Key Takeaways

• Illinois and New York are the only two states in the country that expressly require applied behavior analysis businesses to be owned by licensed behavior analysts. Illinois did not begin issuing behavior analyst licenses until January 2025.
• Section 150 of the Illinois Behavior Analyst Licensing Act (225 ILCS 6/150), passed in 2022, requires that by January 15, 2027, every owner and equity holder of an ABA business hold a currently valid Illinois behavior analyst license, or divest.
• A survey conducted by the Council of Autism Service Providers found that among Illinois ABA providers who responded, 60 percent were not 100 percent LBA-owned, 30 percent were LBA-owned, and 10 percent were unsure of their ownership status.
• Two bills currently before the Illinois General Assembly, SB 3807 and HB 5171, would repeal Section 150 and replace it with language explicitly prohibiting any non-licensed person from making clinical decisions regarding patient care.
• The Illinois Association for Behavior Analysis has actively opposed the repeal bills. ILABA president Zhihui (John) Yi and lobbyist Stephanie Vojas Taylor did not respond to multiple requests for comment from Acuity Media Network.

When the Illinois Behavior Analyst Licensing Act passed in 2022, the primary goal was access. Behavior analysts in Illinois were not yet licensed, which meant they could not enroll as Medicaid providers. Children whose families relied on Medicaid could access ABA therapy only through already-licensed professionals: psychologists, speech pathologists, social workers. Children with commercial insurance faced no such restriction. The result was a two-tier system organized around the accident of what kind of coverage a family happened to carry. Licensing was meant to fix it.

What few anticipated was that the bill would also contain a clause that would spend the next several years quietly reshaping the legal landscape for every ABA business in the state.

Section 150 of the Behavior Analyst Licensing Act is a single dense paragraph written in standard corporate practice of medicine (CPOM) boilerplate. It prohibits any business entity from providing ABA services unless every owner, partner, shareholder, director, officer, and holder of any other equity interest holds a valid Illinois behavior analyst license. The Illinois Department of Financial and Professional Regulation (IDFPR) began issuing licenses on January 15, 2025. The compliance clock started that day. The deadline is January 15, 2027.

Illinois and New York are now the only two states that expressly require ABA businesses to be owned by licensed behavior analysts. The companies operating in the Illinois network were not built with that requirement in mind. Many have been operating for 10, 15, or 20 years.

Rebecca Thompson, PhD, BCBA-D, leads two state trade associations: the Illinois Providers for ABA Access and Quality (IPAAQ) and its Massachusetts counterpart (MPAAQ). She has been tracking the Illinois legislation since before the licensing law passed and has become a leading voice for revising Section 150 before its deadline arrives.

“The existing network is already fragile and inadequate,” Thompson said. “These restructuring requirements could destroy the limited network of providers.”

The Workaround That Swallows the Rule

The provision’s patient protection argument rests on a straightforward premise: if licensed clinicians own the business, licensed clinicians control the clinical decisions. The problem, Thompson and others contend, is that this premise does not survive contact with how corporate restructuring actually works.

For the majority of ABA companies not solely owned by licensed behavior analysts, the practical path to compliance runs through a bifurcated ownership structure. The clinical entity, organized as a Professional Limited Liability Company or Professional Service Corporation, is owned by a licensed BCBA. The operational side of the business is placed under a separate Management Service Organization (MSO), which is owned by the original non-licensed owners under the terms of a Management Service Agreement (MSA). The BCBA serves as the nominal owner of the clinical entity, but the contractual arrangement between the two entities often leaves real control with the MSO.

“The BCBA owner can be swapped out at any time,” Thompson said. “So in practice, no real control lives with them.”

The MSO structure is not a loophole invented to circumvent Illinois law. It is an established legal practice with a well-developed specialty bar, common across medicine. The result, as Thompson describes it, is that restructuring will cost ABA companies substantial sums in legal fees, entity formation, credentialing, and recontracting, while producing no material change in how clinical decisions are made day to day. Private equity-backed companies, which have legal and compliance infrastructure already in place, are better positioned to absorb those costs than small and mid-sized independent practices. Whatever concerns exist about the role of private equity in ABA, Section 150 does not resolve them.

Veronica Glickman, MA, MS, BCBA, LBA, founded Autism Behavioral Educational Services in the Chicago suburbs in 2010. She has operated clinics in Geneva and Sycamore for more than 15 years and, as a BCBA owner, already satisfies Section 150’s ownership requirement. She still faces the administrative and financial burden of restructuring her corporate form to meet the statute’s entity requirements.

“I’d rather put the money towards quality and training,” Glickman said. “And yet, what they want is already in the modified language. Why not just accept it?”

Her concern extends beyond her own practice. Sycamore is semi-rural, and the only other ABA provider in the area is a private equity-backed company. If that company closes rather than restructure, Glickman said, the families it serves have essentially nowhere else to go. Her clinic does not have the physical space or staffing capacity to absorb a sudden influx of displaced clients.

“Those families would likely turn to us for services,” she said. “However, we do not have the capacity to accommodate all of them simultaneously.”

Restructuring, at Any Cost

Karem Alnatafgi founded his Chicago-area ABA practice in 2023. He completed the majority of coursework toward a master’s in ABA and advanced through the credentialing process for the BCBA designation but ultimately focused on the operational side of the business, staffing the clinical program with licensed supervisors from the outset. Under Section 150, he must either divest his equity or complete a full restructuring before January 2027.

He started that process last November.

“It’s still not done,” Alnatafgi said. “It’s nowhere near done. It’s a lot more complex than people are thinking.”

