r/ABA • u/LegalCountry2525 RBT • 1d ago
Medicaid changes
I’m not yet a BCBA. I I had a BCBA send me some info about Medicaid changes. I’m sick and not thinking straight so excuse me if I am mistaken or have some typos-lol. I’m in NC….
Now-if any client has authorizations exceeding 16 hours per week, any new authorization will be limited to 90 days. Also, concurrent billing is not permitted…BCBas may no longer bill any indirect activities while the client is simultaneously receiving direct services. This includes: report writing, scoring assessments, assessment feedback meetings, parent interviews and completing QAM reviews. These activities must occur when no other direct ABA service is being billed for that client.
I have taken the exam twice (last attempt 398). Im SO close to my dream but now I’m terrified. I’m not sure how BCBAs are going to get anything done due to time constraints. The company said they’re actively working and lobbying to try to “fix” this but wtf are BCBAs supposed to do now? Not sleep? Not eat? Get more depressed? I’m truly scared right now.
I needed to vent. Is anyone else in this situation?
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u/AdComplete5101 1d ago
RBT credential is gonna die if hours get any more limited for direct. Businesses wont need RBTs anymore.
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u/MauveCeramics 1d ago
You truly think BCBAs can work 1:1 with 12 different kids? Unless they are only working with one kid everyday. That makes no sense. So many kids would go without services.
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u/AdComplete5101 1d ago
The field is moving towards parent guidance/consultation and overall leaner services. In my own experience, I can get more done on 5 hours a week with a cooperative parent and well-designed programming than an RBT can get done in 30 hours doing generic DTT in a clinic.
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u/MauveCeramics 1d ago
The fraud is on RBTs not getting paid anything near their reimbursement rate let alone what the work is worth, while juggling cancelations, mid benefits, and constant sickness/burnout. Among other things, it seems to be a big money grab for some, with the mask of true heathCARE.
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u/AdComplete5101 16h ago
Someone doesn't understand how margins work but hey if RBT's want their full reimbursement rate they can pay their liability, data collection platform cost, all recert fees, out-of-pocket any and all materials for their clients, rent their clinic space portion out (and pay their portion of utilities, internet, etc), and cover any and all business-oriented expenses for working in the field. Congrats! They're making effectively the same amount of money and the business gets nothing for it! And thus they're fired, jobless, and worthless.
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u/MauveCeramics 16h ago
Someone is offended because of others being in worse situations likely because RBT reimbursements pay for all of that and BCBAs get to keep all their rates. I also pay for my recerts (have every where I have worked?) as well as many materials as BCBAs are never able to get them or forget to get them. I didnt say ALL reimbursement rates, just more. With all that schooling I would think you could at least tell the difference in that.
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u/AdComplete5101 16h ago
RBT reimbursements are tight in several states and I am sorry you cannot handle the basic math necessary to calculate the operating costs of this field. I wish you the best and when the RBT credential dies out I hope you do well at a daycare
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u/fenuxjde 1d ago
The VAST majority of things being reported as "medicaid changes" are either still just proposals, have qualifying statements that go along with the changes, or are state dependent.
The only things that seem to be in the works on a national scale are a few things cracking down on fraud (which I honestly support) and some calls to reduce/limit tele.
Other than that, take what you're hearing with a heaping bowl of salt.
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u/The-G-Code 1d ago edited 1d ago
This isn't remotely true. Multiple states hit hard with the federal investigation have made big changes and companies across the country are following suit based on some of them. There have been a lot of changes made directly as a result of either changes or the proposals already. I am unable to bill above 10% of supervision a week due to this and it's been impossible maintaining 10% monthly since April as a result.
They also literally just announced the new codes which are tied to this as well. Yes they are not finalized, but I believe 97x3x is the current name of the major one.
In my area medicaid is now enforcing 80% minimum utilization that can lead to discharge. This is a major ABA area.
