Best States to Open an ABA Clinic in 2026, Ranked by Medicaid Rate

The best states to open an ABA clinic, judged by what Medicaid pays for the core service, are Alaska, Georgia and Iowa. Alaska ranks 1st of the 41 states compared, paying $31.95 per 15 minutes ($127.80 an hour) for one-on-one ABA therapy by a technician. Georgia ranks 2nd at $30.91 ($123.64 an hour), and Iowa ranks 3rd at $28.59 ($114.36 an hour). All three pay more than 80% above the national median of $63.44 an hour.

A high rate is a starting point, not a verdict. This guide ranks states on the Medicaid rate for code 97153, sets each rate against the local median technician wage, and shows whether managed-care plans in that state are bound by the published figure. Licensing, staffing, payer mix and local competition are just as important to a location decision, and you will need to research those yourself.

The table ranks the ten states that pay the most for one-on-one ABA therapy by a technician. Margin per hour is the hourly rate minus the median technician wage after employer costs such as payroll taxes and benefits.

Two things stand out. The top four are well clear of the field: after the District of Columbia at $110.00 an hour, the next state, Virginia, drops to $93.92. And rank and margin do not move together. North Carolina ranks 9th but keeps more per hour than Maryland or Wisconsin, because its technician wage is lower.

Alaska Medicaid pays $31.95 per 15 minutes for one-on-one ABA therapy by a technician, or $127.80 an hour. That ranks 1st of the 41 states compared and sits 101.5% above the national median, the only state to more than double it.

The median technician wage in Alaska is $22.77 an hour, which takes 25.3% of the rate. After a loaded wage, the margin is $95.44 an hour. That is gross room to pay for supervising analysts, clinic space, billing and the hours a technician spends unbilled.

We have no managed-care rule on file for ABA in Alaska, so ask the state how ABA claims are paid before you build a budget around the fee schedule. A high rate only pays off if there are enough families to serve, and only local research will tell you how many you can realistically reach.

See the full breakdown on Alaska ABA Medicaid rates.

Georgia pays $30.91 per 15 minutes, or $123.64 an hour, for one-on-one ABA. It ranks 2nd of the 41 states compared and is 94.9% above the national median.

Georgia's distinctive feature is its wage picture. The median technician wage is $18.98 an hour, only 21.8% of the rate, the lowest share in the top 10. That leaves a margin of $96.66 an hour after a loaded wage, slightly more than Alaska despite Alaska's higher rate.

The caveat is managed care. In Georgia, plans negotiate their own ABA rates, and the published rate applies out of network. If most of your families are enrolled in a plan, your contract with that plan, not the fee schedule, sets what you are paid. Use the published rate as your anchor in negotiation and as the floor you know you can collect out of network.

Compare the codes on the Georgia ABA rates page.

Iowa pays $28.59 per 15 minutes, or $114.36 an hour, ranking 3rd of the 41 states compared and 80.3% above the national median.

The median technician wage in Iowa is $20.42 an hour, 25.4% of the rate, leaving a margin of $85.34 an hour after a loaded wage.

What separates Iowa from the other leaders is its managed-care rule: plans must pay at least the published rate. For a new clinic that is valuable. It means the high fee schedule rate is a floor in plan contracts rather than an opening bid, which makes revenue easier to forecast before you have negotiating leverage. Of the top three states, Iowa is the one where the published number is most likely to be the number you actually receive.

Details, including analyst and assessment codes, are on the Iowa ABA Medicaid rates page.

The District of Columbia pays $27.50 per 15 minutes, or $110.00 an hour, ranking 4th of the 41 states compared and 73.4% above the national median.

The difference here is cost. The median technician wage is $28.59 an hour, the highest in the top 10, and it takes 36.9% of the rate. The margin after a loaded wage is $69.37 an hour, well below the three states ranked above it even though the rate gap is smaller.

We have no managed-care rule on file for ABA in the District, so check how claims for children in plans are paid. The questions to research are how many ABA providers already operate there, how hard it is to hire and keep technicians at local wages, and how much of your caseload would be Medicaid versus commercial insurance.

See the District of Columbia ABA rates.

Virginia pays $23.48 per 15 minutes, or $93.92 an hour, ranking 5th of the 41 states compared and 48.0% above the national median.

The median technician wage is $20.89 an hour, 31.6% of the rate, leaving $64.23 an hour after a loaded wage. That is a meaningful step down from the top four, but still a healthy cushion compared with most of the country.

