Utah Makes Automatic ABA Medicaid Rate Increases Permanent

SB 160 Guarantees Rising ABA Rates

SALT LAKE CITY, UTAH – Over the past year, many state Medicaid programs have cut ABA reimbursement rates. According to BreakingNewsABA, six states did so by May. Utah took a different approach by making its increases permanent. Senate Bill 160, signed by Gov. Spencer Cox on March 18 and effective May 6, ‘makes permanent the budgeting mechanism under which Medicaid reimbursement rates for applied behavior analysis may increase,’ as stated in the bill’s long title.

This rule is found in Utah Code 26B-3-203, which sets the base budget for Medicaid accountable care organizations and behavioral health plans. If Utah’s General Fund growth factor—next year’s revenue estimate divided by this year’s appropriations—reaches 102 percent or more, the base budget must include an increase that gives ‘substantially the same year-over-year percentage point increase’ to managed-care payments and to ‘each ABA service reimbursement rate.’ When forecast revenue growth is at least 2 percent, ABA rates also go up. The law does not allow for rates to be lowered.

Before this spring, the guarantee was temporary. The 2024 law that created the escalator only covered fiscal years 2025 and 2026. Beginning with the 2027 base budget, the automatic increase would have applied only to managed-care payments, not ABA. SB 160 removes the two-year limit and the planned change.

The law sets three levels. If the growth factor is below 100 percent, managed-care payments stay the same. Between 100 and 102 percent, payments rise with the growth factor. At 102 percent or higher, ABA rates must also increase by at least 2 percentage points, so managed-care payments and ABA rates go up together. Each year by November 1, the Governor’s Office of Planning and Budget gives the Department of Health and Human Services a General Fund estimate so the agency can plan for the increase.

The law ensures that Utah’s ABA rates increase only in years when General Fund growth is expected to exceed 2 percent. It also adds another important feature: parity. The law requires the first increase to ‘increase and substantially equalize’ each ABA rate with the rate paid for similar services under an ACO or behavioral health plan. The difference is clear from a rate comparison in January 2022, which showed that Medicaid paid ABA front-line staff $37.52 per hour, while similar mental-health workers earned $71.68 per hour, a 48 percent difference. Behavior analysts were paid $88.00 per hour, compared to $145.07 for licensed clinical social workers and similar roles, a 39 percent difference.

Efforts to equalize rates started before this law. The Coalition of Utah ABA Providers says a budget request for equal pay led to a rate increase that took effect retroactively on April 1, 2023.

Making the increase permanent has almost no cost on paper. The Office of the Legislative Fiscal Analyst said SB 160 has no net cost to state funds and does not allocate any state money. The analyst noted it could shift $18,000 in ongoing expenses to the General Fund starting in fiscal 2028, with similar shifts in other years when the 2 percent trigger is met.

Three Sessions to Permanence

SB 160 was the third Medicaid rate bill from Sen. Todd Weiler in three years. He introduced the first, SB 197, to the Senate Health and Human Services Committee on February 8, 2024, with Kerry Gibson from the provider coalition present, according to the committee minutes. The bill passed the Senate 27-0 and the House 71-0 in amended form, making the escalator law for two fiscal years.

The 2025 follow-up bill did not pass. SB 246, Weiler’s proposal to make an annual ABA rate appropriation part of every base budget, passed the Senate 24-0 on February 24, 2025, and a House committee 13-0 on March 4. However, the House removed its enacting clause on March 7 as the session ended, so the mechanism was set to expire with the 2027 budget.

SB 160 completed the process in 2026. Weiler filed the bill on January 19 with Rep. Stephanie Gricius, who had also sponsored it in the House in 2024. The bill passed its Senate committee 6-0, the Senate 24-0 on February 10, and the House 68-1 on February 25. It reached the governor’s desk without any appropriation.

The Cut Wave Utah Declined to Join

Across the country, the trend is different. Direct state Medicaid payments to autism therapy providers rose to $2.2 billion in 2023, up from $660 million in 2019, according to a Wall Street Journal analysis of national billing data. States with the fastest spending growth are now making the biggest cuts.

Nebraska cut behavior-technician reimbursement 48 percent effective August 1, 2025. North Carolina imposed a 10 percent ABA-specific cut on October 1, 2025, then canceled it in December after families sued and won a preliminary injunction. Indiana, which had already replaced its percentage-of-billed-charges model with a flat fee schedule, cut again in April 2026. In Georgia, Medicaid managed-care organization CareSource cut ABA reimbursement 20 percent effective May 2026. Even a state that raised rates has retrenched: Virginia lifted ABA reimbursement 10 percent in July 2025, then capped services at 20 hours per week a year later.

Providers pay close attention to these changes and their effects. ‘We’ve seen state Medicaid authorities reduce their rates, and then commercial payers try to follow suit, despite increasing pressure on access,’ said Jim Spink, CEO of Autism Care Partners, during a webinar conducted in November 2025. Utah is moving in the opposite direction. Once its rates match managed-care levels, every ABA rate in the state will increase along with behavioral health funding in the base budget.

The next test for the escalator is set by law. By November 1, the Governor’s Office of Planning and Budget must give a General Fund estimate to the Department of Health and Human Services. This will show whether the growth factor will reach 102 percent, triggering another ABA rate increase in the 2028 base budget.

AT A GLANCE

SOURCES & REFERENCES