Amerigroup’s Georgia ABA cut, unsized when Acuity reported it in August, falls on technician services, and clinics report 30 percent. Foster children cannot switch plans.
Key Takeaways
- The size of the cut is now known.Amerigroup lowered reimbursement for some technician-delivered ABA on September 1, a 30 percent cut by clinics’ account, and raised rates for treatment planning and caregiver engagement, the company told Acuity.
- Foster children have one plan. Amerigroup is the only care management organization for Georgia Families 360, which covers about 27,000 children in foster care, adoption assistance, and juvenile justice.
- Clinics describe closing intake. Rep. Lee Hawkins said industry representatives told him 75 percent of surveyed clinics expect to reduce or stop serving foster children within three months.
- The state says its review comes later. No Georgia rule sets a managed care rate floor for ABA, and Amerigroup’s contract runs through June 30, 2027 while the procurement protest continues.
When Acuity reported in August that Amerigroup Community Care was cutting Georgia Medicaid ABA rates, the size of the reduction was unknown. Autism Providers of Georgia (APG) had published the objection deadline, October 1, and the rule that silence would count as consent. The notice itself, the percentage, and the codes it reached had not been made public.
The number is now 30 percent. Clinics told the Georgia Recorder that a letter arrived in August announcing a 30 percent cut to ABA therapy payments beginning September 1, and at least one clinic’s first remittances bear it out. Dr. Michelle Zeanah, who runs a clinic in southeast Georgia, told the Recorder that her benefit statements for September appointments came back 30 percent lower. Some providers have stopped accepting new patients at the new rate, the Recorder reported, and others have dropped existing ones.
The reduction lands hardest on one group of members. Amerigroup is the sole care management organization for Georgia Families 360, the Medicaid program covering about 27,000 children and young adults in foster care, receiving adoption assistance, or involved with the juvenile justice system. Most Georgia Medicaid members can choose among Amerigroup, CareSource, and Peach State. Georgia Families 360 members cannot.
What Amerigroup’s Georgia Medicaid ABA Technician Rate Cut Changes
Amerigroup’s notice to clinics described the reduction as intended to better align reimbursement across autism services, according to the Recorder. Amerigroup laid out the restructuring for the Georgia Department of Community Health (DCH) in a July 16 email to Stuart Portman, Executive Director of the department’s Medical Assistance Plans Division, which the Recorder obtained and published. The company said it would remove what it called “excess reimbursement” from the U5 modifier, which it identified as technician-level services delivered by Registered Behavior Technicians, while raising reimbursement for the in-person family and caregiver codes, 97156 and 97157. It said it would maintain reimbursement for 97155 and for the U1 through U4 licensed and certified practitioner levels, and described the new structure as “a more targeted and clinically defensible approach,” supported by a parity review its executive leadership approved. Medical necessity criteria and prior authorization requirements would not change, the email said, and where a provider’s exit created an access gap, Amerigroup would use single-case agreements or similar tools.
The email set September 1 as the go-live date, said providers had to be notified by August 1, and stated that the updated fee schedule, the amendment, and a cover letter had been submitted to DCH’s compliance team for expedited review. It does not state the size of the reduction.
In a statement to Acuity, Amerigroup said that, consistent with CMS’s recently released ABA toolkit, it had “rebalanced ABA reimbursement based on service complexity and clinical expertise.” The changes “were not across the board,” the company said, with rates increasing for treatment-planning and caregiver-engagement services and decreasing for some technician-delivered services. Rates for ABA services provided by licensed clinicians did not decrease, and coverage and medical necessity criteria did not change, Amerigroup said. The company confirmed that the changes took effect September 1 and apply across its Georgia Medicaid business rather than to Georgia Families 360 members alone.
Therapy advocates told the Recorder that caregiver training matters but cannot replace trained clinicians.
The published fee schedule shows what is at stake. Georgia pays $15.58 per 15-minute unit for treatment delivered by a Registered Behavior Technician in a clinic and $18.69 outside one, as Acuity has reported. The family guidance codes Amerigroup says it will raise are priced separately and top out at $26.10. The email and Amerigroup’s statement place the reduction on technician-delivered services, though the company said it applies to some of those services rather than all of them and did not specify its size. If the 30 percent applies to the published rates, the technician rate falls to about $10.91 in a clinic and $13.08 outside one. Acuity has not seen the notice and cannot confirm the base Amerigroup used; the company said in March that it would align its ABA reimbursement with Georgia Medicaid’s effective April 1.
Measured that way, the cut goes deeper than the one CareSource made in May, when it moved to 80 percent of the schedule, or $12.46 for the same unit. It would also bring Georgia’s clinic rate for foster children within a dollar of the $10.00 that Alabama Medicaid pays, a rate Alabama advocates say ranks 49th in the country.
What Happened at Amerigroup’s October 1 Objection Deadline
The August notice gave providers until October 1 to object in writing by certified mail, but the reduction took effect a month earlier. APG advised providers to have objections delivered by September 1 to avoid being paid at the lower rate. The objection clause, as APG reproduced it, said the change would take effect until both parties agreed on a resolution, which would leave the cut in force during any dispute.
