Is Your State Fee-for-Service or Managed Care for ABA Medicaid?

Medicaid pays for ABA one of three ways, and which one applies in your state changes how you get paid. In a fee-for-service (FFS) state, the state Medicaid agency publishes one rate and pays it directly, so the fee schedule is the rate. In a managed care state, private health plans (MCOs) handle every ABA claim and each one negotiates its own contract rate, so there is no single number to look up. In a mixed or carve-out state, both paths exist at the same time, or ABA is administratively split out from the state’s broader managed care system and run separately. As of 2026, 15 states run ABA Medicaid as pure fee-for-service, 8 run it entirely through managed care with no FFS fallback, and 28 use some version of a hybrid or carve-out. Find your state in the table below to see which model applies, who the main payers are, and where the published rate actually comes from.

How to Read This Table

The Delivery model column tells you what kind of billing relationship you are walking into before you ever look at a dollar amount. “FFS” means one enrollment, one fee schedule, one payer. “Managed care” means there is no statewide FFS rate for ABA at all. Every dollar routes through a health plan, and your actual rate depends on the contract you sign with that plan, not a number published by the state. “Mixed / carve-out” covers two different situations that both function the same way in practice: states where FFS and MCO coverage exist side by side depending on which client you’re billing, and states where ABA is pulled out of the general Medicaid managed care system and handled by a separate carve-out administrator, like a behavioral health MCO or a regional authority, even though most other Medicaid services in that state run through ordinary health plans.

The Main MCOs (or FFS) column names the payers you would actually need to credential with. If a state says “FFS,” state enrollment is the only step. If it lists managed care organizations, plan on a separate credentialing and contracting process with each one, because state Medicaid enrollment alone will not get you paid for a client on that plan.

The Fee schedule source column links to the official document or portal each rate comes from: a state Medicaid agency’s fee schedule PDF, provider manual, or MMIS portal. In managed care states with no published FFS schedule, we’ve linked to the state’s official managed care organization page instead, since that’s the closest thing to an authoritative source when the real rate lives inside private MCO contracts.

Delivery models are not permanent. States move between them, usually during a procurement cycle or a budget year. Oklahoma launched SoonerSelect, a statewide shift to managed care, in April 2024. Idaho’s legislature passed House Bill 345 in 2025, requiring the Department of Health and Welfare to submit the federal waivers and state plan amendments needed for a shift to comprehensive Medicaid managed care no later than July 1, 2026. If you’re building a multi-year plan around a state’s delivery model, check for a pending procurement before you assume today’s structure holds.

What actually changes for your practice when a state shifts models: moving from FFS to managed care usually means more credentialing work (a separate contract per plan) and a rate that becomes negotiable rather than fixed, for better or worse. It also means prior authorization rules can vary by plan instead of following one state policy. Moving the other direction, toward FFS or a single carve-out administrator, simplifies your billing relationship to one set of rules, but it also removes any room to negotiate a better rate than what’s published.

The Federal Backdrop: CMS’s Managed Care Access Rule

The delivery-model split above is a state-level decision, but federal rules shape what managed care states are supposed to require of their MCOs. CMS’s 2024 Medicaid and CHIP Managed Care Access, Finance, and Quality rule set new access standards for state Medicaid managed care programs, including national maximum wait-time standards for routine appointments and a requirement that states publish an annual payment analysis comparing what their MCOs pay against Medicaid fee-for-service and Medicare rates for the same services. That payment-analysis requirement is directly relevant here: it’s the closest thing to an official mechanism for checking whether a managed care state’s negotiated ABA rates are actually competitive with a comparable FFS state’s published schedule.

As of mid-2025, that rule was one of several Biden-era Medicaid regulations under active consideration for repeal as part of federal budget reconciliation, according to KFF’s tracking of the issue (KFF, “Implications of Congress Eliminating Major Biden-Era Regulations for Medicaid”). We have not independently confirmed its current implementation status in every state. Before you assume a specific access or rate-transparency requirement is still in force, check your state Medicaid agency’s current managed care bulletins or your MCO’s provider manual.

ABA Medicaid Delivery Model by State

Bottom line: if your state shows “Managed care” or “Mixed / carve-out,” treat the published fee schedule as a reference point, not your actual rate. Your real number comes from the contract you sign with each MCO. If your state shows “FFS,” the schedule linked above is the rate, full stop.

Related Pages in This Series

This table is one piece of a larger series on ABA Medicaid reimbursement. See also:

• Medicaid ABA Reimbursement Rates by State: the full state-by-state rate hub, with the ranked 97153 table and methodology.
• The ABA CPT Code Family: 97151 Through 97158: what each code covers and how units work.
• ABA Medicaid Margin Benchmarks: Rate vs. Cost: what’s actually left after you deliver the unit.
• Medicaid vs. Commercial ABA Rates: how the Medicaid number compares to commercial payers.
• How to Negotiate a Better ABA Rate With a Medicaid MCO: if your state runs managed care or a hybrid model, this is where your real leverage is.

Frequently Asked Questions

Which states are pure fee-for-service for ABA Medicaid?

Fifteen states run ABA Medicaid as pure fee-for-service with no managed care organization involved: Alabama, Alaska, Colorado, Connecticut, Idaho, Maine, Maryland, Missouri, Montana, North Dakota, South Dakota, Utah, Vermont, Wisconsin, and Wyoming. In each of these, the state publishes one fee schedule and pays it directly. See the table above for each state’s current source document.

Which states have no fee-for-service option at all for ABA Medicaid?

Seven states route ABA Medicaid entirely through managed care organizations, with no statewide FFS rate to fall back on: Delaware, Kansas, Louisiana, Massachusetts, Nebraska, Pennsylvania, and Tennessee. In these states, your actual rate is whatever you negotiate with each MCO, since there’s no published state rate acting as a floor or benchmark.

Can a state switch between fee-for-service and managed care?

Yes, and it happens more often than most practice owners expect. Oklahoma moved most of its Medicaid population to managed care with the SoonerSelect launch in April 2024. Idaho’s legislature passed House Bill 345 in 2025, requiring the state to submit the federal filings needed for a shift to comprehensive Medicaid managed care no later than July 1, 2026. Check your state Medicaid agency’s procurement calendar if you’re planning more than a year or two ahead.

If my state uses managed care, do I still need to enroll with the state Medicaid agency?

Yes. State Medicaid enrollment is the first step in every state, including pure managed care states. It gives you a Medicaid provider ID and confirms you meet the state’s ABA credentialing requirements. But in a managed care or hybrid state, that enrollment alone does not get you paid. You still need a separate credentialing and contracting process with each MCO whose members you want to bill.

Does a managed care or carve-out state pay less than a fee-for-service state?

Not necessarily. There’s no consistent pattern where one delivery model pays systematically more or less than another. A managed care state’s negotiated rate can land above or below a comparable FFS state’s published number, depending on the specific MCO contract. Delivery model tells you how the money moves and who you have to credential with. It doesn’t by itself tell you the rate. For actual rate comparisons and margin math, see the margin benchmarks page linked above.

Where do the fee schedule sources in this table come from?

Every link in the Fee schedule source column points to an official state Medicaid agency document or portal: a published fee schedule PDF, a provider manual, or the state’s MMIS system. In the handful of managed care states with no statewide FFS schedule for ABA, we’ve linked to the state’s official page listing its Medicaid managed care organizations instead, since that’s the closest available authoritative source. This table is refreshed on the same monthly cadence as the state-by-state rate hub.