervision, compliance, and administrative costs. Many clinics note that to remain sustainable—and provide competitive pay to retain skilled staff—they need to operate at a minimum 10% profit margin. Anything less, and quality suffers or doors close.
Some providers have already signaled that they may have to limit the number of Medicaid families they can serve, or even stop accepting Medicaid altogether. As one Nebraska parent told KLKN-TV, “If these rates don’t cover the cost, we’ll see providers leave the state, and that hurts families like mine in the long run.”
It’s also important to recognize that in many other states, ABA providers have managed to operate at lower rates—but often with larger networks, economies of scale, or by subsidizing Medicaid clients with higher commercial reimbursements. In smaller markets, or in rural areas, that flexibility doesn’t always exist.
What Does This Mean for Nebraska Families?
Families whose children rely on Medicaid for ABA services are understandably anxious. The new rates could mean:
- Longer waitlists as some providers limit Medicaid slots
- Traveling farther to find a clinic still accepting Medicaid
- Disruption in continuity of care for children with autism who need consistent support
- Added pressure on public schools and other community resources as families seek alternatives
As always, the biggest impact falls on those with the least ability to pay out of pocket.
What Can Providers and Families Do?
- Document your costs. If you run an ABA practice, make sure you have clear, evidence-based records of your cost structure—payroll, taxes, insurance, supervision, and all overhead. This data is vital for advocacy and for making your case to policymakers.
- Advocate at the state level. Now is the time for providers, families, and professional organizations to reach out to state legislators and DHHS, share stories, and request a review of the rates. Data and real-world examples matter.
- Explore all options. Some providers may be able to continue offering Medicaid services by optimizing staffing, leveraging technology, or joining larger networks, but this isn’t possible for everyone.
- Support each other. Share resources, coordinate advocacy efforts, and keep families informed. The more the community works together, the more likely it is to be heard.
Bigger Picture: ABA Insurance Mandates and Sustainability
Nebraska’s experience is part of a larger national conversation about ABA insurance mandates, provider reimbursement, and the tension between access, sustainability, and quality. Most states now require insurance coverage for autism services—including Medicaid—but low reimbursement rates can subvert the intent of those mandates . As Stephen puts it, “We can’t deliver ethical, sustainable care on rates that don’t cover our costs—no matter how strong the mandate.”
To build a sustainable ABA business that puts clients and staff first, rates must be high enough to cover not just payroll, but also the real costs of compliance, quality, supervision, and growth. Anything less is a recipe for burnout, turnover, and lost opportunities for kids who need help most.
Sources
- Nebraska dad of boy with autism criticizes Medicaid rate cuts
- Nebraska DHHS to adjust ABA service rates amid audit concerns
- Nebraska families, providers concerned about Medicaid rate cuts for autism services
Need help keeping your ABA business sustainable?
Running an ABA practice in Nebraska or anywhere in the U.S.? We can help you navigate the challenges of Medicaid rates, ABA business sustainability, and insurance mandates. Get proven resources, expert guidance, and practical solutions with our startup checklist (https://3piesquared.com/productDetails/the_aba_business_start_up_list) or book a free consult at https://3piesquared.com/stephen-booking-page. If you need support in understanding your numbers and making your business sustainable, don’t go it alone.
