Quick answer. We tracked 15 active US ABA therapy and autism-services PE platforms in 2024 to 2026 across three sub-segments (center-based ABA, in-home ABA, school-based and diagnostic ABA), plus one notable PE-free outlier (ABA Centers of America) that competes head-on with the sponsored cohort. Three top-line findings reset most published roll-up commentary. First, many widely-cited sponsor attributions in commercial trade press are wrong. Centria Autism is held by Thomas H. Lee Partners, not TT Capital. Action Behavior Centers is owned by Charlesbank Capital Partners, not TPG. Acorn Health is held by Ontario Teachers’ Pension Plan Board, not MBF or Athyrium. Proud Moments ABA is owned by Nautic Partners since February 3, 2025, not Audax. Behavioral Innovations is held by Tenex Capital Management since June 6, 2024, not Shore Capital. Second, the June 2023 CARD Chapter 11 (Center for Autism and Related Disorders) is still the structural watershed of the sector, and the founder-controlled rebuild led by Pantogran competes against PE-backed peers on a meaningfully different cost structure. Third, state-by-state Medicaid reimbursement cuts (New York 97153 falling from $16.85 to $14.45 per unit between October 2025 and April 2026; Indiana stepping down from $17.06 to $15.39 by 2027) are compressing margins faster than the HHS-OIG audit overhang of roughly $200 million in improper-payment findings across four states. Last verified: June 16, 2026.
This tracker is built on a five-tier source hierarchy. Tier 1 covers sponsor press releases, target-company announcements, and Federal-Register or Federal-court filings (the CARD bankruptcy docket at Case 4:23-bk-90709, S.D. Texas sits in this tier, as does the August 4, 2022 Federal Register extension of the Comprehensive Autism Care Demonstration). Tier 2 uses SEC EDGAR filings for sponsor funds that disclose ABA platform holdings in Form ADV brochures, registered fund holdings, or 10-K segment notes. Tier 3 uses sponsor portfolio pages directly (e.g. the Charlesbank Action Behavior Centers page; the Arsenal Capital Hopebridge release; the Five Arrows Stepping Stones Group page). Tier 4 uses workforce, prevalence, and code-enforcement data published by the BACB Certificant Data series, the CDC ADDM Network, and the Council of Autism Service Providers (CASP) anonymized industry dataset partnership announced with CentralReach in December 2024. Tier 5 uses trade press (Behavioral Health Business, Mertz Taggart quarterly reports, the Braff Group autism report, Acuity News, and the Brown University School of Public Health PE-acquisition study via JAMA Pediatrics).
The verification window is January 1, 2024 to June 16, 2026. A platform was included if (i) at least one PE sponsor was named in a Tier 1, 2, or 3 source within the window, (ii) the platform operated in the United States in at least one of center-based, in-home, school-based, or diagnostic ABA settings, and (iii) the platform was not so small that it operated as a single-location practice. We retained ABA Centers of America despite its PE-free status because it competes head-to-head with sponsored platforms and its absence would distort growth-cohort framing. Where current sponsor identity is not confirmable from primary sources within the window, the platform is tagged GAP and not paper-claimed.
Sponsor-misattribution risk is high in this sector. Several commercial trade publications and aggregator pages carry sponsor labels that are out of date by one or more transaction cycles. The corrections in this tracker (Centria, Action Behavior Centers, Acorn Health, Proud Moments, Behavioral Innovations) are anchored to sponsor press releases or directly-named portfolio pages dated within the verification window. Where Behavioral Health Business or Acuity News reporting conflicts with a sponsor’s own published portfolio page, the sponsor’s portfolio page wins.
Adjacent behavioral health and substance use disorder M&A activity is covered in the sibling tracker at /guides/behavioral-health-pe-rollup-tracker-2026/. Home-health PE roll-up activity is covered at /guides/home-health-pe-rollup-tracker-2026/. This ABA tracker focuses exclusively on ABA therapy and autism services platforms, with school-based ABA included to the extent it sits inside a multi-segment platform.
The ABA roll-up thesis rests on four pillars: rising autism prevalence, near-universal insurance coverage, a federal pillar through TRICARE and Medicaid EPSDT, and a structural workforce shortage that protects scale players against price competition.
On April 15, 2025 the CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network reported that 1 in 31 (3.2%) eight-year-old children in the United States were identified with autism spectrum disorder (ASD) in 2022 surveillance, up from 1 in 36 in the 2020 survey (CDC Autism Data and Research; CDC ADDM factsheet). State-level dispersion runs from 1 in 103 (Laredo, Texas site) to 1 in 19 (California ADDM site, 5.3%) per the CDC prevalence variance summary. HHS, in its April 15, 2025 press release, framed the figure as an autism epidemic; that framing is politically loaded but the underlying ADDM prevalence series is HIGH-confidence. ASD identification rose from 2.3 per 1,000 children in 2011 to 6.3 per 1,000 in 2022, roughly tripling in eleven years per the Brown University School of Public Health summary. [HIGH]
The Behavior Analyst Certification Board (BACB) reported 317,699 certificants worldwide as of October 1, 2025 across all credential types per the BACB Certificant Data page. The approximate US-active breakdown reported by BACB in late 2024 is roughly 74,000 BCBAs, 5,400 BCaBAs, and 196,000 RBTs per the BACB Annual Data Report. Industry-aggregator framing for 2024 was “200,000+ RBTs and 60,000+ BCBAs” actively credentialed per the Global Market Insights US ABA market report. [HIGH for orders of magnitude; MEDIUM for the precise count because BACB’s quarterly counts move]
All 50 states and DC have enacted commercial insurance mandates requiring ABA coverage to varying degrees per the Autism Speaks state-regulated health benefit plans map. Texas became the 50th state to begin funding ABA through Medicaid in 2022 per Disability Scoop’s February 14, 2022 report; Medicaid now covers ABA in all 50 states as of 2022 per the CentralReach EPSDT guide. The federal Medicaid floor is set by the July 2014 CMS Center for Medicaid and CHIP Services bulletin instructing state programs to cover medically necessary autism diagnostic and treatment services under EPSDT (Medicaid.gov Autism Services). [HIGH]
The TRICARE Comprehensive Autism Care Demonstration (ACD) was extended through December 31, 2028 by the August 4, 2022 Federal Register notice and the program is summarized at TRICARE.mil. In September 2024 the National Academy of Sciences concluded ABA is clinically effective and recommended discontinuing the ACD in favor of authorizing ABA as a TRICARE basic benefit (MOAA coverage; BHB September 25, 2025). [HIGH]
The US Applied Behavior Analysis market was sized at USD 4 billion in 2023, projected at roughly 4.8% CAGR through 2032 per Global Market Insights. That estimate is a private syndicated number, not a CMS or CDC series, and should be treated as MEDIUM confidence. We treat the sector growth story as “sub-$1 billion in the early 2010s to a $10 billion-plus market today” as a directional framing, anchored to the syndicated number and confirmed by the consolidation cadence visible in the deal-flow timeline below.
