The Hopebridge Chief Executive on the audits she ordered, the centers she consolidated, and why RBT credentialing hurt more than Indiana’s rate cut.
Key Takeaways
- Regulation is outrunning provider infrastructure: Hester describes one month in which three states rolled out significant policy changes inside 72 hours, each requiring rewritten standards, retraining and new webinars. She says that weight lands on clinicians in ways the company’s systems were never built to absorb.
- Indiana Medicaid tightened on two fronts at once: IHCP bulletin BT202627 cut nongroup ABA rates by 6 percent in April, with a further 4 percent scheduled for April 2027, and restricted coverage to members under 21. Hester says the rate reductions hurt, but that confusion over technician credentialing through managed care organizations did more operational damage.
- She audited Hopebridge before she changed it: In her first months the company commissioned an outside coding and compliance audit, an external cybersecurity assessment and surveys of Board Certified Behavior Analysts inside and outside the organization. Those three subjects, she says, now set the order in which Hopebridge prioritizes initiatives.
- The next build is clinical rather than administrative: Focused Care, a reduced-hour skills-based program piloting at 10 centers, has found that more than 20 percent of children transitioning to school still meet medical necessity, against a 10 percent hypothesis. The company is working through staffing and scheduling before moving to a second phase.
When LeAnne Hester became Chief Executive Officer of Hopebridge on March 31, the company did not announce it. It announced the vacancy in February, when Dennis May’s retirement after 10 years of service was made public, and announced the filling of three other executive seats on August 13. In between, for four and a half months, the largest open question in the company’s leadership was settled without a public statement.
Hester brought up the missing announcement herself, unprompted, in a recent interview with Acuity Media Network. “I didn’t think it was important enough to just talk about me,” she said. She had assumed the news would read better alongside the other appointments, which is eventually how it was published.
How the Hopebridge CEO Transition Actually Unfolded
The sequence, as she described it, is longer than either release suggests. She first met Hopebridge in July of 2025 and began working with the company in an advisory capacity that August. That work ran through ailumis advisors, the advisory and interim executive practice she founded in February 2023 to serve private equity sponsors and executive teams across healthcare, technology and tech-enabled services, and which she ran until December 2025. She joined the organization in December as President, at a point when May’s departure was known internally and a transition was being planned deliberately. May left in March. Board approval followed, and Hester stepped into the role on March 31.
The February 6 announcement had said that Hester, then President, would assume responsibility for day-to-day operations and strategic execution beginning March 1 while the Board of Directors advanced the next phase of its Chief Executive Officer transition process, and that Hopebridge expected to name its next Chief Executive at a later date. That second notice never came. The seat had changed hands before: May had led Hopebridge since 2016, moved to Executive Chairman in May 2023 when Chief Operating Officer David McIntosh was promoted, and resumed the role after McIntosh departed in January 2024.
The August 13 release described Hester as having come into the role in March, alongside three appointments drawn from outside applied behavior analysis. Doug Folsom had joined as Chief Information Officer in January, after nine years at TRIMEDX, where he served as Chief Information Officer, President of CE Cybersecurity, and Chief Technology Officer. Stacey Jensen, a Registered Nurse with a Master of Business Administration and 25 years in clinical operations, came in as Chief Clinical Operations Officer in May, from Upward Health, where she was Chief Clinical Operating Officer. Denise Bohnert, a Registered Nurse and attorney who holds a Certified in Healthcare Compliance credential, arrived in July as Chief Compliance Officer and General Counsel from Amedisys Home Health and Hospice, where she was Compliance Officer. All four appointments were made between December and July, and all four were announced at once.
Hester’s own path to the seat did not run through applied behavior analysis, but it has been grounded in healthcare throughout her career. She began working for provider organizations, including Community Health Network, where she developed an appreciation for the realities of patient care delivery and the role clinicians play in achieving outcomes. She later held leadership roles spanning healthcare technology, clinical analytics, commercialization and compliance, including positions at Premier Inc., PeraHealth and TRIMEDX, with a focus on supporting clinicians with the systems, technology and operational infrastructure needed to deliver high-quality care. From July 2018 to January 2023 she was Chief Marketing and Solutions Officer at TRIMEDX, the Indianapolis clinical technology management firm, a tenure that falls within the nine years Folsom spent at the same company. The two worked together as peers there, and Hester credits that period with showing her what Folsom could do with technology to support compliance and the clinical team. The pattern across the four appointments is strategy, compliance and health technology, alongside a clinical leadership bench that did not change: Jana Sarno remains Chief Clinical Officer and leads the clinical governance council, and Founder Kim Strunk, an Occupational Therapist by training, heads clinical strategy.
The Board’s Three Priorities: Clinical Quality, Compliance, and Technology Infrastructure
Hester says she and the board agreed on three priorities before she took the title. Clinical quality and outcomes came first, compliance and governance second, technology and operating infrastructure third. “It was really important to me to have that clarity before stepping into the role officially,” she said.
