Episode 35: Prove It: The Policy Shift That’s Forcing ABA to Grow Up

ABA is under pressure—and a lot of it is deserved.In this episode of Rad N Bad, Sean and Mike break down the real impact of North Carolina’s recent Medicaid policy changes and what they signal for the future of the field. This isn’t speculation. This is a direct response to rising costs, federal audits, and growing questions about how ABA services are delivered and justified.For years, the industry has been highly effective at getting services authorized—but far less consistent at proving meaningful, real-world outcomes. Now, states are starting to ask better questions:Why this many hours?What is actually changing outside the session?Can caregivers implement the intervention independently?Where is the plan to fade services?North Carolina didn’t eliminate ABA.They challenged it.And in doing so, they introduced a new reality:Telehealth is being restrictedSupervision is being defined and enforcedParent training is no longer optionalHigh-intensity services must be justified—monthlyExceptions for rural and underserved areas must be proven, not assumedThis episode goes beyond the policy language and gets into what it actually means for providers, BCBAs, and organizations trying to navigate the shift.Sean and Mike also call out the uncomfortable truth:At some point, hours became the product.Instead of focusing on independence, generalization, and caregiver competency, parts of the field leaned into volume—and now the system is correcting it.But this isn’t just criticism.They break down what a defensible, outcome-driven model actually looks like, including:Lower direct hours with higher impactParent-Mediated Intervention (PMI)Caregivers as the primary agents of changeMeasuring outcomes through adaptive functioning and real-world performanceBuilding models that lead to titration and discharge—not dependencyThe takeaway is simple:This isn’t the end of ABA.It’s a filter.And the field is being asked one question:Does what you do actually create independence?Because the future of ABA won’t be defined by how many hours are provided…It will be defined by what changes because of them.Here is the policy if you would like to read it:https://webservices.ncleg.gov/ViewBillDocument/2025/7815/0/H696-PCCS10584-LUXR-3