40 Hours Down to 10
On August 6, Alliance Health announced a contract with Cortica, a physician-led autism provider, to serve children with autism and other developmental differences in Raleigh and Charlotte. Alliance is a public managed care organization and North Carolina Medicaid Tailored Plan serving seven counties, including Wake, Durham, and Mecklenburg. It manages care for 464,000 Medicaid-eligible and uninsured people through a network of more than 4,000 private providers.
The press release lists three goals: improve quality, reduce “sole reliance on Applied Behavior Analysis,” and address costs that have climbed sharply over the past two years. Alliance says it is the first North Carolina Medicaid managed care plan to contract with Cortica.
A month later, Cortica CEO Neil Hattangadi spelled out the economics to Behavioral Health Business:
“If imagine 40 hours a week of ABA and no medical care, and then our model where that comes down to 10 hours a week, that 30-hour-a-week delta represents a lot of dollars.”
The same article puts average ABA hours in North Carolina Medicaid at about 32 a week.
Put those two numbers side by side and you can see what Alliance is testing. The plan wants to know whether a child who gets medical, developmental, and behavioral care in one place needs a fraction of the ABA hours the typical NC Medicaid client receives today.
What Alliance Actually Signed
The details matter, because the headline version (“MCO cuts ABA hours”) runs ahead of the facts.
It is a provider contract, not a coverage policy. Nothing in either announcement changes the hours Alliance will authorize for anyone else. Neither source says anything about the other ABA providers in Alliance’s network, and we won’t guess.
It is not a full value-based arrangement. Sean Schreiber, Alliance’s chief innovation and strategy officer, told Behavioral Health Business the deal is “not a full-blown value-based care arrangement” and is built so the terms can shift as results come in. Hattangadi didn’t share specific terms. He said Cortica has made commitments on speed to care, total cost of care, and fewer emergency room visits.
It took a while. The two organizations talked for about nine months before the announcement. Cortica says it is the company’s 15th partnership of this kind.
The model is multispecialty. Cortica’s care covers four areas: medical care, ABA, developmental therapy (speech, feeding, occupational), and family support, with progress tracked across all of them. Per Behavioral Health Business, its clinics also offer counseling, physical therapy, neurophysiology, genetics, gastroenterology, and nutrition. Its North Carolina clinics are in Cary and Charlotte.
Alliance is framing this as a different lever than enforcement. CEO Rob Robinson said Alliance “is not solely reliant on fraud, waste and abuse prevention to address spending concerns.”
Schreiber was open about where it could go: “I think over time there would be a good opportunity for the total cost of care, but I think we need to also see what they find with these members.”
That is a pilot, with a plan to scale if the data holds up.
Why North Carolina, Why Now
This deal lands in a state that has spent all of 2026 tightening ABA.
The numbers explain the pressure. Per NC DHHS figures reported by North Carolina Health News, state and federal Medicaid spending on ABA went from $1.9 million in 2020 to $505 million in fiscal year 2025, with 2026 projected to top $1 billion. Schreiber’s version: “Before we knew it, the spending was on a trajectory that really was not sustainable for us.”
The legislature has already acted. We covered the March oversight hearing and then HB 696, which Governor Stein signed April 30 as Session Law 2026-1. Its rewrite of Clinical Coverage Policy 8F took effect August 1. As first passed, HB 696 required plans above 16 hours a week to be reapproved every month. A July budget revision eased that to every three months, and NC Medicaid’s August 31 bulletin confirms that treatment plans above 16 hours per week must be reauthorized every three months.
Now compare that 16-hour line to the 32-hour average. The average NC Medicaid ABA client sits at twice the threshold. For a typical practice, a large share of the caseload now goes through a payer review four times a year.
Federal guidance points the same way. CMS’s August ABA toolkit, which we covered last month, lists excessive hours that continue without documented improvement as a red flag and tells states to require plan updates built on established outcome measures.
Alliance’s Cortica deal adds a benchmark to every one of those reviews. Until now, a reviewer mostly compared your request to your own history and to general guidelines. Now one plan has a contracted provider whose whole pitch is that the same child might need 10 hours when the medical side is handled.
What This Means for Your Authorization Renewals
This part is our analysis, not anything Alliance has announced.
Utilization managers read the same trade press you do. When one plan in the state is funding a model built on “fewer ABA hours once medical issues are treated,” expect reviewers at that plan, and at others watching, to start asking questions that used to be rare:
- Has this child had a medical workup? Sleep, GI problems, seizures, feeding issues, and medication effects all show up in behavior. If your treatment plan is silent on them, a reviewer can fairly ask whether the hours are compensating for something nobody has addressed.