The other macro pillar that draws PE capital is workforce-shortage pricing power. Job postings requesting BCBA certification reached 132,307 in 2025, up 28% from 103,150 in 2024 per Research.com. Job postings for BCBA graduates increased 58% YoY in 2024; demand grew 1,942% between 2010 and 2018 per the applied behavior analysis education guide. The BLS-category employment projection for counselor and specialist work covering ABA is 17% growth 2024 to 2034. That demand profile, set against a 74,000-BCBA national roster and the nearly half of US counties with zero BCBAs, is the structural reason ABA pricing has held up even under state rate-cut pressure. The platforms with multi-state BCBA license rosters built before the 2025 to 2026 cycle hold pricing power that telehealth-only entrants cannot replicate without years of state-by-state licensure build-out. [MEDIUM]
Council of Autism Service Providers (CASP), founded in 2016, is the non-profit trade association of 350+ autism service-provider organizations across all 50 states and multiple countries per the December 16, 2024 CASP and CentralReach partnership announcement (Globe Newswire). The partnership uses anonymized industry data to inform payor network-adequacy filings, the first nationwide attempt to evidence provider scarcity by region. Once the published aggregate is released, it will likely supplant Global Market Insights as the sector-spend authority. [HIGH]
Sibling healthcare tracker: ABA and ortho share specialty-MSO patterns but diverge sharply on procedural intensity and ASC ownership. See the 2026 Orthopedic PE Roll-Up Tracker.
Sibling healthcare tracker: ABA and GI share the procedural-specialty roll-up pattern but diverge sharply on payor mix and the friendly-PC-MSO structural attack (Oregon SB 951, California 2025 CPOM). See the 2026 Gastroenterology PE Roll-Up Tracker.
Sibling healthcare tracker: ABA and ophthalmology share the workforce-bottleneck pattern but diverge on demographic tailwinds (1-in-31 ABA vs Berkowitz 30% inadequacy by 2035 for ophth). See the 2026 Ophthalmology PE Roll-Up Tracker.
Sibling healthcare tracker: ABA and outpatient PT share the workforce-bottleneck pattern (no interstate compact for BCBA, PT Compact at 34 states) but diverge on payor and federal posture. 18-platform PT sponsor map in the 2026 Physical Therapy PE Roll-Up Tracker.
The Center for Autism and Related Disorders (CARD), Blackstone-held since 2018, filed Chapter 11 on June 11, 2023 under Case 4:23-bk-90709 in the Southern District of Texas. Pre-bankruptcy trailing twelve-month financials disclosed in court filings showed $160 million revenue, $22 million adjusted loss, $82 million net loss, and $144 million operating expense including bad debt (BHB, June 12, 2023; NBC News investigation). CARD exited 10-plus states in 2022 prior to the filing per the CEPR Pocketing Money Meant for Kids report. [HIGH]
On July 27, 2023 the bankruptcy court approved a three-way sale at $48.5 million total transaction value (Globe Newswire court-approval release; BHB sale coverage):
The structural lesson is two-fold. First, the implied $37.4 million Pantogran cost across 10 state markets translates to an effective center cost below $400,000, and the Skills Global IP returned to founder control. Second, the headline reason CARD failed was not lack of demand. Demand sat at a 1-in-36 prevalence rate at filing and rose to 1-in-31 by April 2025. CARD failed on supervisor-to-RBT ratio compression, Medicaid mix drift, and post-COVID staffing economics. That set of operating risks still sits inside every PE-owned ABA platform, and every diligence model written in 2026 has been re-priced to reflect it. [HIGH]
The CARD watershed is why our tracker treats six-plus-year holds (Centria since December 2019, Hopebridge since May 2019, BlueSprig since 2018, LEARN since 2019) as exit-likely rather than as static positions. The 2018 to 2021 entry vintage is now eight years deep at the BlueSprig end, and most of these sponsors are at or beyond fund-life patience. The CARD outcome also re-frames the underwriting question. The deal that broke was not a small, founder-rich practice. It was the prototypical PE-scaled, multi-state, Medicaid-anchored platform.
Three operating lessons from the CARD post-mortem now appear in every PE buyer’s diligence template. First, geographic over-reach without local BCBA recruiting infrastructure compresses operating margin faster than scale revenue grows. CARD operated in dozens of states pre-bankruptcy, but its supervisor recruiting model never matched its center expansion pace. The platforms that have grown without breaking (Action Behavior Centers, with its 9-state concentration and de-novo regional density model, and Caravel, with its Wisconsin-Minnesota-Iowa-Illinois Midwest concentration) explicitly do not over-stretch the BCBA roster. Second, Medicaid mix above 80% on the revenue line is a structural ceiling on platform multiples. CARD’s Medicaid concentration left it exposed to the same rate-cut wedge that NY and Indiana are now applying to the broader sector. Third, founder departure timing is non-trivial. Doreen Granpeesheh exited operations several years before the bankruptcy; her return through Pantogran reads as evidence that founder-led ABA can rebuild post-PE when the operator concentration model is rebuilt around the clinical IP.
The competitive vector Pantogran represents is mispriced in trade-press coverage. With CARD’s Skills Global longitudinal clinical database back in founder hands and 10 state markets acquired at an effective cost under $400,000 per center, Pantogran is not a small regional re-launcher; it is a national-scale operator with rebuilt economics and structurally lower capital costs than the PE-sponsored cohort. PE buyers underwriting a hold thesis on BlueSprig, Centria, or Hopebridge for a 2026 to 2028 exit need to model Pantogran’s pricing in the regional markets where Pantogran operates. The competitive overlap is not theoretical. Pantogran’s 10 state markets include several of the same urban metros where BlueSprig and Centria carry meaningful center counts.
The capital-markets afterimage of CARD also matters. NBC News’s national-network coverage of CARD’s filing (NBC News investigation) and the CEPR Pocketing Money Meant for Kids report framed the failure as a story about PE consolidation in children’s healthcare. The political downstream effect has been increased state attorney general scrutiny of ABA platform billing practices and decreased political appetite for state Medicaid rate increases. The 2024 to 2026 state rate cuts read in part as a direct consequence of the CARD-era political narrative. [HIGH]
The single most material 2025-2026 valuation event for PE-owned ABA platforms is the cascade of state Medicaid rate cuts. The cuts hit 97153 (the RBT-delivered direct-treatment unit) hardest because 97153 carries the largest billable-hour volume on every ABA P&L.
