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Teachers work with kids at the Bounce ADA Preschool in Essex Junction on Tuesday, December 16, 2025. Photo by Glenn Russell\/VTDigger<\/p>\nTeachers work with kids at the Bounce ADA Preschool in Essex Junction on Tuesday, December 16, 2025. Photo by Glenn Russell\/VTDigger<\/p>\n
For Jennifer Beane-Edgar, seeing her son learn how to express his needs has been revelatory.\u00a0<\/p>\n
\u201cHe went from being totally non-speaking, non-communicating, not engaging (and) kind of withdrawn into himself to being able to play and interact with peers,\u201d she said of her 6-year-old.\u00a0<\/p>\n
Sam has profound autism. The diagnosis means he needs help with daily tasks like going to the bathroom or having a snack. It\u2019s likely he will need 24\/7 support for the rest of his life, his mother said.<\/p>\n
After being discharged from a daycare that couldn\u2019t keep up with his high needs, Sam started attending an early intervention clinic for children with autism. The clinic, Keene Perspectives, in Hartford, is one of many in Vermont that specializes in Applied Behavior Analysis, or ABA, therapy. The therapy focuses on building up helpful behaviors \u2014 like communication or toileting \u2014\u00a0and decreasing problem behaviors \u2014\u00a0like running into the street or biting and scratching.<\/p>\n
\u201cThe amount of growth that I\u2019ve seen is immeasurable. It\u2019s incredible,\u201d Beane-Edgar said.<\/p>\n
Sam does puzzles and plays games. He has started repeating words and can communicate his needs through something called a Picture Exchange Communication System, which uses little illustrations to express things like \u201cI want,\u201d \u201cbathroom,\u201d \u201cwater,\u201d \u201cplay.\u201d\u2019<\/p>\n
Yet Sam\u2019s progress stalled in February when Keene Perspectives informed his mother that it was discharging him from the clinic, six months earlier than he was supposed to transition into public school.<\/p>\n
It comes as Keene Perspectives and the nearly 20 other ABA providers in Vermont race to adapt to a change in how Vermont Medicaid pays for its services. The shift has caused a drastic drop in revenue for many ABA providers \u2014\u00a0one that some say threatens their ability to continue providing services altogether. Yet, Medicaid says the change is an essential way to protect against fraud and safeguard its ability to pay for ABA services in general. Though the changes were set in motion late in 2025, they are now colliding with a Congressional inquiry into<\/a> the state-federal health insurance program.\u00a0<\/p>\n At Keene Perspectives, Sam follows the specific protocol a clinician called a board certified behavior analyst, or BCBA, has designed for him. A BCBA has graduate-level training and licensure as a health professional. Sam spends his days one-on-one with a behavior technician who stays with him to implement the clinical guidance and lessons that the BCBA has designed. The behavior technician position is an entry-level, paraprofessional role that requires far less training.<\/p>\n As part of the protocol, the BCBA spends a portion of the day with a child, such as Sam, and the behavior technician, monitoring how the client responds to treatment and where his plan needs to be altered.<\/p>\n Until the end of 2025, Medicaid paid ABA Centers for both the behavioral technician\u2019s and the BCBA\u2019s time. This January, Medicaid instituted new changes that no longer allow providers to bill for both the BCBA and behavior tech\u2019s concurrent services.<\/p>\n This concurrent billing, explained Grace Johnson, a Medicaid policy analyst for the Vermont Agency of Human Service\u2019s Medicaid Policy Unit, was simply not \u201ccorrect coding.\u201d<\/p>\n She and her colleagues identified ABA as the primary area where the state is already acting to avoid potential federal investigations into Medicaid fraud, waste and abuse in Vermont.<\/p>\n Under President Donald Trump, the federal government has increasingly scrutinized how states spend money in the state-federal partnership health coverage program. Johnson noted that last summer, the federal government found Wisconsin had paid $18.5 million for \u201cimproper\u201d ABA billing claims<\/a>.<\/p>\n She said Vermont Medicaid wants to reduce its vulnerability to federal probes by ensuring that its payments are in line with federal guidelines.<\/p>\n Cortney Keene, a BCBA who founded and runs Keene Perspectives with her husband, Chris Keene, said that about half the clinic\u2019s client base are Medicaid patients. Their revenue has dipped about 16% in January and February, she said.<\/p>\n Medicaid\u2019s billing for ABA services works in a lump sum, so providers submit the number of hours a client spends receiving services, rather than the specific services provided. So, if a child attends a clinic like Keene Perspectives for 10 hours a week, working with a behavior technician, Medicaid will reimburse the clinic for 10 hours of time \u2014\u00a0even if two of those 10 hours are spent with a behavior technician and the licensed BCBA, who is guiding and writing the protocol. Previously, those 10 hours could have been reimbursed as 12, to reflect the two hours of the BCBA\u2019s time, on top of the behavior technician\u2019s.<\/p>\n \u201cHonestly, the structure of our work is too complex for a behavior technician to do with fidelity, the way it should be done, without BCBA oversight,\u201d Keene said. \u201cWe\u2019re ethically required to provide services in that structure. You have to have two people there for a portion of the time to make sure it\u2019s done right.\u201d\u00a0<\/p>\n So the Keenes\u2019 process remains the same. BCBAs still design protocol and observe how a child responds to it, they just aren\u2019t reimbursed for their time.\u00a0<\/p>\n The same is true at Little Royals Early Intervention Center, an ABA center in Williston. It was important, explained Celia O\u2019Flaherty, a BCBA and the center\u2019s clinical director, to maintain that standard of care.<\/p>\n But it has resulted in a 17% drop in income for the center and a drop in what they are paid for some individual clients that ranges from 15%-50%.<\/p>\n \u201cThe 50% feels staggering to us,\u201d O\u2019Flaherty added.<\/p>\n She and the Keenes both know of clinics that are already looking at closing their doors entirely.\u00a0<\/p>\n READ MORE<\/p>\n
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