Texas Medicaid ABA Spending Hit $153.5M. All 16 MCOs Say They Pay $14.50.

HHSC's Rider 30 report, posted September 2, shows ABA grew from under 3% of Texas Medicaid autism spending to more than half in three years. Every MCO attested it pays the September 2025 rate, and HHSC is checking encounter data.

Texas HHSC posted its Rider 30 report, Utilization of Medicaid Autism Services, on September 2. It covers ABA spending since the benefit began in February 2022, and it answers a question Texas providers have had since last September: did the managed care plans raise the rate the rider paid for?

On paper, yes. On January 29, 2026, HHSC sent an attestation form to all 16 MCOs. “All Medicaid MCOs returned completed forms attesting to their implementation of the increased reimbursement rates for ABA procedure codes by the September 1, 2025 effective date.”

The turn: HHSC hasn't checked the claims yet

The attestation is a signed statement, not a payment audit. HHSC says it “is also reviewing encounters data for fiscal year 2026 but the data is not complete.” Your remittances are the first real test of what the MCOs signed.

Rider 30 set 97153 at $14.50 per unit in both fee-for-service and managed care, up from $13.00. HHSC's July 2025 rate notice proposed matching increases of about 11.5% for 97151 (HO), 97155 (HN and HO) and 97156 (HN and HO), and the report says other ABA increases took effect the same day. 97154 and 97158 didn't change.

The spending curve

  • Fiscal 2023: 790 average monthly ABA clients, $26.7 million.
  • Fiscal 2025: 3,044 clients, $4,201.50 per client per month, $153.5 million.
  • ABA went from under 3% of autism service spending in fiscal 2022 to more than half in fiscal 2025, overtaking PT, OT and speech combined ($129.4 million).
  • HHSC says the per-client increase “is largely driven by increases in the average number of units utilized per client,” with the March 2024 rate change having “a small impact.”

The limits

Fiscal 2022 covers only February through August, so it isn't a fair baseline. HHSC declined to say whether utilization matches need. It estimates 105,726 Medicaid clients aged 2 to 20 would be expected to have autism and found 105,351 with an autism claim, but says “data limitations and other factors complicate a direct comparison.” The report makes no recommendation.

What you must know or do

  • Billers: pull remittances for 97153 from each MCO for dates of service since September 1, 2025 and confirm $14.50 per unit. Do the same for 97151, 97155 and 97156 against your fee schedule.
  • Escalate any shortfall to the MCO citing HHSC's January 29, 2026 attestation, which the report says every MCO signed.
  • Owners: know your own units per client per month. Units per client are the figure HHSC used to explain the cost increase.