If your child receives ABA therapy through North Carolina Medicaid, the behavior analyst supervising that therapy may live somewhere else. About half of them do. Of the 4,010 people certified as behavior analysts by North Carolina's board, 1,917 live in the state. The remaining 2,093 live elsewhere, and only 355 of those come from South Carolina, Tennessee, Georgia, or Virginia. The rest are spread across the other 46 states and a list of countries that runs from Canada to Malta.

That arithmetic is why North Carolina is changing the rules on August 1, and why some families are hearing that their child's therapist may not be there in the fall. The changes are real, but they are narrower than the early conversation suggests, and the difference matters for what you should do this week.

What the Legislature Passed

House Bill 696, now Session Law 2026-1, cleared the General Assembly on April 22 by votes of 112 to 1 in the House and 48 to 1 in the Senate. Governor Josh Stein signed it on April 30. Section 3C.18 is the portion that reaches autism services.

Cost drove it. State and federal Medicaid spending on ABA in North Carolina was $1.9 million in 2020. By the fiscal year ending in 2025 it had reached $505 million, with projections above $1 billion by 2027. The number of children receiving ABA rose from 8,704 in 2024 to 13,447 in 2025, an increase of about 54%, while spending grew 65% and averaged close to $37,600 per child. In April, Attorney General Jeff Jackson opened an investigation into ABA billing practices, and a state analysis found that private equity-backed providers collected some of the largest ABA payments in 2025.

The Out-of-State Rule Is Narrower Than It Sounds

The statute bars board certified behavior analysts and Qualified Autism Services Practitioner Supervisors from enrolling in North Carolina Medicaid as out-of-state providers. Section 3C.18(e) limits that restriction to enrollment applications submitted on or after the law took effect. On its face, the statute does not terminate the enrollment of an out-of-state analyst who was already in the program.

The 40-mile figure circulating among providers comes from a different document. North Carolina Medicaid's draft rewrite of Clinical Coverage Policy 8F, posted May 15 with comments accepted through June 14, would prohibit out-of-state providers from billing unless they work within roughly 40 miles of the state border. That draft has not been finalized, and as of July 14 a department spokeswoman said the revised policy had been updated to reflect recent legislative changes and would be posted "in the coming days."

So the question for your family is not whether out-of-state analysts are banned in the abstract. It is whether the specific person supervising your child's care is already enrolled, and how your provider plans to bill for that supervision after August 1.

Reauthorization Moves to Every Three Months

The original bill required monthly reauthorization for any treatment plan exceeding 16 hours of therapy per week. The budget approved July 2 and signed July 7 eased that to every three months. The prior standard was every six months.

The paperwork behind a single reauthorization can run 50 pages and take weeks to assemble. Providers question whether the state can process approvals fast enough to prevent gaps in care, which is the practical risk for a family: not a formal denial, but an authorization that lands late while therapy sits idle.

Remote supervision tightens as well. The bill permits behavior analysts to supervise therapists remotely no more than half the time, and North Carolina Health News reports that department policy narrows that to 20% of therapy time.

Four Questions Worth Asking This Week

Call your provider and ask, in this order: Is my child's supervising analyst enrolled in North Carolina Medicaid, and was that enrollment in place before this spring? Does my child's plan exceed 16 hours per week? Who assembles the reauthorization packet, and when does the next one get submitted? If our analyst can no longer bill, who replaces them and when?

Write down the answers with the date and the name of the person who gave them. If your provider cannot answer the first question, that itself tells you something about how closely they are tracking this, and verifying who is delivering and supervising your child's care has become a standard part of using Medicaid-funded ABA.

If a notice arrives reducing or ending your child's hours, you can ask for services to continue while you appeal. Under federal Medicaid rules that request generally must come within 10 days of the notice date, which is a short window and an easy one to lose to a mailbox. The mechanics of building an appeal that succeeds are the same ones that work for any therapy denial, and if your provider exits entirely, families in this position have had to find replacements mid-treatment before.

The General Assembly meets monthly through the end of the year before reconvening in 2027 for the long budget session. State Senator Natalie Murdock has told families that persistence during those negotiations is what keeps access on the agenda. North Carolina's Medicaid program came close to running out of money this month, which is the budget climate any request now enters.

Watch for the revised Policy 8F to post. Until it does, the enrollment date of your child's analyst and the hours on your child's plan are the two facts that determine how much of this reaches you at all.