Medicaid Cuts Are Here. Are You Ready for What’s Next?

Aug 28 / Dr. Kristyn Peterson, PhD, BCBA, LBA, LSSMBB

The Cuts Aren’t Coming. They’ve Already Started.

In just the past few months, multiple states have implemented sweeping changes to Medicaid reimbursement and coverage:

Nebraska Medicaid Cuts

41% average rate cut for ABA services (97151, 97153, 97155, and 97156), effective August 1

New Hampshire Medicaid Cuts

Loss of access to 97155 (treatment planning & supervision) starting September 1

Colorado ABA Changes

Retroactive requirement for technician registration, effective April 2025 (announced in July 2024)

North Carolina Medicaid Cuts

3% Medicaid rate cut slated for October 1
This is a tide of change, not a ripple. And while the exact nature of the changes varies, from rate reductions to code eliminations, and administrative burdens, the direction is consistent: 
Downward pressure on reimbursements. Upward pressure on operations.

It's Bigger Than Just the Numbers

A rate cut is hard enough. But what makes this moment especially dangerous is that the changes are stacked:

Lower rates mean tighter margins.
More admin requirements mean higher costs.
Client access issues mean more complaints and fewer referrals.
Clinician burnout increases as job security decreases.

In isolation, any one of these would be manageable. Together? They create the perfect storm for clinic instability.

This Isn’t Just a Local Problem.

If you’re a clinic leader in a state not mentioned above, it’s tempting to breathe a sigh of relief.

But here's the truth: you’re not off the hook, you’re just on borrowed time.

What we’re seeing in these four states is likely a preview of what’s to come elsewhere. Medicaid policy often travels in clusters. When one domino falls, others tend to follow. And with ongoing federal scrutiny around cost containment, it's not a matter of if other states will take action, it's when, even if you're in a pro-Medicaid state. 
Write your awesome label here.

What happens if you wait?

Clinics that wait to are going to face real consequences. What we're hypothesizing?
  • Emergency staffing changes
  • Broken trust with families
  • Delayed billing and revenue gaps
  • Last-minute cost-cutting decisions that erode culture and care
By the time your team feels the effects, it’s already too late to plan.

What You Can Do (Right Now)

The clinics best positioned to survive, and even grow, through Medicaid changes are already doing three things:

We call this the Medicaid Mitigation Model, and it’s what we’re using to support clinics across the country, no matter what state you’re in.

You’re Not Powerless. But You Do Need a Plan.

This isn’t your fault. But it is your responsibility.

If your state has already implemented changes, it’s time to stabilize and respond with precision. If your state hasn’t made changes yet, don’t waste the time you still have.

We can help you build a plan that protects your people, your clients, and your organization’s future.

Want to learn more about our Medicaid Mitigation Planning services? 

About the Author

Dr. Kristyn Peterson, PhD, BCBA, LBA, LSSMBB

Founder, Moralis Machina 
Dr. Peterson is an award-winning behavioral scientist and the founder of Moralis Machina. A two-time OBM Network Outstanding Applied Intervention Award recipient, she consults and teaches at the intersection of organizational behavior management, systems thinking, and leadership.
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