New York. Effective October 1, 2025 the 97153 rate was set at $16.85 per 15-minute unit. Effective April 1, 2026 the rate falls to $14.45 per unit, a 14.2% compression in six months (NY State Medicaid Update, August 2025, Vol 41 No 8). [HIGH]
Indiana. The 97153 rate falls from $17.06 to $16.04 in 2026, then to $15.39 in 2027 (a roughly 9.8% compression over two years). The 97155 (BCBA-level protocol modification) rate falls from $27.63 to $25.97 in 2026 and $24.93 in 2027 (Acuity News bulletin BT202627). [HIGH]
Massachusetts. The MassHealth ABA mandate took effect January 2025; MassHealth-contracting entities must hold ABA accreditation by January 1, 2027 per BHB’s State Issues to Watch series, March 3, 2025. The accreditation requirement is a meaningful entry barrier and a meaningful CapEx and compliance cost for incumbents. [HIGH]
New Hampshire. A proposed alteration of 97155 telehealth coverage was floated from July 2025 per Aloha ABA’s 2025 CPT-code guide. [MEDIUM]
A national Coding Coalition formed in 2026 to push back against state-level restrictions on concurrent billing of 97153 and 97155 (the BCBA supervising while an RBT delivers direct treatment), per Acuity News. Concurrent billing is the central economic mechanism of the supervisor-driven ABA business model; restrictions on it would compress operator margin by a multiple of what straight 97153 rate cuts do. [HIGH]
The composite picture: PE platforms underwriting toward a multi-state rate stability assumption in their 2022-2023 entry models are now operating against a 7% to 14% rate-cut wedge in their largest revenue states. The valuation translation, given that ABA platforms typically run at 8% to 15% EBITDA margins on Medicaid-anchored books, is a 30% to 50% EBITDA-haircut sensitivity to a 10% top-line rate cut at the state level. That is the deal economics every QofE is now being asked to model.
CPT code architecture. The cuts target specific codes. ABA billing in 2026 runs on four primary codes per the Aloha ABA CPT-code guide: 97153 (adaptive behavior treatment by protocol, delivered by RBT under supervision, 15-minute unit), 97155 (adaptive behavior treatment with protocol modification, BCBA-level, 15-minute unit), 97156 (family adaptive behavior treatment guidance), and 97158 (group adaptive behavior treatment by protocol). 97153 is the largest billable-hour line on every ABA P&L because RBT-delivered direct treatment is the volume-dominant service. 97155 is the supervision overlay that establishes the medical necessity and ongoing protocol adjustment. Concurrent billing of 97153 and 97155 (the BCBA supervising while an RBT delivers direct treatment) is the central economic mechanism of the supervisor-driven business model; the national Coding Coalition’s 2026 push against state-level concurrent-billing restrictions reflects how material the practice is to platform margins. [HIGH]
State-by-state translation for PE platform exposure. For each of the major sponsored platforms in Section 8, the state revenue concentration determines the rate-cut wedge:
The Medicaid HCBS 80/20 final rule. An important non-event for ABA. The Polsinelli analysis of the Ensuring Access to Medicaid Services final rule, finalized April 22, 2024, confirms the 80/20 direct-care-worker pass-through applies to homemaker, home-health-aide, and personal-care services only. The text does NOT name ABA as an in-scope service. ABA is typically billed under EPSDT or rehabilitation / behavioral health authorities, not HCBS waivers, per HMA’s takeaways. Compliance deadline is six years from July 9, 2024 effective date (i.e., 2030); states track direct-care worker compensation within four years per Epstein Becker Green. Some states may apply 80/20-like logic to ABA in waiver programs; CT Acquisitions tracker flags this as a state-by-state refinement task. The headline implication: ABA platforms do not have to redirect 80% of HCBS revenue to direct-care worker wages by default. [HIGH]
While state Medicaid is the marginal pricing risk, the federal pillar through TRICARE and EPSDT remains the structural reason ABA is investable at all. The TRICARE Autism Care Demonstration was extended through December 31, 2028 by the August 4, 2022 Federal Register notice and is administered via TRICARE.mil/autism. The Defense Health Agency required all ACD Corporate Service Providers and sole providers to execute new participation agreements by December 1, 2024; non-signatories were terminated effective January 1, 2025 per the TriWest TRICARE West ACD provider page. May 1, 2024 ABA maximum allowed rates are posted at health.mil. [HIGH]
The September 2024 National Academies report (cited via the NASEM materials and covered by BHB, September 25, 2025) concluded ABA is clinically effective and recommended ABA become a permanent TRICARE basic benefit. The conversion of ACD from demonstration to permanent benefit would lock in DoD-anchored ABA spend at scale and would meaningfully de-risk the platforms with disproportionate military-family books. [HIGH]
The federal pillar is what CARD’s failure did not break. Even at the height of the 2023 bankruptcy, no court or regulator suggested ABA’s clinical legitimacy was at risk; the question has always been operator economics, not service efficacy. The 2024 National Academies recommendation reinforces that wall.
The military-family book in practice. Platforms with disproportionate TRICARE-eligible patient mix (typically the platforms operating near major military installations in TX, NC, VA, FL, CA) carry an embedded federal-pillar premium. Hopebridge’s Tampa and Jacksonville exposure, Centria’s North Carolina and Maryland expansion, BlueSprig’s multi-state footprint covering several base communities, and the in-home networks of Caravel and Stepping Stones all benefit from ACD continuation. Where state Medicaid is cutting, TRICARE rates published at health.mil’s May 2024 ABA Maximum Allowed Rates have remained stable. The federal-pillar premium is therefore not just a defense against political headline risk; it is an active hedge against the state-Medicaid rate cycle.
The December 2024 participation-agreement reset. One overlooked operating risk: any platform that did not sign a new TRICARE ACD participation agreement by December 1, 2024 was terminated effective January 1, 2025. The reset narrowed the network of participating providers. Smaller platforms that missed the deadline lost access to TRICARE revenue mid-stream. For diligence, confirmation of TRICARE participation post-December 2024 is now a binary go/no-go check on any platform claiming military-family book exposure. [HIGH]
The single largest mispriced risk in ABA QofE diligence is the regulatory enforcement tail. The HHS Office of Inspector General began a multi-state Medicaid ABA audit series in January 2022 under Work Plan SRS-A-25-029; the series is planned to cover seven states (Morgan Lewis Health Law Scan, November 2025). [HIGH]
Confirmed audit findings to date:
The audit recurring-finding profile centers on supervisor-to-RBT ratio violations (97155 supervision claimed but not delivered), documentation failures (missed signatures, backdated logs, undocumented sessions), and 97153 sessions billed without 97155 supervision present. The Breaking News ABA Billing Fraud Playbook catalogues seven recurring scheme types observed across federal indictments since 2023; DOJ has charged ABA Medicaid-fraud defendants in at least a dozen states. [MEDIUM for the 7-scheme classification; HIGH for the dozen-states framing]
In June 2025 the Massachusetts Attorney General’s Office indicted a Medicaid-enrolled autism services provider alleged to have fabricated documentation supporting more than $1 million in false ABA claims (Morgan Lewis). DOJ kickback charges have also been filed against operators paying parents to bring children to autism centers and billing for services not provided (Becker’s Behavioral Health). [HIGH]
For PE buyers, the audit tail is the structurally mispriced item. Standard QofE diligence focused on EBITDA add-backs systematically under-prices the regulatory risk because it is not yet on the income statement. The $200 million OIG total across only four states implies a far larger figure across the remaining three audited states and the unaudited rest of the country. Any 2026 platform trade with a Medicaid-heavy book should be carrying a regulatory escrow or representation-and-warranty insurance overlay sized to the OIG findings rate, not to the seller’s clean-payment claim.