The Recorder’s reporting suggests that is how it has played out. Katie White, a guardian ad litem whose adopted son started ABA after a year-long search, said he lost his services in mid-September after about six weeks. “They have yet to respond to my provider’s certified notice declining the new rate,” she told the Recorder.
An Amerigroup spokeswoman told the Recorder that medically necessary services are still covered and that patients should keep their appointments. The company has not said publicly how many providers objected or whether any were terminated. Its confirmation that the changes apply across its Georgia Medicaid business is consistent with APG’s account in August that Amerigroup’s leadership had described the notice as going to every ABA provider in the state. The reduction therefore also reaches Georgia Families members outside foster care, who, unlike Georgia Families 360 members, can choose among plans.
Georgia Families 360 Members Have One Plan and No Rate Floor
DCH’s answer to access concerns is an out-of-network obligation. “In those instances where an in-network provider is not available, Amerigroup is required to secure services with an out-of-network provider,” DCH Spokeswoman Lauren Williams said in a statement to the Recorder. Krystina McQueen, a Hall County foster mother whose provider warned it may not be able to keep treating her son, told the Recorder she had heard nothing from Amerigroup, and White said she had been offered no alternatives. Amerigroup told Acuity that members who have difficulty accessing medically necessary ABA services can contact Amerigroup Member Services for individualized help identifying available care.
Clinic operators describe a wider pullback. State Rep. Lee Hawkins, a Gainesville Republican who chairs the House health committee, said industry representatives told him that 75 percent of the clinics they surveyed expect to reduce or stop serving foster children within three months at the new rate, and that more than 90 percent would limit or stop new intake. The survey’s methodology has not been published.
Nothing in Georgia’s contracts prevents the cut. No statute or regulation requires a care management organization to pay at or above the published ABA schedule, and the current contracts were signed without rate floor language, a gap APG identified after meeting with DCH in April. Anna Bullard, an APG board member, told Acuity in May that Georgia defines an adequate network as one provider within 60 miles, a standard built for primary care rather than a therapy delivered several days a week.
Mental health advocate Roland Behm argued to the Recorder that federal law gives the state both the authority and the obligation to review a rate change’s effect on network adequacy before approving it. Portman described a different sequence. “Our ability to review things is much more on the back end,” he told the Recorder, adding that the department is engaging as early as it can. Amerigroup’s email indicates the department’s compliance team received the new fee schedule about six weeks before it took effect.
DCH’s most recent posted network adequacy filing for Georgia Families 360, an annual report submitted to CMS in December 2025 for July 2024 through June 2025, found Amerigroup out of compliance on 28 of the program’s 34 access standards, including distance standards for mental health providers in 32 urban and 119 rural counties. None of the 34 standards is specific to ABA. Federal rules require plans to submit updated network documentation after a significant change, as the state defines it, including changes in payments to providers. DCH has not said whether it treated Amerigroup’s reduction that way.
Why Amerigroup Still Sets Georgia’s Foster Care ABA Rates
Amerigroup was not selected to remain the foster care plan. In December 2024, the state issued a Notice of Intent to Award that named UnitedHealthcare of Georgia the apparent successful bidder for Georgia Families 360. The procurement has remained in its protest phase since, and DCH said in an April 23 update that it would extend the Amerigroup, CareSource, and Peach State contracts through June 30, 2027 pending a Notice of Award. No transition date for foster care members has been published.
The outgoing plan is acting in a market where every Georgia care management organization has changed its ABA policies within the last year, the Recorder reported. Governor Brian Kemp vetoed $15.86 million in clinic rate parity funding in May. The federal pressure runs the same way: the Centers for Medicare & Medicaid Services reported in August that Medicaid and CHIP spending on ABA rose 421 percent from 2021 to 2025. The toolkit, which Amerigroup cited in its statement, creates no new federal requirements, CMS said. Bullard acknowledged concerns about fraud and overbilling to the Recorder but said rate cuts do not address whether children can reach quality care, an argument provider advocates have made to Acuity about cuts in other states.
What Georgia ABA Providers Should Watch Next
Three questions remain open. The first is whether DCH will act before the back end Portman described, including whether it treats the cut as a significant change that requires Amerigroup to document its network capacity, by reviewing Amerigroup’s network for Georgia Families 360 members now rather than after providers exit. The second is how Amerigroup is handling the certified objections it received, and whether objecting providers remain in network at any rate. The third is which technician-delivered services the decrease reaches and by how much, since Amerigroup has said it applies to some of them rather than all.
Acuity also requested comment from the Georgia Department of Community Health and Autism Providers of Georgia.
For the roughly 27,000 children in Georgia Families 360, the practical question is narrower. A family whose clinic stops serving Amerigroup members cannot change plans. It can contact Amerigroup Member Services, which the company says will help identify available care, or ask Amerigroup to arrange an out-of-network provider, as DCH says it must when no in-network option exists. How often that has happened since September 1 has not been made public.