What she did first was measure. Hopebridge engaged an outside firm to conduct a coding and compliance audit, commissioned an external cybersecurity assessment, and surveyed Board Certified Behavior Analysts both inside the company and outside it. The three subjects were not chosen at random. Recruiting and retention determine clinical capacity, compliance protects a clinician’s license as much as the company’s claims, and, as Hester put it, “you can’t be in healthcare today and not worry about cybersecurity threats.” The timing is also its own answer: federal auditors have now recommended more than $123 million in refunds across four state ABA programs, and in every one of those audits, all 100 sampled enrollee-months contained at least one improper or potentially improper claim.
She said the coding and compliance audit came back well, and noted, wryly, that she probably would not be bringing it up otherwise. Hopebridge did not release the audit or name the firm that conducted it.
Hopebridge’s Clinical Governance Model and Its First Chief Information Officer
The Chief Information Officer seat is new. Hopebridge went years without one, which Hester describes as untenable for an organization of its geographic spread. Her framing of the role’s purpose is deliberately narrow. “Technology is not the strategy, but it should be an enabler,” she said.
The example she returns to is prior authorization. Payers differ on what they require and how much, and those differences change. “If I don’t have that embedded in a system, then our BCBA has to remember it, and that’s not what they went to school for,” she said. Hopebridge is building its own Plan of Care App, currently in a sandbox environment, which the company’s internal beta studies suggest can cut the time a behavior analyst spends writing a plan of care by up to 20 percent. The company’s stated goal is to reach 50 percent as the tool and the clinicians using it gain familiarity, and as planned enhancements and user feedback are incorporated.
The structure she has assembled around it separates functions that many providers run together: a clinical governance council covering standards, quality, education, outcomes and research, led by Chief Clinical Officer Jana Sarno; operations to execute against those standards day to day; compliance as the check; and information technology underneath. “Each of those functions cannot operate independently in today’s environment,” she said. Where clinical and operational authority meet is a live problem across the industry, where adding an operations manager to every clinic solved one problem and created another.
Holding a common standard across state lines is the part she is least satisfied with. “We had one month where three states, within 72 hours, all rolled out pretty significant changes,” she said, and each change meant rewriting standards, running webinars and retraining staff. What she wants instead is to encode the rules and, in her phrase, turn a knob. “It’s not perfect yet,” she said.
Indiana Medicaid Bulletin BT202627: Why RBT Credentialing Hurt More Than the Rate Cut
Hopebridge is headquartered in Indianapolis and operates more centers in Indiana than in any other state, which makes it unusually exposed to a program in the middle of the most aggressive ABA reform cycle in the country. IHCP bulletin BT202627 took effect April 1, applying a 6 percent reduction to all nongroup ABA codes, with a second cut of 4 percent scheduled for April 2027. It also introduced a 1:8 supervision ratio, a telehealth ban on assessment and direct treatment codes, a 4,000-hour lifetime cap, and a restriction of coverage to members under 21, with a transition window for adults already in services that closed on September 30. Providers were required to apply for accreditation by August 1 of this year and to hold it by October 1, 2027.
Hester does not minimize the rates. “Can’t tell you that they didn’t hurt,” she said. But when asked what had actually cost the company more, she named something else. “The thing that I would tell you that was even harder is the administrative work,” she said. Indiana requires technicians to be individually credentialed, and the rollout of that requirement through the state’s managed care organizations produced inconsistent guidance. Registered Behavior Technicians also turn over at a different rate than behavior analysts do, so any friction in credentialing compounds.
Technician turnover is a structural feature of the model rather than a temporary condition, and providers have been rebuilding onboarding around it for several years. Hester’s objection is not to the oversight itself. “I completely support what each of the states is doing,” she said. “I want to be one of the providers that are held as a standard of good care.” Her qualification is about sequencing: “Accountability has to be implemented in a way that protects access to care and doesn’t reduce it.”
What Makes an ABA Market Worth Staying In: Clinical Capacity, Location, and Consolidation
Asked what determines whether Hopebridge stays in a state, Hester put reimbursement third. First is whether the company can recruit and retain behavior analysts there. “The clinical capacity has been the biggest one,” she said. Second is the individual site. “A location that was good maybe three years ago may not be ideal today,” she said, a judgment the company weighs against patient demand and community needs. Third is the state environment, particularly where uncertainty affects access to services or the stability of the wider healthcare system. She described one market where managed care organizations are exiting and their replacements have been delayed by litigation, possibly until 2028, leaving an 18-month gap. She did not name the state.