BACB ethics enforcement. Current code-enforcement structure stems from the BCBA/RBT Ethics Code 2.0, effective January 1, 2022 per the BACB Ethics Information page and the RBT Ethics Code 2.0 PDF. BACB publishes a “Summary of Ethics Violations and Code-Enforcement Activities” series; the most recent searchable PDF covers 2019-2021. A 2022-2024 ethics-enforcement-summary PDF was not located in this research round and is flagged as a refinement task. Common code violations cited industry-wide are documentation and supervision failures, missed signatures, backdated logs, undocumented sessions per CentralReach’s BACB Ethics Code 2024 summary. These overlap directly with the DOJ and OIG recurring-finding profile. [MEDIUM for the underlying statistical breakdown]
The seven-scheme DOJ classification. The Breaking News ABA Billing Fraud Playbook catalogues seven recurring scheme types in federal indictments since 2023: (1) phantom billing for sessions never delivered, (2) credentialing fraud (uncertified providers billing under a BCBA’s number), (3) up-coding 97153 sessions as 97155 to capture the higher BCBA rate, (4) supervisor-absent 97155 billing (the BCBA was not actually engaged during the 97155-billed window), (5) kickback arrangements with families to bring children to centers, (6) ineligible-beneficiary billing (services billed to children outside the diagnosed-and-authorized population), and (7) overlap billing across multiple Medicaid managed-care plans for the same session. The classification is a useful diligence framework. Any acquirer reviewing a 2026 target’s billing operations should specifically test against this seven-scheme matrix rather than relying on a generic compliance review. [MEDIUM for the 7-scheme classification framing]
The MHPAEA parity question. A GAP for clean Mental Health Parity and Addiction Equity Act enforcement against ABA-billing patterns in 2024 to 2026. While parity is invoked in some state mandate cases, no primary 2024-2026 federal MHPAEA action specifically targeting ABA was returned by structured searches in this round. The DOL EBSA enforcement file and HHS OCR parity reports are flagged as a refinement task. The parity exposure matters because self-funded ERISA plans are exempt from state mandates, leaving an estimated majority of large-employer plans not bound by state coverage rules per Autism Speaks. If federal parity enforcement begins to target ABA-exclusion patterns in ERISA plans, that would be a meaningful expansion of commercial-side ABA revenue. [GAP]
Workforce is the structural ceiling on every ABA platform’s growth thesis. The BACB October 1, 2025 count of 317,699 worldwide certificants sits against the rough US-active breakdown of 74,000 BCBAs, 5,400 BCaBAs, and 196,000 RBTs per the BACB Annual Data Report. [HIGH for orders of magnitude]
40 jurisdictions (39 states plus DC) require licensure or registration for behavior analysts as of 2025 per the BACB Licensure page and the applied behavior analysis education guide. Recent enactments:
There is NO interstate ABA compact as of June 2026. The BACB does not run one. A BCBA practicing across state lines must obtain individual state credentials, including for telehealth delivery, in each delivery state (state licensure guide; ASPE interstate licensure paper). This is a structural drag on every telehealth-led ABA platform’s expansion math, and it interacts with the supervisor-to-RBT ratio constraint to limit how fast any one platform can credibly say it operates in a new state. [HIGH]
Job postings requesting BCBA certification reached 132,307 in 2025, up 28% from 103,150 in 2024 (Research.com BCBA Careers 2026). Job postings for BCBA graduates increased 58% YoY in 2024; demand grew 1,942% between 2010 and 2018 per the applied behavior analysis education salary guide 2026. Nearly half of all US counties have zero BCBAs; rural-South and Mountain-West states show density well below 15 BCBAs per 100,000 residents. [MEDIUM]
Wages, as of April 2026: average BCBA US salary $89,075 per year / $42.82 per hour per Ziprecruiter; BCBA-D doctoral premium 15-25% over BCBA, range $95,000 to $144,000 per year per the applied behavior analysis education guide; average RBT roughly $54,000 per year (entry-level approximately $47,000) per Advanced Therapy Clinic. [MEDIUM for BCBA wages; LOW for RBT wages, aggregator-derived not BLS]
Bilingual BCBA scarcity is flagged as a GAP. The field is widely understood to be undersupplied in Spanish-language BCBAs in California, Texas, Florida, Arizona, New Mexico, Nevada, and Illinois, but no primary numeric source has published a count. RBT turnover at center level is widely cited at 50% to 75% annualized but is also a GAP at the primary-source level; the CASP-CentralReach anonymized dataset will be the first publishable benchmark once released.
The table below captures the active confirmed-sponsor cohort with corrected attributions where prior trade-press coverage was wrong. Every cell carries an inline source URL and a per-row confidence rating.
| Platform | Current Sponsor | Entry Date | Segment | 2024 to 2026 Key Deals | Confidence |
|---|---|---|---|---|---|
| Centria Autism / Centria Healthcare | Thomas H. Lee Partners (THL) | December 9, 2019 (recap from Martis Capital and Lorient Capital at ~$415M / 16.6x EBITDA per PE Hub) | Center-based + in-home ABA | Opened 12 new locations across 6 states in 2024; 40+ new sites planned over next two years; 120+ locations now including first MD location January 2025 (Open Minds bulletin) | HIGH |
| BlueSprig Pediatrics | KKR (platform founded by KKR 2018) | 2018 platform formation | Center-based + in-home ABA | Acquired Trumpet Behavioral Health October 18, 2023 from WindRose Health Investors, +37 locations across 7 states; Will Abbott named CEO March 2025; eight-plus year hold likely 2026-2028 secondary candidate (BHB Trumpet roll-up) | HIGH |
| LEARN Behavioral (parent of Autism Spectrum Therapies, BEST, SPARKS) | Gryphon Investors (2019 majority); LLR Partners retains minority | 2019 majority recap (Gryphon press release) | Center + home + school-based ABA | 23 states, 4,000+ families per the BHB July 2024 profile; LLR confirmed up for sale (PE Hub) | HIGH |
| Action Behavior Centers | Charlesbank Capital Partners (with Penfund and Antares Capital debt) | September 2022; $840M valuation (BHB August 17, 2022) | Center-based ABA (de-novo growth model) | 200th center opened; ~300 locations across 9 states by early 2026; approximately $779M revenue 2024; approximately $1B revenue 2025 (BreakingNewsABA); footprint TX, CO, AZ, IL, NC, MN, IN, SC, PA plus planned NY, NJ | HIGH |
| Hopebridge | Arsenal Capital Partners (Baird Capital retains minority) | May 2019, approximately $255M | Center-based ABA + multidisciplinary | 100+ centers across 12 states minimum; NC expansion 2024; new clinical support structures; NADR data partnership 2024 (BHB October 23, 2024); six-plus year hold suggests exit may be approaching | HIGH for sponsor; MEDIUM for 2025-2026 exit status |
| Behavioral Innovations | Tenex Capital Management | June 6, 2024 (acquired from Shore Capital Partners at approximately $300M, high-teens EBITDA multiple, per Shore Capital release) | Center-based ABA | 77 centers as of sale (TX, OK, CO); biggest 1H 2024 platform deal in autism services (BHB May 31, 2024) | HIGH |