As in Georgia, Virginia's plans negotiate their own rates and the published rate applies out of network. Virginia's technician wage is close to Iowa's, so the gap in margin between the two comes almost entirely from the rate. For a clinic that can win plan contracts at or above the published rate, Virginia offers solid economics on the technician hour at a lower wage than the District of Columbia.

Read more on Virginia ABA Medicaid rates.

South Dakota pays $21.73 per 15 minutes, or $86.92 an hour, ranking 6th of the 41 states compared and 37.0% above the national median.

Its median technician wage is $18.44 an hour, the lowest in the top 10, at 30.2% of the rate. The margin after a loaded wage is $60.71 an hour.

We have no managed-care rule on file for ABA in South Dakota. For an operator weighing South Dakota, the open questions are local ones: where families are located, how far technicians would travel for in-home sessions, and whether you can recruit and credential enough staff.

See the South Dakota ABA rates page.

At the bottom of the ranking, the technician wage eats most of the rate. New York pays $9.63 per 15 minutes, or $38.52 an hour, ranking 41st of the 41 states compared and 39.3% below the national median. With a technician median of $22.69 an hour, the wage takes 83.7% of the rate and the margin after a loaded wage is $6.27 an hour.

Alabama and Louisiana each pay $10.00 per 15 minutes ($40.00 an hour), 36.9% below the median. Their wages are lower, so margins land at $15.51 and $15.55 an hour. Louisiana requires plans to pay at least the published rate, which at this level is a low floor.

North Dakota pays $10.81 ($43.24 an hour), New Jersey $11.20 ($44.80 an hour) and Montana $11.36 ($45.44 an hour). New Jersey and North Dakota both see the wage take more than 73% of the rate.

A low rate does not make a state impossible, but a clinic there depends far more on commercial insurance and on tight control of unbilled time.

States are ordered by their Medicaid rate for one-on-one ABA therapy by a technician, ranked among the 41 states compared. Rates are converted to a per-hour figure so a 15-minute unit and an hourly unit can be compared directly.

Worker wages are median hourly wages from Bureau of Labor Statistics data for the closest comparable occupation, where available. The margin figure takes the hourly rate and subtracts that wage after employer costs. It is a gross margin, not profit.

All rates are compiled from official state Medicaid publications, and each one on the site links to the source document it came from. See the full methodology for how units and provider levels are matched.

A high Medicaid rate tells you that each billable technician hour brings in more revenue. It does not tell you how many hours you can bill, how many families need services, or what your other costs will be.

The margin figure helps, but it stops at the technician's wage. It does not cover analyst supervision, cancellations, drive time, clinic rent, billing staff or the time it takes to get authorizations approved. A state with a slightly lower rate but faster authorizations can beat a higher-rate state on cash flow.

Payer mix matters as much as the rate. If most of your families are commercially insured, Medicaid rates set the floor of your revenue, not the average. Before choosing a state, research:

• licensing and credentialing requirements for clinics and staff;
• how easy it is to hire and keep technicians and analysts;
• the local mix of Medicaid, commercial and self-pay families;
• how many ABA providers already serve the area.

In many states, children on Medicaid are enrolled in managed-care plans, and the plan, not the state, pays the claim. Whether the published rate binds those plans changes how much weight to put on the ranking.

• Plans must pay at least the published rate (Iowa, Louisiana): the fee schedule is a floor. Strong for Iowa, a low floor for Louisiana.
• Plans negotiate; the published rate applies out of network (Georgia, Virginia, North Carolina, Minnesota, Nebraska): your plan contract sets the rate. The published figure is your negotiating anchor.
• Paid directly by the state, outside managed care (Maryland, Wisconsin, Utah): the published rate is what you are paid.

Where no rule is on file, as in Alaska, the District of Columbia and South Dakota, ask the state how claims are paid before you rely on the fee schedule.

One-on-one technician time is the core of most ABA revenue, but a clinic bills other codes too, and the rankings differ for each. National medians across ranked states:

• ABA therapy with plan changes by an analyst (97155): $101.04 an hour.
• ABA assessment by a behavior analyst (97151): $116.56 an hour.
• ABA assessment support by a technician (97152): $77.04 an hour.

A state that ranks modestly on technician hours can rank highly on analyst work, so model your expected mix of codes rather than relying on one rate.

Start with the ABA Medicaid rates by state hub to compare every ABA code across all states. Then open the state pages for your shortlist, such as Alaska, Georgia, Iowa and Virginia, to see every rate with its source and effective date.

If you are building a pro forma or preparing for plan contracting, pricing covers full access to rates and exports. The methodology page explains how rates are matched and converted.