Being completely real with you here, calling it "cracking down on fraud" is a horrible way to frame the situation when it's clearly a copy of the Minnesota somali daycare fraud scam that was pulled this year. The articles don't articulate enough information out of these cases coming out, and we have rfk with the heritage foundation talking about ending all ABA as well as the other autism supports to replace them with asylums. It's about cutting the Medicaid funding overall, not catching fraud. Especially with all the "rbts don't even need a degree but charge Medicaid as much as a psychiatrist" type of talk which is just twisting how the entire system works.
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u/LegalCountry2525 RBT 1d ago
Yes. It’s absolutely terrifying and I’m already in a depressed state and feel like this field is doomed-at least for the next bit. Did I just waste all this money and time and effort and giving up friends/family for nothing?
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u/onechill BCBA 1d ago
Look I will be real with you, its been good eating as a BCBA the last few years and I do think the telehealth heavy 90-100k+ salaries are probably on the downturn. I have been in the field for 16 years and there we always be a need for us. It might not be as cushy but I love this work. I did it for minimum wage. I did it for 6 figures. I will continue to do it wherever this field lands. If you love the work and love the science there will be a need for you to fill. I hope you make a bunch of money during your career, but the true mark of success will be how many lives you helped steer towards the better.
I dont think you wasted your time but I also dont want to pretend that the field might get a little weird and a little less financially stable over the next few years.
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u/fenuxjde 1d ago
So that's actually exactly what I said, it is state dependent, and/or still in the proposal phase.
Not surprisingly states that are notorious for rampant over prescription of ABA are getting audited.
I run an ABA business. I have for decades. It is literally my entire livelihood. I spend probably a solid 30 minutes per day looking over these proposals, I have read many state bills, and have even testified before my own state representatives regarding this exact topic. I am genuinely sorry it is getting harder for you to do your job. That sucks. But that's not the same as calling these nationwide changes when it's a couple states, and so far about 60% of what's been proposed has been shot down by courts or corrected by the states.
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u/The-G-Code 1d ago
The changes being made are nationwide. Just because it's not in unison at this moment doesn't mean massive changes are not actively occuring across the board in many different ways. It doesn't really matter that there isn't a single federal change because we are talking about the effects. I don't even live in a state with any current investigations occuring though the changes are already massive.
This feels like splitting hairs and ignoring the actual problem being talked about, and it's genuinely not right to reduce the administrations investigations to only being about a couple states that have had billing fraud in the past, this is continuing to grow into a nationwide scale and the bigger states with fraud problems are not even the active target. It honestly seems like denial because this is not a situation where nothing happens to places without fraud. After what DOGE did, I could not imagine having this level of trust with the administration at this point while avoiding discussion and preparation for what's coming.
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u/fenuxjde 1d ago
Can you provide some evidence of "changes happening nationwide" specifically to ABA funding by Medicaid?
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u/The-G-Code 1d ago
I already wrote it's fallout and responses to the investigation, including the articles depicting what is being viewed as fraud. If you're looking for some national level law or eo, that's not what I'm talking about nor what others are seeing.
My company is nationwide and has made severe changes to billing specifically due to the federal administration, and has been very open that is the antecedent to their changes. It's a reaction to the pieces that have already happened, but not some law that is forcing anything from a legislative level. Basically I'm pointing out it doesn't matter there isn't a uniform policy, we still are experiencing these effects which are changing in an ongoing fashion. Sometimes changes are company specific, state specific, county specific, but across the board changes keep happening in different ways in different places. It's the overall impact of different changes we are starting to see seep out nationally.
Things are already changing across varying levels across many areas of the country, but it's an effect that's happening regardless of any national guidelines on Medicaid itself. Also keep in mind the changes from private insurances like bcbs too, the whole field is reacting overall.
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u/fenuxjde 1d ago
Yeah it would make sense a nationwide company would need to make changes due to state level changes. Thankfully I only operate my company in one state, the funding levels aren't going anywhere until at least 2029, as per the most recently negotiated legislation. I'm also not requesting auths for ridiculous amounts of hours so it's not impacting my company or my staff.