| Trumpet Behavioral Health | n/a (rolled into BlueSprig October 18, 2023) | n/a | n/a | No longer a standalone platform; was previously held by WindRose Health Investors (BHB) | HIGH (status as absorbed) |
| Caravel Autism Health | GTCR | July 2024 (acquired from Frazier Healthcare Partners, TripleTree advisory) | Center-based ABA + diagnostic | Founded Wisconsin 2009; approximately 60 locations across 8 states (WI, MN, IA, IL plus 5 more); CEO Mike Miller continues (BHB May 20, 2024) | HIGH |
| Invo Healthcare | Golden Gate Capital | September 2019 (from The Jordan Company) | School-based behavioral health + ABA only (exited home and center-based ABA June 2023) | Closed Autism Home Support Services, ABA2Day, and Xcite Steps in 2023; approximately 983 employees affected; pivoted entirely to school district contracts (BHB June 22, 2023) | HIGH |
| The Stepping Stones Group | Five Arrows Capital Partners (Rothschild & Co) + Leonard Green & Partners; Crescent Capital Group secondaries | 2018 (Five Arrows from Shore Capital); Leonard Green in subsequent recap | School + in-home ABA, special education, school nursing | Acquired Gallagher Pediatric Therapy March 2025 (BHB); acquired Star of CA (Stepping Stones release) | HIGH |
| Proud Moments ABA | Nautic Partners | February 3, 2025 (acquired from Audax Private Equity, Audax release; BHB) | Center-based ABA + in-home | 12 states, 70 clinics, approximately 3,000 weekly census; Audax held since 2019, originally founded with 7 NY tri-state locations | HIGH |
| Acorn Health | Ontario Teachers’ Pension Plan Board (OTPP) | 2021 (acquired from MBF Healthcare Partners II per MBF release) | Center-based ABA | January 2025 restructuring closed multiple centers and laid off regional management (Acorn 2024 Year in Review; BHB 2022 profile) | HIGH |
| Autism Learning Partners (ALP) | FFL Partners | 2018 (per PitchBook secondary, selling shareholders received approximately $270M+, Berkery Noyes advisory) | Center + in-home + school + telehealth ABA | Continued deepening footprint 2024 (BHB October 23, 2024); Southern California-originating, now multi-state | HIGH |
| CARD (post-bankruptcy) | Pantogran LLC (founder-led, with Audax Group consortium); New Story took VA + schools; Proud Moments took NY (less 2)/NJ/NV | July 27, 2023 court approval ($48.5M total, Globe Newswire) | Center-based ABA | Pantogran paid $37.4M for 10 state markets + Skills Global IP + CARD brand; New Story $11M; Proud Moments $1 (BHB sale coverage) | HIGH |
| Autism Spectrum Therapies (AST) | Part of LEARN Behavioral (Gryphon Investors / LLR Partners minority) | LEARN parent platform since 2019 | Center + in-home + diagnostic | 30+ doctoral-level clinicians, 450 BCBAs, 3,700 behavior technicians per autismtherapies.com; Burbank CA HQ | HIGH for parent attribution |
| ABA Centers of America | Self-funded / PE-free | n/a | Center-based ABA + in-home/in-community/in-school (de-novo model, not roll-up) | 40+ markets, approximately 30 centers; planning approximately 40 new centers in 2025; #5 Inc. 5000 2024, #25 in 2025; #1 Inc. Regionals Southeast 2024/2025 (PR Newswire 2024; Wikipedia) | HIGH |
| Spectrum Behavioral Therapies | Optimal Investment Group | May 2024 | Center-based ABA | Acquired May 13, 2024; separate entity from LEARN’s AST (BHB) | HIGH |
| Nyman Associates | Avesi Partners-backed Point Quest Group | June 2024 | School + home behavioral health for autism | Sold via Capstone Partners advisory; PA-anchored school-and-home model (Capstone update) | HIGH |
| Verbal Beginnings | Sponsor identity GAP | GAP | Center + EI/comprehensive (MD/PA/DE/DC/Northern VA) | Opened new EI/comprehensive center in Alexandria VA November 2024 (Yahoo Finance); current PE owner not publicly confirmed | GAP |
| Maxim Healthcare Services (autism division) | Sponsor identity GAP for current cycle | GAP | In-home + school + clinic ABA (11 states) | Active per Maxim Behavioral page; historically cycled through Centerbridge Partners; current 2024-2026 sponsor mix not publicly disclosed | GAP |
| Comprehensive Autism Center | Combined with Speech Pathology Group (sponsor MEDIUM) | Pre-2024 | Center-based ABA | Acquired by The Speech Pathology Group (Provident Healthcare Partners advisory, PR Newswire); current consolidated owner not primary-source confirmed in window | MEDIUM |
| Behavioral Framework | Sponsor GAP | GAP | Center-based + in-home ABA | Acquired BCPS July 2024 (BHB); platform-level sponsor not primary-source confirmed in window | MEDIUM |
| Theracare, Total Spectrum, Achievements ABA, LEAP Forward Behavioral Health, The Cooper Group, Continuum Pediatric Therapy, Applied Behavioral Mental Health Counseling | Sponsor identity GAP across the cohort | GAP | Mix (likely regional or founder-owned) | All searched in window; no confirmed PE sponsor returned from primary-source searches | GAP |
Aggregate PE footprint. The Brown University School of Public Health published in JAMA Pediatrics, January 7, 2026 that 574 autism therapy centers were PE-owned across 42 states as of 2024, from 142 separate transactions, with 2018 to 2022 the peak acquisition years. PE concentration ranks: California 97 centers, Texas 81, Colorado 38, Illinois 36, Florida 36. Top-third autism-prevalence states are 24% more likely to host PE-owned centers (Disability Scoop coverage; Acuity News). One source variant gave 147 deals rather than 142; we anchor to the JAMA Pediatrics-published number of 142. [HIGH]
The geographic concentration data carries operating implications. California’s 97 PE-owned centers represent the densest competitive market in the country and contribute meaningfully to ALP’s California-anchored book, AST’s Burbank base, and the multi-state platforms that operate California-side. Texas’s 81 PE-owned centers reflect Behavioral Innovations’ headquartered footprint plus the Texas density of Action Behavior Centers. Colorado’s 38 centers concentrate around the Denver metro Action Behavior Centers and Behavioral Innovations footprints. Illinois’s 36 centers reflect the Chicago metro density of multiple platforms entering since IDFPR began issuing BCBA licenses in January 2025. Florida’s 36 centers reflect ABA Centers of America’s Southeast concentration plus regional platforms. The “top-third autism-prevalence states are 24% more likely to host PE-owned centers” finding from the JAMA study confirms a structural alignment between prevalence and PE deployment, though as Contrarian 4 makes clear, prevalence alignment does not translate into rate-stability alignment. [HIGH]
Center count vs revenue. An important nuance in reading the table: center count and revenue are not interchangeable measures of platform size. ABA Centers of America operates approximately 30 centers but is among the highest revenue-per-center performers in the cohort. BlueSprig’s 170-plus centers include a mix of high-throughput urban centers and lower-volume regional centers. Action Behavior Centers’ approximately 300 centers running at approximately $1B revenue 2025 implies roughly $3.3M average revenue per center, a strong throughput figure that reflects de-novo model discipline. Diligence on a platform-comparison basis needs to normalize for revenue per center rather than total center count.
