The future of ABA is being decided right now — not in corporate boardrooms or legislative chambers, but in the signatures of the people who approve a child’s care.
This letter is to those clinicians. And to every parent reading: you deserve to know how those decisions are made.
I began raising these concerns last year, long before the Medicaid rate cuts put ABA in the headlines. At the time, there was little awareness and no political momentum. In the past two months, I’ve pressed harder — meeting with lawmakers, providing data, and asking for action. There’s been some engagement, but much of it has been dismissive.
Now that rate cuts have gone into effect, the conversation is louder — but for the wrong reasons. Legislators are rushing to calm fears that access to care is at risk, when in truth, what’s really threatened is the bottom line of companies built on Medicaid as their primary revenue source. Inflated reimbursement rates have been used to prop up payrolls, perks, and pay structures that could never survive in a healthy, ethical market.
Here’s the truth: these companies cannot survive without clinicians. They rely on your signature to approve treatment plans and authorizations. Without that, they cannot bill. Without it, they cannot operate.
I know many of you are doing your best in difficult circumstances — working under policies you didn’t create, pressured to sign off on decisions you may question, and forced to balance doing what’s right with keeping your job. Some may have followed procedures they now wish they had challenged: defaulting to 30–40 hours, approving supervision hours beyond what is truly needed, managing caseloads so large that quality oversight becomes impossible. I understand how people get swept into it. The pace, the pressure, and the promise of resources can pull you in before you fully see the cost.
If that’s you — it’s not too late to come back to the work you envisioned when you started. Many of us have faced moments in our careers where we compromised more than we wanted to. What matters is what you do now.
Sometimes, change begins quietly. It starts with asking questions — of ourselves, of our teams, and yes, of our supervisors. Why are these hours being prescribed? How are discharge timelines decided? What is our fading plan? Are we supporting a child’s participation in speech or OT, or unintentionally competing with it? These are conversations worth having, even if the first step is just to ask.
And remember: when your signature is on a treatment plan or authorization, it’s your certification and license — not the company’s — that will be on the line if those decisions are ever scrutinized. If something goes wrong, the organization will move on; you will be the one accountable.
When you resist pressure to prescribe 30–40 hours as a default, to bill for supervision beyond what is clinically necessary, or to manage caseloads so large that ethical oversight is impossible — and instead insist on meaningful, ethical involvement in every case you authorize — you make it harder for exploitation to continue. And when enough of us do it, the model that enables it begins to crack.
If you are in a place where change seems impossible, you still have options. Document everything. Advocate internally. And if needed, take your credential somewhere that allows you to use it with integrity. Without your name, the business model that harms children and families cannot stand.
If you’re already practicing ethically, your voice is critical in shaping what comes next. Contact your state senators. Support common-sense regulations that protect access to care while ending waste, fraud, and abuse. The companies we’re talking about have been effective at mobilizing families to protect their business interests. We need to be equally persistent — not to preserve inflated payrolls or billing practices, but to protect the integrity of our field and the children we serve.
To parents and advocates: ask your BCBA how your child’s hours are determined, how often they are on site, and whether they have ever recommended fewer hours, delayed discharge, or adjusted a plan to allow for other therapies like speech or OT. If the answers are vague, defensive, or rehearsed — press harder. Expect their name to stand for more than revenue.
The future of ABA will not be decided by investors or corporate boards. It will be determined by the clinicians who choose what to sign, what to approve, and what to stand behind. That is the leverage we hold. Together, we can use it to make ethical practice the norm, not the exception.
— Corey Cohrs, PhD, BCBA-D, LIMHP
Founder, Radical Minds
Sincerely,
Corey Cohrs
Founder & CEO, Radical Minds
📞 Want clarity or a second opinion—no pressure?
Visit radicalmindsomaha.com or call (402) 230-5861.
