ABA Workers Strike in Maryland. Union Fights Spread. Clinics Squeezed as Funders Slash Reimbursement

ABA Therapists Starting to Strike

At 6:30 on Monday morning, 33 workers at Verbal Beginnings in Rockville, Maryland, walked off the job.

They are registered behavior technicians, the people who sit on the floor every day with young children on the autism spectrum, and they are represented by Teamsters Local 639. According to a release from the union, they went on strike over the company’s refusal to reach a fair first contract, more than a year after becoming the first ABA workplace in the country to unionize back in May 2025.

And they are not alone. According to the ABA Workers’ Union, five ABA workplaces have now voted to organize, two of them just this spring, at Golden Steps ABA in Maryland and Aspire Learning Center in Massachusetts.

But here is the bigger picture, and it is not really about any one company.

The way ABA is often paid for makes supporting the people who deliver it incredibly hard. When a session is canceled, the union says workers frequently go unpaid, even when they showed up ready to work. Healthcare can hinge on hitting billable-hour targets. Turnover exceeds 50-70+ percent per year based on various estimates, which means BCBAs spend much of their time training, retraining, and covering for new technicians instead of doing the clinical work only they can do. And at the end of the day, it is the BCBA’s certification and license on the line for decisions made well above their heads.

That is the story the picket line represents. These are not just income fights. They are questions about whether the system is built to support the clinicians it depends on. As the union puts it, “our working conditions are our clients’ ‘learning conditions.’”

Ultimately, the Verbal Beginnings strike is ongoing, and how it resolves may say a lot about where the field goes next.

Clinics Are Being Squeezed, Too

The pressure is not limited to workers. Many ABA providers are also being squeezed by the organizations that fund care.

Medicaid programs and commercial insurers increasingly expect providers to absorb rising wages, benefits, training costs, supervision requirements, cancellations, administrative work, and compliance expenses while reimbursement rates remain flat or, in some cases, are reduced. Unlike most businesses, ABA practices cannot simply raise their prices when their costs increase. Their rates are largely dictated by government agencies and insurance companies.

That leaves providers caught in the middle. Behavior technicians are understandably asking for more dependable hours, better pay, stronger benefits, and greater support. BCBAs are carrying increasingly difficult caseloads and supervisory responsibilities. At the same time, many clinics say the reimbursement they receive is not keeping pace with what it costs to provide high-quality care.

None of that makes poor working conditions acceptable. But it does help explain why labor disputes are likely to spread. The conflict may appear to be between workers and ABA companies, but the deeper problem is a funding system that often asks both sides to do more with less.

When reimbursement is cut, the pressure eventually reaches the clinic floor. Providers may limit raises, reduce benefits, increase productivity expectations, leave positions unfilled, or close programs altogether. Workers feel the effects directly, while families face longer waitlists and fewer choices.

The emerging union movement is therefore not only a warning to ABA employers. It is also a warning to Medicaid agencies and commercial payers: a system cannot continually reduce or restrict funding while expecting providers to improve wages, retain clinicians, expand access, and maintain clinical quality.

AT A GLANCE

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