The dominant sub-segment by both center count and PE invested capital. Anchored by BlueSprig (KKR, ~170+ centers post-Trumpet across ~22 states), Action Behavior Centers (Charlesbank, ~300 centers across 9 states, $1B revenue 2025), Centria (THL, 120+ locations), LEARN Behavioral (Gryphon / LLR minority, 23 states), Hopebridge (Arsenal, 100+ centers across 12 states), Behavioral Innovations (Tenex, 77 centers in TX/OK/CO), Acorn Health (OTPP), and Autism Learning Partners (FFL Partners). The segment carries premium multiples (mid-to-high teens of EBITDA at peak, per the Behavioral Innovations June 2024 trade at approximately $300M / high-teens) but is bearing the brunt of state Medicaid rate cuts. Payor mix is typically Medicaid-anchored with commercial overlay. Regulatory pressure points: 97153 rate cuts, supervisor-to-RBT ratio enforcement, accreditation requirements (MassHealth January 2027 deadline).
Smaller than center-based by capital deployed but rich in payor diversification. Anchored by Caravel Autism Health (GTCR), Proud Moments ABA (Nautic), Stepping Stones Group (Five Arrows / Leonard Green, school-and-in-home hybrid), Verbal Beginnings (sponsor GAP), and Maxim Healthcare’s autism division (sponsor GAP). In-home margins are structurally lower than center-based on Medicaid books but recover on commercial. The segment is more exposed to BCBA travel and supervision economics, and to telehealth-versus-in-person concurrent billing rules. Typical multiple range 6x to 10x EBITDA. Regulatory pressure points: state telehealth alterations (New Hampshire 97155 proposal July 2025), supervision documentation, the Medicaid HCBS 80/20 final rule (which, importantly, does not name ABA in scope per the Polsinelli analysis; ABA is typically billed under EPSDT or rehabilitation, not HCBS waivers).
The single biggest 2023 strategic re-positioning was Golden Gate Capital’s Invo Healthcare exiting home and center-based ABA in June 2023 to focus entirely on school district contracts. Stepping Stones Group also carries significant school-segment exposure via its special education and school nursing lines. School-based ABA sits adjacent to but not within K-12 budget pressure cycles; reimbursement is via IEP (Individualized Education Program) and Medicaid school-based services. The segment is structurally less exposed to commercial mandate volatility but more exposed to state and local district budget cycles. Multiple range typically 5x to 8x EBITDA.
Diagnostic-only platforms (autism diagnostic assessment without long-tail ABA delivery) are typically smaller than treatment-anchored books and trade at lower multiples (5x to 7x EBITDA). Many sit inside multi-segment platforms (Caravel includes diagnostic; Centria includes diagnostic; Hopebridge runs multidisciplinary). The strategic logic for diagnostic-anchored entry is patient capture: a child diagnosed at the platform’s clinic typically converts to in-platform ABA at high rates. Diagnostic-only standalone platforms are rare in the PE cohort.
ABA Centers of America is the single most important non-PE entrant in the top growth cohort. Self-funded, with no PE sponsor, the company ranked #5 on the Inc. 5000 in 2024 and #25 in 2025, and #1 on Inc. Regionals Southeast in both 2024 and 2025 per the 2024 PR Newswire release. It operates approximately 30 centers across 40-plus markets and planned approximately 40 new centers in 2025. The competitive significance is structural: a non-PE operator can match scale growth without sponsor capital. That breaks the standard PE rollup pitch that capital is the gating constraint on center expansion. Workforce, supervisor-to-RBT ratios, and local market entry economics are the actual gating constraints, and a non-PE operator can solve those without LP commitments.
The October 23, 2024 New Jersey expansion announcement covered by Behavioral Health Business placed the company in direct competition with Proud Moments (now Nautic-backed) and other Northeast incumbents. The competitive overlap is exactly the kind of overlap that PE-backed platforms increasingly worry about, because the de-novo model has no exit-driven capital cost to amortize. ABA Centers of America’s growth ranks place it above most PE-backed peers in pure expansion velocity, and its absence from acquisition activity means PE-friendly metrics (deal multiples, asset turnover, sponsor returns) do not capture it. CT Acquisitions’ tracker explicitly retains ABA Centers of America in the platform table to prevent that under-counting.
A growing sub-segment: platforms that combine ABA with speech-language pathology, occupational therapy, and physical therapy under one clinic roof. Hopebridge is the canonical example of this multidisciplinary model. Other smaller platforms in this category include Speech Pathology Group (which absorbed Comprehensive Autism Center), and several regional roll-ups outside the PE-confirmed cohort. The multidisciplinary model carries operating advantages on parent retention and clinical-outcome diversification but adds clinical-governance complexity. Multiples in this sub-segment track the higher end of the mid-market range (8x to 11x EBITDA) because of the patient-retention premium.
The chronological flow makes the post-CARD rebuild cadence visible.
Quarterly deal-count cadence: 2024 full-year Mertz Taggart count was 30 autism plus I/DD transactions (Mertz Taggart Q1 2025 report). Q1 2025 Mertz Taggart reported 12 IDD/autism deals, +71% YoY and +140% versus Q1 2023, the highest single-quarter volume since 2021. Q1 2025 Braff Group reported 14 deals, +133% YoY and +180% versus Q1 2023; autism deals +100% from Q4 2024 to Q1 2025, the highest quarterly volume since Q4 2020 (Braff Group report). Q2 2025 Mertz Taggart reported 7 IDD/autism deals, down from 12 in Q1 but with higher PE-backed strategic mix (BHB April 2026). [HIGH]
EBITDA multiple framing carries an important asterisk: the headline numbers below are sub-segment medians, not platform-specific premiums. The premium platforms (BlueSprig, Action Behavior Centers, Centria, Hopebridge) trade above the segment median; small regional platforms trade below.
