What HB 696 Means for North Carolina Families Seeking ABA Therapy?
HB 696 does not create an automatic, across-the-board end to North Carolina Medicaid coverage of ABA therapy. Your child’s specific services and hours still go through the same medical-necessity review and authorization as before — now on an updated schedule. The best step is to ask your provider and your child’s Medicaid health plan how the new rules apply to your child’s next authorization.
The updated policy took effect August 1, 2026. Here’s what changed, in plain language, and what it means for your family.
What is HB 696?
HB 696 is a North Carolina law (Session Law 2026-1) signed in April 2026. It addressed the state’s Medicaid budget and directed changes to how Medicaid manages ABA therapy for children with autism.
In Medicaid, ABA falls under a benefit called RB-BHT (Research-Based Behavioral Health Treatment), and the detailed rules live in a coverage policy known as CCP-8F. NC Medicaid published the updated CCP-8F with an effective date of August 1, 2026.
Why did North Carolina make these changes?
The state made these changes because spending on the benefit grew very quickly, and it wants to keep the program sustainable while protecting access. According to data NC DHHS presented to state lawmakers in March 2026, Medicaid spending on this benefit rose sharply.
Total RB-BHT medical spending grew from $121.7M in 2022 to $544.4M in 2025 — about a 4.5× increase — with the state projecting it will pass $1 billion by 2027. Source: NC DHHS presentation to the Joint Legislative Oversight Committee on Medicaid, March 10, 2026. Figures approximate; 2026 and 2027 are projections.
| State Fiscal Year | Spending | Type |
|---|---|---|
| 2022 | $121.7M | Actual |
| 2023 | $199.4M | Actual |
| 2024 | $329.4M | Actual |
| 2025 | $544.4M | Actual |
| 2026 | $842.8M | Projected |
| 2027 | $1,141.1M | Projected |
The state has said its goal is to improve quality and oversight while preserving access to medically necessary care. That’s the balance the new rules are meant to strike.
What’s actually changing for families?
🔶 More frequent reviews for higher-intensity plans. Treatment plans of more than 16 hours per week are reviewed and reauthorized at least every 90 days. Plans of 16 hours or fewer per week continue on a 180-day cycle.
🔶 More detailed treatment plans. Plans now include clearer goals, a service schedule, a titration plan (how hours are gradually adjusted as your child progresses), and a crisis-management plan.
🔶 More built-in caregiver involvement. The plan must include caregiver goals and at least six caregiver training sessions per authorization period (the window your health plan approves services for).
🔶 Staff credentialing. Behavior technicians must earn a national behavior-technician certification (RBT or ABAT) within 120 days of hire to keep delivering billable services.
🔶 Telehealth limits. Certain services now have caps on how much can be delivered by telehealth.
For most families, the most visible change is that your child’s plan is reviewed more often and that you’ll be more actively involved through caregiver training.
Will my child lose access to ABA therapy?
There is no blanket end to ABA coverage under HB 696. For children under 21, a federal Medicaid rule called EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) requires the state to cover medically necessary care for a child’s condition.
That said, every child’s services still depend on their own authorization and medical-necessity review, so continuity is not automatic. Confirm your child’s next authorization date and documentation with your provider and Medicaid health plan. If you’re choosing a provider, ask how they’ve prepared for the new documentation and credentialing requirements — readiness varies from practice to practice.
What should families do now?
1️⃣ Ask your provider or Medicaid health plan whether any records need updating before your next authorization. Don’t schedule a new diagnostic evaluation solely because of this article.
2️⃣ Confirm your child’s next authorization date and what documentation the plan will need.
3️⃣ Expect to be more involved — caregiver goals and training are now part of the plan.
4️⃣ Don’t assume services will automatically stop. This changes how care is authorized and reviewed, not whether the benefit exists — confirm the specifics for your child.
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Questions About the Next Steps?
Current AutismCOE families: contact your treatment team with questions about upcoming authorizations or documentation. Contact Us: (800) 557-6330
Families considering AutismCOE: our intake team can walk you through insurance verification, current availability, and getting started. Availability varies by location and clinical fit.
Frequently Asked Questions & Answer
Will my child lose ABA therapy because of HB 696?
HB 696 does not create an automatic, across-the-board end to NC Medicaid coverage of ABA therapy. Your child’s specific services and hours still go through medical-necessity review, authorization, and your Medicaid health plan. Ask your provider and health plan how the rules apply to your child’s next authorization.
When did the new rules take effect?
The updated coverage policy (CCP-8F) took effect August 1, 2026.
How often will my child's plan be reviewed now?
Treatment plans of more than 16 hours per week are reviewed and reauthorized at least every 90 days. Plans of 16 hours or fewer per week continue on a 180-day cycle.
Does this reduce my child's therapy hours?
There is no blanket cut to hours. Hours must match your child’s assessed needs, and the policy bars providers from using default hours or requiring a minimum number of hours to access care. Your child’s approved hours are set through their own authorization.
Does HB 696 affect private insurance, or only Medicaid?
These changes apply to North Carolina Medicaid. ABA covered by private or commercial insurance is not governed by this policy, though commercial plans have their own review processes.
Will I need to be more involved in my child's therapy?
Yes. The updated policy requires caregiver goals in the treatment plan and at least six caregiver training sessions per authorization period — designed to help you reinforce progress at home.
Sources: NC Medicaid Clinical Coverage Policy 8F (RB-BHT for ASD), amended effective August 1, 2026; House Bill 696 / Session Law 2026-1; NC DHHS “Update on Autism Benefits,” Joint Legislative Oversight Committee on Medicaid, March 10, 2026.
This article is general information, not legal or medical advice. Your child’s coverage and authorization may differ. For guidance about your child’s services, contact your ABA provider and your child’s Medicaid health plan.
Last reviewed August 1, 2026. We will update this article if NC Medicaid issues additional implementation guidance.
Please Note: The content of this blog is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Consult a qualified healthcare professional for personalized guidance tailored to your specific situation.
Esha Bhasin
Esha Bhasin is the award-winning CEO & Founder of Autism Center of Excellence (AutismCOE). She was honored with the 2026 Triangle Business Journal Corporate Leadership Award. Before founding AutismCOE, she spent over nine years as a Senior Consultant at KPMG US. She specialized in Medicaid and State Public Health. Inspired by her own family's autism journey, she founded AutismCOE to improve access to quality autism care. Esha writes about autism care, Medicaid policy, and healthcare operations.