The company’s history on this is public. Hopebridge ended ABA services across its eight Colorado locations in 2023, closing six of them outright, and said at the time that it had spent years trying to negotiate a workable Medicaid rate in a state where operating costs ran well above the others it served. It withdrew from Arkansas effective October 3, 2025, closing centers in Bentonville, Hot Springs and Little Rock, after a change to the state’s Child Care Facility Licensing Act reclassified centers serving five or more unrelated children as child care facilities, a designation the company said conflicted with its clinical model as a provider of medically necessary services. Company materials now list more than 100 centers across 10 states, against the 112 locations counted in a January impact release that also reported more than 11,700 families served during 2025.
That difference is partly consolidation, which Hester describes in operational rather than financial terms. Two centers, each below 50 percent physical capacity and within a 25-minute drive of one another, prompted a question she says she asked directly: “Am I providing the best possible care I can with these two locations?” After one such consolidation in Georgia earlier this year, more than 25 percent of staff stayed and as many as half the children transferred to the receiving site, which she attributes to a tolerance radius of roughly 20 to 25 minutes. Those figures describe a single site rather than a company-wide average, and Hopebridge says it weighs consolidations against continuity of care, retention of team members and patient outcomes. The clinical argument runs alongside the arithmetic. A center staffed by one behavior analyst and one speech therapist offers less to both clinicians and children than one with a clinical director and four or five analysts.
Private Equity Ownership, Scale, and Board Governance at Hopebridge
Hester raised private equity before the question was asked. Arsenal Capital Partners acquired Hopebridge in 2019, and the company now sits among the largest ABA platforms in the country by location count. “Let’s just call the elephant out in the room,” she said, referring to the assumption that size and sponsorship come at the expense of clinical quality.
Her answer is structural rather than rhetorical. Hopebridge maintains a Clinical Advisory Board composed of clinicians who are not company employees, funds interdisciplinary grand rounds that draw outside faculty, and seats independent directors, including two physicians and a former Chief Financial Officer of both a public and a private company. The board runs subcommittees for compliance, audit and risk; for human capital; and a separate clinical advisory committee. “Without profit, you can’t invest in clinicians, and you can’t do the things we’re talking about,” she said. “But it doesn’t mean you have to sacrifice one for the other.”
How Hopebridge Measures ABA Outcomes
Hopebridge tracks goal attainment, skill acquisition, behavior reduction, adaptive behavior, and contracts an independent data analytics firm to survey families after a child transitions out and to track whether those children continue to progress without returning to intensive services. Hester is candid that pulling any of it is harder than it should be. “Our current infrastructure doesn’t make it as easy as it should be for us to pull out outcomes,” she said, which leaves the clinical team assembling by hand what a practice management system ought to produce. She is pointed in crediting them for it.
That constraint is not unique to Hopebridge. Sarno represented the company in a seven-provider effort that benchmarked more than 5,000 children’s outcomes against CASP treatment intensity standards, an exercise in which one participating Chief Clinical Officer spent 40 to 60 hours matching billing records to test scores by hand because the software could not do it.
The company has also invested in measurement it does not own. Hopebridge uses EarliPoint’s eye-tracking assessment in some of its diagnostic work and joined Project ALIGN, the consortium EarliPoint Health launched in July, as a founding member. The tool received expanded FDA clearance through age eight in March, which is what makes longitudinal use possible. Hester’s interest in it is partly translational: payer medical directors come from medicine and are accustomed to reading graphs, and the field has historically handed them something else. It is also familiar ground. The Rothman Index, the predictive surveillance score she spent a year commercializing at PeraHealth, exists to compress a patient’s trajectory into a single line a clinician can read at a glance.
The internal measure she describes as most telling is one that runs downward. Hopebridge titrates services against outcomes, which in practice means watching a child’s authorized hours step down across successive plans of care. A child who begins at two years old at 28 to 30 hours a week should, if the work is succeeding, need progressively fewer, in preparation for school.
Inside the Hopebridge Focus Care and Skills-Based ABA Pilot
The newest initiative came out of that transition point rather than out of a strategy session. A parent told Hester that her child was doing well but wanted to play sports, which is a different environment with a different set of demands. As children age, the skills expected of them shift: more advanced language, more complex behavioral skills, and more sophisticated peer and social skills. Sports alone call for self-regulation, reading and responding to social exchanges in real time, following complex and shifting routines, tolerating losses, taking longer turns, and waiting for extended stretches. Hopebridge has not historically offered anything for children at that stage.
The company calls the answer Focused Care, reduced-hour skills-based programming for children who are already in school, and is piloting it at 10 centers, timed to the return to school. The hypothesis was that 10 percent of children transitioning out would still meet medical necessity for it. The pilot has since returned more than 20 percent. “It exceeded my hypothesis,” Hester said. A second phase will work through the operational questions the first one raised: evening staffing, Saturday hours, whether evening rates should differ, and how to use the part-time behavior analysts who have shown interest.
If it scales across the company’s more than 100 centers, Focused Care would extend Hopebridge’s involvement with a child past the point where its core service ends, which is an unusual direction for a provider under pressure to reduce hours. Hester frames it as continuity rather than expansion.