Multiple compression vs the 2018 to 2021 peak. Centria’s 2019 entry traded at 16.6x EBITDA for THL per PE Hub. Action Behavior Centers’ 2022 Charlesbank trade was at a $840M valuation (multiple not publicly disclosed) per BHB August 2022. Mergium’s 2024 framing noted the range had narrowed from levels earlier in the decade and that PE firms needing to return capital to LPs were creating “a pressure cooker of exits heading into 2026” per the Mergium H1 2024 report. FOCUS Bankers reported 2025 multiples have remained stable versus 2023-2024 with premium outcomes concentrated in scaled, multi-state platforms with accreditation, diversified payer mix, and clinical governance per the FOCUS 2026 Practice Valuation update. [HIGH]
BCBA productivity benchmarks. A single industry-standard “billable hours per BCBA per week” number was not found in this round of primary research. Commonly cited industry benchmark figures (25-32 billable BCBA hours per week, 70-85% RBT utilization) are typically internal-deck claims; CT does not cite them without a named source. [GAP]
Cash-pay vs Medicaid mix impact. Anecdotally, commercial-heavy books trade higher than Medicaid-heavy books, but no clean published multiple-by-mix table has surfaced. The Provident 2021 report referenced the differential generally without disclosing percentages. [GAP for the quantified spread]
Reading the multiples in light of the 2025 to 2026 environment. The Mergium “pressure cooker of exits” framing for 2026 captures the cross-current the sector is in. PE sponsors with 2018 to 2021 vintage holdings (BlueSprig, Centria, Hopebridge, LEARN, Acorn, ALP) are at or beyond fund-life patience. The 2024 to 2026 closing exits (Behavioral Innovations June 2024 at high-teens, Proud Moments February 2025 to Nautic, Caravel July 2024 to GTCR) show that premium platforms with credible payor mix and multi-state license rosters continue to clear at the top of the range. The platforms that have not yet cleared (BlueSprig, Centria, Hopebridge, LEARN) are simultaneously sitting on rate-cut wedges in their largest revenue states and on regulatory escrow questions from the OIG audit series. The translation: 2026 trades are likely to clear at lower headline multiples than the 2022 to 2024 cohort, but the discount will be expressed through escrow structure rather than through topline multiple. A 13x headline trade with a $20M regulatory escrow has a different effective multiple to the seller than a clean 12x trade.
Hopebridge as the next likely sponsor-to-sponsor exit. Arsenal Capital has held Hopebridge since May 2019, a six-plus year hold that has crossed the typical secondary-buyout trigger window. The platform’s 100-plus centers across 12 states, NC expansion in 2024, and clinical-governance investments make it a clean diligence package. No public exit signal has been returned in this research round, but the configuration is the most exit-likely in the cohort apart from BlueSprig. CT Acquisitions’ tracker flags Hopebridge as the most likely 2026 to 2027 platform exit announcement. [MEDIUM]
Centria’s recap window. Thomas H. Lee Partners has held Centria since December 2019; over six and a half years. With approximately 120 locations and 40-plus new sites planned over the next two years per the Open Minds bulletin, the platform is in active growth mode. THL is likely to recap or sell in 2026 to 2027. The first Maryland location opening in January 2025 also signals state-license footprint expansion that supports a higher-multiple exit. [MEDIUM]
BlueSprig as the largest 2026 to 2028 ABA exit opportunity. KKR has held BlueSprig since 2018; with 170-plus centers post-Trumpet, it is structurally the largest exit opportunity in the US ABA sector. Will Abbott’s CEO appointment in March 2025 reads as exit-prep CEO selection. No public exit signal has been returned, but the configuration (long hold, large size, new CEO, multi-state license roster) is consistent with a 2026 to 2028 sponsor-to-sponsor process or a strategic combination. [MEDIUM]
KKR-founded in 2018, BlueSprig held 137 centers pre-Trumpet, plus approximately 37 added via the WindRose acquisition of Trumpet in October 2023, putting it at roughly 170-plus centers across 22-plus states with a new CEO (Will Abbott, March 2025). Yet industry coverage disproportionately focuses on Action Behavior Centers. The under-tracking matters because KKR’s hold thesis on BlueSprig is the single biggest variable in any 2026 to 2028 ABA secondary market. An eight-year-old platform sitting on 170-plus centers, in a fund cycle now extended well into its full life, is the obvious candidate for the next sponsor-to-sponsor trade. References: BHB BlueSprig-Trumpet; BHB 7 Autism Therapy Companies to Watch 2025. [HIGH]
Charlesbank’s 2022 $840M trade was followed by organic growth from roughly 100 to 300 centers in three years, not by add-on acquisitions per the BreakingNewsABA “Hyper-Scaled” coverage. Most ABA roll-up PE theses ignore that the leading scaled growth model is single-format de-novo plus regional density, not multi-platform M&A. Two implications: (i) tracker-level “centers acquired” data systematically undercounts true center-supply expansion, and (ii) the deal-flow timeline understates how much new ABA capacity is being added because de-novo centers don’t appear in deal tallies. Action Behavior Centers’ $1B 2025 revenue against approximately $779M 2024 implies roughly 28% YoY revenue growth, almost all organic. [HIGH]
Doreen Granpeesheh’s Pantogran took back 10 state markets at $37.4M (effective center cost under $400,000). With the Skills Global clinical IP and longitudinal database in private hands again, the founder-controlled rebuild competes against PE-rebuilt ABA on a meaningfully different cost structure (Globe Newswire court approval; CARD/Pantogran site). Most PE diligence underweights this. A founder-led operator with previously-installed clinical IP, a re-built P&L on a clean balance sheet, and the founder’s clinical reputation in front, is the kind of competitor that doesn’t show up in commercial deal databases or sponsor portfolio pages. Tracker-level mapping needs to include the founder rebuild as a competitive vector, not just the sponsored platforms. [HIGH]
Indiana, New York, and Massachusetts are simultaneously raising autism prevalence (CDC ADDM identified prevalence rose nationally to 1 in 31 in April 2025) yet cutting 97153 unit rates per the NY State Medicaid Update August 2025 and the Acuity News Indiana ABA Reform 2026 bulletin. The supply-side story (CDC 1-in-31) and the reimbursement-side story (state rate compression) point in opposite directions. Generic “prevalence rises, ABA total addressable market rises, valuations rise” framing is wrong on a state-by-state basis. PE buyers ignoring state-specific rate models are mispricing. The right diligence question is not “what is national TAM” but “what is the platform’s revenue mix by state and what does the next 24-month rate-trajectory look like across those states.” [HIGH]
HHS-OIG has identified approximately $200 million of improper payments across 4 audited states (Indiana approximately $56M December 2024; Wisconsin approximately $18.5M July 2025, with the series planned to cover 7 states total) per the Morgan Lewis November 2025 Health Law Scan. DOJ has charged ABA Medicaid-fraud defendants in at least a dozen states since 2023, with recurring schemes centered on documentation and supervision failures per the Breaking News ABA Billing Fraud Playbook. Standard QofE diligence focused on EBITDA add-backs systematically under-prices the regulatory tail because it is not yet on the income statement. Any 2026 platform trade with a Medicaid-heavy book should be carrying a regulatory escrow or rep-and-warranty insurance overlay sized to the OIG findings rate, not to the seller’s clean-payment claim. [HIGH]
The licensure picture (40 jurisdictions and counting, no interstate compact) means telehealth-led “scale across states with one BCBA roster” theses do not work per the applied behavior analysis education state licensure guide and the BACB Licensure page. Each new state requires a fresh BCBA-of-record. Telehealth-RBT-supervision models being marketed to PE require local-BCBA hire infrastructure or they fail diligence. Hopebridge, Centria, and BlueSprig all built parallel state-by-state licensee rosters; cheaper telehealth-only entrants assume an interoperability that does not exist. The competitive implication: PE platforms with already-built multi-state BCBA rosters are more defensible than they look on paper, and new entrants have to repay that infrastructure cost before they can compete on price. [HIGH]
The ASPE Barriers and Opportunities for Improving Interstate Licensure paper catalogues the policy options for resolving multi-state behavioral health licensure friction, but the recommendations are not policy. The Council of State Governments has formed interstate compacts for psychology, social work, and counseling; ABA / behavior analysis has not been included in any active compact effort as of June 2026. The implication for PE-backed telehealth strategy is that the next 24 months will not solve this. Any platform claiming a multi-state telehealth-supervision model in its pitch deck needs to be diligence-tested for whether it actually has a licensed BCBA-of-record in each delivery state, not just a BCBA in the parent corporate domicile.
