The 2026 Squeeze: Why Independent ABA Practices Can’t Go It Alone Anymore

As the ABA and behavioral health landscape moves toward 2026, the pressure on providers is no longer theoretical. It’s structural—and it’s accelerating.

At the Behavioral Health Business Autism Investor Summit East, Jason Slocum, Managing Director of Sustainable Investing at Goldman Sachs Alternatives, delivered a clear message: smaller, founder-owned and BCBA-owned practices are approaching a point where operating independently may no longer be sustainable.

According to Slocum, expanding payer requirements, heightened compliance expectations, and growing technology demands are converging in ways that disproportionately impact small ABA practices. While all providers will feel these pressures, independent ABA practices and solo BCBAs are far more likely to reach a breaking point.

At Hi-5 ABA, this reality isn’t new. It’s exactly the environment we’ve been preparing for.

Complexity Is Becoming the Cost of Entry in ABA

Today’s ABA practice is no longer evaluated solely on clinical quality. Increasingly, payers and regulators expect providers to operate with enterprise-level rigor across multiple operational domains, including:

• Comprehensive documentation and data defensibility
• Ongoing ABA compliance and audit readiness
• Accurate ABA billing, coding, and credentialing
• Secure, scalable technology infrastructure

Individually, these requirements may seem manageable. Together, they create an operational load that many BCBA-owned practices were never designed to carry.

As Slocum noted, the cumulative weight of documentation standards, compliance audits, billing and coding audits, and required technology investments can become “too much to do on their own” for a single BCBA or small founder-led team.

This is not a reflection of poor leadership or weak clinical outcomes. It’s a structural mismatch between rising system expectations and the realities of small-scale practice management.

Why Consolidation Is No Longer a Strategic Choice

Consolidation in healthcare is often framed as a growth strategy. What’s changing now is what’s driving it.

Slocum pointed to payer-driven requirements as a force that may actively push consolidation—especially in smaller or underserved markets. When compliance standards, audit expectations, and reporting requirements outpace a practice’s administrative capacity, independence becomes increasingly fragile.

For many independent ABA practices, this means facing hard decisions:

• Absorbing growing administrative and financial risk
• Diverting clinical leaders into non-clinical roles
• Selling or merging earlier than planned—not for growth, but for survival

This shift may also give rise to new business models. But the message is clear: the era of “doing everything yourself” in ABA is ending.

A Different Model for Supporting BCBA-Owned Practices

At Hi-5 ABA, we believe consolidation does not have to mean loss of identity, loss of clinical autonomy, or loss of local leadership.

Our ABA franchise model was built specifically for BCBA-owned and founder-led practices facing increasing operational complexity. Rather than asking clinicians to become compliance officers, billing specialists, IT managers, and marketers, Hi-5 provides centralized, non-clinical administrative support—while preserving clinical independence.

This includes support across:

• ABA billing, coding, and credentialing
• Compliance management and audit readiness
• Practice management systems and technology infrastructure
• Bookkeeping, collections, and operational reporting
• Strategic marketing and growth support

The goal isn’t control. It’s sustainability.

Infrastructure Is the New Competitive Advantage in ABA

As 2026 approaches, what will separate sustainable ABA practices from those that struggle won’t be passion or expertise. It will be infrastructure.

Practices that thrive will be those with:

• Centralized ABA compliance and documentation systems
• Scalable billing and revenue cycle management
• Secure, compliant technology platforms
• Operational redundancy and administrative depth
• The ability to adapt quickly to payer and regulatory change

Hi-5 ABA exists to provide this foundation—so BCBAs can focus on care delivery, team leadership, and long-term impact instead of constant operational firefighting.

From Forced Consolidation to Strategic Partnership

The future described at the Autism Investor Summit doesn’t have to end in forced exits or burned-out founders.

For many BCBA-owned practices, it can be a transition into a more resilient operating model—one that combines clinical independence with the scale, compliance, and operational support required in today’s environment.

As payer expectations rise and regulatory pressure increases, the question facing independent ABA practices is no longer whether change is coming.

It’s whether they will face it alone—or with a partner built for what comes next.