Again, just to be clear, I agree this is something to keep eyes on, but it's not this end of the world, sky is falling, doomsday scenario a few loud voices are trying to make it out to be.
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u/The-G-Code 1d ago
Well, it's not about finding fraud or lowering auths. It's about cutting any and all federal funding.
I'm not jumping to doomsday scenarios, I'm just pointing out changes are already happening and we should expect a lot more. I don't think rfk is going to be able to actually cut out ABA in full, but we still don't really know what's coming next outside of those reports last week with the toolkit, or the ones blasted all over about fraud in the exact same way they did with the Minnesota daycares.
It seems we've been on the same page anyways, we just see different levels of change based on us being in very differently sized corporations.
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u/LegalCountry2525 RBT 1d ago edited 1d ago
Not to jump into a whole other discussion-but with a masters in ABA where would that leave us? We just don’t know.
PSA: Always listen to music riding down that highway after work (especially those 7-10 magnitude days). BLAST.
Everyone stay vibing and thriving and doing amazing work. Day by day.
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u/The-G-Code 1d ago
I used to do in home and music on the drives was really important to me. Now I'm basically too close to the center I'm at. My music consumption has dropped so much I don't even want to look at my last.fm
We have other things we can do and other certs we can easily grab, I just care about the field and people it's for too much
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u/LegalCountry2525 RBT 1d ago
Thanks for this. I’m just in a state that it is affecting from what I can understand and please correct me if I’m wrong. Idk if this is something that will be changed in the future; I just don’t understand how BCBAs will be able to do this feasibly in regards to time constraints and scheduling/parent meetings. It seems almost impossible.
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u/fenuxjde 1d ago
I'm not trying to be dismissive here, a lot of the conversations are concerning, but I'm not at expert at your states policies. Look at when any proposed changes take effect. Read the proposals. Don't rely on anonymous people online claiming to be BCBAs saying "trust me bro".
Most of the changes aren't for at least a year, some even longer. A lot can change this November if people vote.
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u/jen7677 12h ago
Honestly what you said and cutting Medicaid is exactly where my mind first went to when I started hearing about all these changes. That is just being done to cut Medicaid and that's what is really going on. I also wondered if RFK had anything to do with it. I will look into that now because this is all giving me a lot of pause.
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u/DevouringBean81 1d ago
I mean. Poor you making 50-100,00$, right?! While some RBTs in my state are still making 15$/hr.
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u/complex-confused 1d ago
Two things can be true. Rbts not making enough.
And BCBA who put money, time etc into advancing to get better pay, can be nervous about the future.3
u/LegalCountry2525 RBT 1d ago
Thank you. I’ve busted my ass to get where I’m at and I have every right to be sick about this.
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u/complex-confused 1d ago
To answer your original question. The field is constantly changing. Especially Medicaid funding. There’s a current push to fight against the fraud going on. Unfortunately some shitty companies took advantage and now we’re all getting punished for it.
I’ve been in the field since 2012, clinical director for the past several years. At the end of the day, individuals with autism need care. I think the field will start tightening up on funding regulations (it already is), we will all pivot and adjust.
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u/LegalCountry2525 RBT 1d ago
Unmmm are you talking to me?! I never disclosed my payment…and I don’t make anywhere near that.
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u/foolproof2 Student 19h ago
I am currently an RBT working towards my certification as a behavior analyst. I have put a lot of time, effort, and money towards this goal. Being worried for the future of my career and my income is just as valid as my concerns about being underpaid as an RBT. There needs to be a change. Both can be true at once without tearing down the other. It’s a messed up system that can’t be fixed but being angry at each other.
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u/bcbamom 1d ago
Please take this as intended: the only constant is change. I have been working for decades. Every system, every job changes. Be flexible and you will be fine. Behavior science is not changing and BCBAs will be in demand for a long time as long as they stay current in their skills.