- Why this many hours for this child? A request for 30 hours backed by a narrative that could describe any client is the easiest one to trim. We made this point in June about why payers cut hours: reviewers trim what they can’t tie to evidence.
- What changed since the last authorization? On a three-month cycle, “continued need” doesn’t hold up for long. Each renewal needs to show movement or explain why there wasn’t any.
- Is the plan stepping down? A plan that asks for the same hours quarter after quarter, with no fading criteria, reads as open-ended. A plan with a stated path to fewer hours reads as clinical.
None of this means lower hours are right for your clients. The dose-response research still supports intensive treatment for many young children with significant needs; we walked through it in Defending ABA Hours. The point is that the argument now has to be made on paper, every quarter, against a live counter-example in the same state.
How Independent Practices Compete
Most North Carolina ABA practices can’t open a neurology and GI clinic. You don’t need to. You need to show a reviewer that the things Cortica says it does in one building are happening around your client anyway, and that your hours hold up.
1. Coordinate with the child’s medical providers, and write it down. Get releases signed at intake for the pediatrician and any specialists. Ask the family about sleep, GI symptoms, feeding, seizures, and medications, and record their answers. When something looks medical, refer out and note the referral and the result in the chart. A treatment plan with a line like “GI referral made in May; constipation treated; self-injury during toileting down since” makes your case for you.
2. Measure outcomes on a schedule, not just when a renewal is due. Run standardized assessments at consistent intervals and pull goal-level mastery data into every renewal. If a reviewer is weighing your 30 hours against someone else’s 10, the only answer that works is evidence of progress at 30. We laid out what to track in From Growth to Proof.
3. Justify hours per child, in the child’s terms. Tie the requested dosage to specific deficits, the assessment results behind them, and the setting where treatment happens. Show variation across your caseload. If every client is authorized at 35 to 40 hours, that pattern invites scrutiny no matter how good each file looks.
4. Build fading criteria into every plan. Define what progress triggers a step-down. A practice that reduces hours when goals are met, and says so in the renewal, earns credibility for the requests where it doesn’t.
5. Keep utilization high on what you already have. A plan that authorized 30 hours and saw 20 delivered has already made the reviewer’s argument for them. Close the gaps from cancellations and staffing before the renewal, not in it.
6. Track the 16-hour caseload as its own workload. Every client above 16 hours has a reauthorization every three months. Know which ones are due in the next 45 days and start the packet early. A late renewal causes a service gap no matter how strong the clinical case is.
7. Talk to your plans before they talk to you. Alliance spent nine months on this deal. Plans are clearly interested in models that show cost and outcome data. If you already coordinate medical care and can produce caseload-level outcomes, that’s a conversation worth starting with your network contacts now, while terms are still being figured out.
Where Software Fits
The renewal packet described above pulls from four places: assessment scores, goal-level progress, delivered-versus-authorized hours, and notes on outside providers and referrals. Most practices keep those in different tools, which is why renewals get written from memory.
StreamABA keeps them together. Authorization tracking shows hours approved against hours delivered and flags exhaustion pace before it becomes a problem. Session data rolls up into goal-level progress that renewal requests can cite directly. Each client record can list the outside providers on the case (referring, treating, prescribing), so the coordination story lives in the chart instead of an inbox.
Software doesn’t make the clinical case. It keeps the evidence you already collect in one place, where you can find it for a quarterly review.
One Pilot, and a Warning
Alliance’s deal is one contract, with one provider, in two metro areas. It may not work as hoped. Schreiber himself said they need to see what Cortica finds.
But a North Carolina Medicaid plan has now put money behind the idea that the average child is getting more ABA than they would need with coordinated medical care. That idea will reach utilization reviews well before any results are published.
The practices that do well in North Carolina’s next renewal cycle will be the ones whose files already answer three questions: what the medical picture is, what the outcomes are, and why this child needs these hours.
Want help building a renewal packet that holds up to North Carolina’s three-month reviews? Reach out at [email protected].
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Sources
- Behavioral Health Business: North Carolina MCO Alliance Health Taps Cortica to Rein in Autism Spending, Improve Outcomes (September 8, 2026)
- Alliance Health: Ensuring Access to Quality, Cost-Effective Care for Children with Autism and Other Developmental Differences (August 6, 2026)
- PR Newswire: Alliance Health and Cortica Partner to Ensure Access to Quality, Cost-Effective Care for Children with Autism and Other Developmental Differences (August 6, 2026)
- NC Medicaid: Updated Reminder: Requirements for Research-Based Behavioral Health Treatment Service Delivery (August 31, 2026)
- North Carolina Health News: NC families fear losing access to autism therapy as new rules take effect (July 15, 2026)
- WUNC: Gov. Stein signs Medicaid funding bill despite concerns about some provisions (April 30, 2026)