The legal fees and setup costs are already in the tens of thousands of dollars, with more expected through the end of the year. For a practice at his stage, that spending is directly competitive with investment in clinical quality, staff training, and expansion. Alnatafgi also accepts Medicaid, which adds a further layer of complexity: recontracting with managed care organizations involves documentation requirements, potential rate renegotiation, and, in some cases, the risk of not being welcomed back into a network at all.

The risk to insurance contracts is not theoretical. Thompson referenced two cases among her members in which practices that went through restructuring were not re-credentialed by payers they had previously been contracted with, or were offered lower reimbursement rates as a condition of reentry. Alnatafgi described waiting on new contract terms without yet knowing what rates he would receive under his newly structured entity.

“All of those funds I could have put toward better quality,” he said. “I could have put them toward expansion to serve more people on wait lists. I could have put them toward better training, more oversight, more clinical positions. Instead they go to legal fees, filing fees, credentialing fees, technology.”

The CASP survey, which achieved roughly a one-third response rate from Illinois ABA providers, found that 60 percent of respondents said their organization is not 100 percent LBA-owned, 30 percent reported being LBA-owned, and 10 percent were unsure. Thompson noted that providers uncertain about their ownership status are in all likelihood not LBA-owned, which would push that figure higher.

Alnatafgi’s more pressing concern is the effective timeline. The January 2027 deadline appears distant on a calendar. In practice, it is not. Alnatafgi began restructuring in November 2025 and, as of March 2026, the process remained incomplete. Glickman estimated the full restructuring process takes roughly six months from start to finish. For providers who have not yet started, the window is already narrowing.

“If we move forward with restructuring and determine who will remain, that process needs to begin soon,” Glickman said, “It can take several months to complete.”

A Vital Question Without an Answer

The two bills currently before the Illinois General Assembly offer an alternative path. SB 3807 and HB 5171, introduced with support from IPAAQ, would repeal Section 150 outright. In its place, the bills would add language to the practicing-without-a-license section of the Behavior Analyst Licensing Act, explicitly prohibiting any person who is not licensed from making clinical decisions regarding patient care. Violations would carry the same penalties as unlicensed practice.

According to Thompson, the process began when IPAAQ proposed a narrower modification to Section 150 that would have neutralized the ownership and restructuring requirement while expanding licensure requirements to any owners making clinical policy decisions. IDFPR reviewed that proposal and recommended going further: repealing Section 150 entirely and moving the patient protection provision to the unlicensed-practice section instead. The bill’s language replicates what IDFPR provided.

“If somebody is making clinical policy decisions and they’re not licensed, they are violating this law and practicing without a license,” Thompson said. “That would actually enhance patient protections that are absent today.”

The principal opposition has come from the Illinois Association for Behavior Analysis (ILABA), the state professional association for behavior analysts. ILABA has actively opposed SB 3807 and HB 5171. Acuity Media Network contacted ILABA president Zhihui (John) Yi and lobbyist Stephanie Vojas Taylor on multiple occasions. Neither responded. The bills have drawn support from a notable set of organizations, including CASP and Autism Speaks, the national advocacy organization that originally sponsored the licensing legislation whose CPOM provision the bills now seek to undo.

The absence of a public statement from the opposition leaves a significant gap in the debate. The argument for maintaining Section 150 as written is not irrational on its face: CPOM doctrine exists in some form in roughly two-thirds of states, and the intuition that licensed professionals should control licensed professional businesses is a durable one. But the argument has not been made publicly, at least not in response to the specific provisions of SB 3807 and HB 5171. Thompson, Alnatafgi, and Glickman say they have been unable to get a substantive answer to the most basic question: what, specifically, does Section 150 accomplish that the bill’s replacement language does not?

What no one disputes is that the network is under strain. Estimates from providers and trade groups suggest roughly 140 to 150 ABA companies operate in Illinois. The CASP survey data, which drew 51 total responses from which 48 came from qualifying Illinois ABA organizations, tells a stark story: 60 percent of respondents said their organization is not 100 percent LBA-owned, and of that group, 87.5 percent reported that their ownership structure has not yet been addressed at all. Among the 21 organizations that answered a question about potential client impact, the total number of clients who could lose services if those organizations could no longer operate in Illinois was 7,596. In a separate survey IPAAQ conducted in August 2025, half of respondents said they are considering not providing services in Illinois in 2027. Some providers have told Thompson directly they plan to exit the state rather than restructure. Multi-state companies with limited Illinois operations may find it more cost-effective to close their Illinois footprint than to build out a full MSO structure. Every company that closes takes its clients, its staff, and its Medicaid contracts with it.

The scale of what is at stake is not abstract. According to the most recent data from the CDC’s Autism and Developmental Disabilities Monitoring Network, approximately 1 in 31 children aged 8 years has been identified with autism spectrum disorder, a figure that has risen steadily for two decades. The demand for ABA services is not declining. If the Illinois experience sets a precedent, providers in other states are already paying attention. California, where behavior analysts are not yet licensed at the state level, could see similar CPOM requirements take effect the moment licensure legislation is enacted, for the same reason that Section 150 came into force in Illinois. The dynamic would be identical: a licensing law passes, CPOM boilerplate comes with it, and a network built without those requirements is given a deadline to rebuild itself from the inside.

Alnatafgi framed the moment without ambiguity.

“It’s almost like the industry is going through doomsday in Illinois,” he said. “And this is bad because now Illinois is going to be used as a precedent for other states. We either stop it or we let the other ones fall.”