The Medicaid Mess No One’s Talking About (Yet)

Aug 6 / Kristyn Peterson

And why behavioral health leaders can’t afford to wait
It hasn’t made the headlines yet, but it will. 

Behind closed doors, Medicaid-funded organizations are bracing for a wave of reimbursement disruptions, code eliminations, and eligibility changes that could radically reshape how ABA services are delivered and funded.


Most providers aren’t publicly talking about it. Not yet. But if you’re a clinic owner or operational leader, you’ve likely already felt it: the uncertainty, the rumors, the race to find contingency plans that don’t yet exist.

And that silence? It’s costing us time we just don’t have.

What we’ve seen before: When funding gets pulled fast

Our team has deep roots in behavioral health, across clinical, operational, and consultative roles. We’ve been in the room when:
  • A major commercial funder pulled out of a state overnight
  • $500k+ in services were clawed back due to a documentation audit
  • Entire teams had to scramble to re-credential with new payers, with no warning
  • Assignments
  • Clinics had to lay off staff, shift caseloads, and absorb the reputational damage of a crisis they didn’t cause
Write your awesome label here.


We didn’t have toolkits then. Just spreadsheets, policy PDFs, and too many emails with no clear path forward. It was reactive, exhausting, and we weren't set up for success. 


We survived it (with scars) but we shouldn’t have had to figure it out on the fly.

Why this time is different

The changes in Medicaid are systemic, structural changes, not just a billing rate adjustment. 

Here’s what makes this moment especially high risk:

Volume of Changes

Most ABA providers are Medicaid-heavy. A 15% drop in revenue could put clinics underwater.

Timeline Compression

Changes like the elimination of CPT 97155 in states like New Hampshire could go into effect with <60 days’ notice.

Eligibility Changes

Proposed work requirements and more frequent eligibility checks threaten to destabilize entire client populations.

Operational Fragility

Most clinics don't have the infrastructure to scenario plan across multiple revenue pathways, or the staffing agility to flex without chaos and major frustrations. 

What isn’t on the balance sheet, but matters just as much

We’ve seen this play out before. When funding drops, there’s a cascading effect:
  • Schedulers break under the weight of chaos
  • Families panic, and some walk
  • Your best clinicians look for safer jobs
  • Google and Glassdoor reviews tank
  • Admin teams scramble to meet new payer rules
  • Revenue lags with tons of denials
  • Reauthorizations crawl to a halt 

And most of the clinics that suffer the worst outcomes didn’t realize they needed a plan until they were already in crisis.

So we built what we wish we’d had.

This time, we decided to act before the fire.

We’ve built a Medicaid Risk Toolkit for ABA clinics, specifically designed for BCBA-, OT-, and SLP-owned organizations.

It’s light-touch, directive, and built by people who’ve sat in your seat but also have specialized knowledge in strategic planning and risk assessment. It's infrastructure and prioritization tools individualized to your unique situation. 

The toolkit includes: 
Medicaid Revenue Risk Snapshot 
Risk Priority Matrix to prioritize your most urgent operational gaps 
Staff-facing communication plans
A 30-day action plan you can implement immediately 
Optional Tier 2 and 3 supports for deeper strategy and planning
Optional session note and treatment plan audits, so you can feel confident in avoiding clawbacks
We’re not here to sell panic. We’re here to help you prevent unnecessary chaos, keep serving your clients, and stay aligned to your values. 
Whether Medicaid cuts are 15%, 25%, or more, your response will shape your clinic’s future.

If your gut says “this could impact us,” it’s time to act.

If you're a decision-maker, book a strategy consult here: 

If you’re not, but care about your organization’s survival, forward this article to the person who needs to see it.