The request seemed modest at the time: could the family's ABA provider come in during the transition to kindergarten, just until the student settled? The superintendent loved the idea of the school having specialized help for the student without having to pay for it. Three years later, the provider is still there, staff plan around her schedule, and the student's day is built partly on her work. On June 1, 2026, Nebraska Medicaid issued Provider Bulletin 26-06, and its changes took effect on July 1. The bulletin doesn't undo that history, but it does change what the arrangement requires going forward.
Quick note: if you’re a superintendent, principal, or school board member and that introductory paragraph sounded like gibberish to you, maybe just forward this email to your special ed director. Read on if you love the sound we nerds make when we speak special ed to each other.
What the bulletin says
The bulletin makes two changes relevant to schools. First, Medicaid treats ABA services delivered in a school setting as part of school-based services reimbursement under NAC Title 471, Chapter 25 and the Medicaid State Plan. Independent ABA providers may not bill Medicaid directly for services delivered at a school. If ABA happens in your building and Medicaid pays for it, the school owns the billing pathway, and the services must meet Medicaid's updated ABA service definitions, also effective July 1.
Second, for dates of service on and after July 1, individuals receiving DD waiver services may receive ABA assessments (HCPCS codes 97151 and 97152) regardless of age, and for waiver recipients only, providers may recommend and use those assessments for non-ABA purposes.
School plan requirement
Medicaid's service definitions have long required a school plan for ABA therapy in any educational setting, public or private: setting-specific target behaviors, behavior reduction goals focused on academic engagement, and a time-limited approach with a clear transition shifting instructional control to school staff. What the updated definitions now make explicit is the piece that matters most to administrators: the Individualized Treatment, Rehabilitation, and Recovery Plan must include a separate school plan within the student's IEP for Medicaid reimbursement. One piece of good news here: daycare and after-school settings remain exempt from these requirements.
FAPE runs through the IEP, not through Medicaid
Medicaid billing rules and IDEA obligations operate on separate tracks. FAPE means the services the IEP team determines the student needs to make appropriate progress; Medicaid is a funding mechanism that neither adds to nor subtracts from what the IEP must contain. When the bulletin says schools are "responsible" for ABA services in school settings, read that as a statement about billing responsibility. It does not declare that every district must provide ABA or that ABA is a required related service for any particular student.
The harder question: you already let a private provider in
Many districts have permitted privately-retained or Medicaid-funded ABA providers to work with students on campus. Does that access concede that ABA is necessary for FAPE? Generally, no… but possibly yes. Access is not an admission, and allowing a parent-arranged provider into your building as a courtesy does not by itself establish that ABA is educationally necessary. But candidly, untangling whether a student's progress stems from ABA services in the school setting or from the numerous other interventions your district uses can prove difficult.
Additionally, how you've handled that access can create exposure. If the provider's services appear in the IEP, PWN, or meeting minutes, or if staff have built the student's daily programming around the provider, a parent can argue the district itself treated ABA as necessary, making the provider's removal look like a unilateral reduction in services. It also means that if the family’s health insurance or Medicaid eligibility cease, they will have a good argument that the school now must pay, because you tacitly admitted that ABA was necessary for FAPE by allowing the provider into the building at all.
Going forward, route any parent request for a parent-selected ABA provider through the IEP team, which decides whether ABA services are necessary for FAPE. Even where the team determines they are, IDEA generally leaves personnel decisions to the district: the school chooses who delivers the services. Expect parents to argue that since Medicaid recognizes only the school for school-based ABA billing, the school must now provide the services. That conflates billing with entitlement, but it still must be addressed through the IEP process, with the team's reasoning documented.
The throughline in all of this: don't make the decision based on the service, make it based on the kid. We can't forget the 'I' in IEP stands for individualized, and therefore the IEP team should consider the information. These situations rarely announce themselves until they're already problems, so if something in this post feels familiar, reach us at ksb@ksbschoollaw.com.