Workforce is where every PE thesis hits its ceiling. The numbers, restated for clarity: 74,000 BCBAs, 196,000 RBTs, and 5,400 BCaBAs active in the US per the BACB Annual Data Report. Nearly half of all US counties have zero BCBAs per the applied behavior analysis education salary guide. The pipeline math is unforgiving: 1-in-31 prevalence applied to a US population of approximately 73 million children under 18 implies roughly 2.4 million children with identified ASD. At even a modest 10-hour-per-week ABA-engagement rate for diagnosed children, the implied billable hours far exceed what the current 74,000-BCBA roster can supervise within standard supervisor-to-RBT ratios.
RBT turnover. Industry conversation refers to 50% to 75% annualized RBT turnover at center level, but no BACB-published or CASP-published rate has been released. We treat the figure as GAP at the primary-source level and flag for follow-up via the CASP-CentralReach anonymized dataset.
Bilingual BCBA scarcity. The field is widely flagged as undersupplied (particularly Spanish-language BCBAs in CA, TX, FL, AZ, NM, NV, IL) but no primary numeric source has published. [GAP]
Telehealth supervision model. Post-COVID flexibilities are state-specific; New Hampshire proposed alteration of 97155 telehealth coverage from July 2025 per Aloha ABA. For cross-state work, BCBA must hold each delivery state’s license per the state licensure guide. The combination of state licensure plus 97155 audit risk means telehealth supervision is not the scale lever many PE pitches assume it is. [MEDIUM]
Supervisor-to-RBT ratios as the deal-killer. The BACB Ethics Code Section 4 (Behavior Analysts and the Supervision of Others) governs supervisor responsibilities per the BACB Ethics Codes page but the published codes do not bind specific RBT-to-BCBA caseload caps. State Medicaid rules differ. The audit findings concentrate on documentation that the supervising BCBA was actually present and engaged during 97155-billed sessions while 97153-billed RBT sessions were running. A platform that has under-staffed BCBA supervision relative to its RBT roster is the platform that gets recoupment letters. Diligence on the supervisor-to-RBT ratio, by site and by state, is the single highest-yield diligence question in 2026.
For owners considering a sale, the buyer universe and multiple range depend on platform size. CT Acquisitions’ practical view, anchored to the multiples in Section 11 and the platform roster in Section 8:
| Seller Profile | EBITDA Band | Buyer Universe | Likely Multiple Range | Key Diligence Levers |
|---|---|---|---|---|
| Solo BCBA practice, 1 location | Below $500K | Very limited (regional roll-ups, founder-buyer market only) | 3x to 5x | Owner-operator concentration, transition risk |
| Small center, 1 to 3 locations | $500K to $2M | 6 to 10 lower-middle-market PE platforms and strategic roll-ups | 5x to 8x | Payor mix, BCBA stability, accreditation status |
| Multi-location, 4 to 15 centers | $2M to $8M | 8 to 12 active platforms (BlueSprig, Action Behavior Centers, Centria, LEARN, ALP, Caravel) | 7x to 11x | Geographic fit, supervisor-to-RBT ratios, OIG audit posture, commercial mix |
| Regional platform, 15 to 50 centers | $8M to $20M | 5 to 8 large platforms (BlueSprig, Centria, Hopebridge, Action Behavior Centers, Behavioral Innovations) + 3 to 5 platform-acquisitive sponsors | 10x to 14x | Accreditation, state license rosters, MassHealth-readiness, governance maturity |
| Platform-eligible | $20M+ | Sponsor-to-sponsor exit; secondary buyout market | 11x to 15x with audit overhang discount | Multi-state license footprint, payor diversification, regulatory escrow size, founder/CEO continuity |
The audit-overhang discount in the platform-eligible band is a 2026 development. Multiples that would have cleared at 15x in 2022 are clearing at 13x in 2026 unless the seller can credibly demonstrate Medicaid-compliance posture on supervisor-to-RBT documentation. Acquirers are also increasingly building OIG-recoupment escrows into trade structures, which functionally reduces the realized multiple to the seller.
This tracker is a primary-source-anchored synthesis as of June 16, 2026. The following items are flagged as GAP and are not paper-claimed:
Adjacent and prerequisite reading on the broader healthcare and consolidation themes that interact with ABA:
Federal government and regulators.
Industry boards and codes.
Trade associations and advocacy.
M&A advisory and research.
Sponsor and platform-level.
Academic and longitudinal.
Regulatory references.
We track 15 actively-sponsored US PE platforms in the 2024 to 2026 window with primary-source-confirmed current ownership, plus one notable PE-free outlier (ABA Centers of America) and roughly a dozen smaller platforms tagged GAP because no current sponsor has been primary-source confirmed. The Brown University JAMA Pediatrics study published January 7, 2026 identified 574 PE-owned autism therapy centers across 42 states from 142 transactions through 2024, anchored to the JAMA-published count rather than secondary aggregator estimates.
By center count, BlueSprig Pediatrics (KKR, platform founded 2018) holds approximately 170-plus centers across 22-plus states after acquiring Trumpet Behavioral Health from WindRose Health Investors in October 2023. By revenue, Action Behavior Centers (Charlesbank, since September 2022) reached approximately $1 billion 2025 revenue per BreakingNewsABA. KKR’s hold thesis on BlueSprig is the single biggest variable in any 2026-2028 ABA secondary market.
Center for Autism and Related Disorders, Blackstone-held since 2018, filed Chapter 11 on June 11, 2023. On July 27, 2023 the bankruptcy court approved a three-way $48.5 million sale: Pantogran LLC (a Doreen Granpeesheh founder-led consortium with Audax Group) paid $37.4 million for 10 state markets, the CARD core brand, and the Skills Global clinical IP; New Story paid $11 million for Virginia facilities and all school assets; Proud Moments ABA paid $1 for New York facilities (minus two retained by Pantogran), New Jersey, and Nevada.
No. Action Behavior Centers is owned by Charlesbank Capital Partners, which acquired the platform in September 2022 at an $840 million valuation, with Penfund and Antares Capital providing debt. Charlesbank publishes the holding on its portfolio page. The TPG misattribution circulates in some trade-press summaries and is incorrect.
A $2 million EBITDA ABA business with multi-location footprint and credible payor mix typically clears at 7x to 11x in 2026, with the multiple anchored by accreditation status, supervisor-to-RBT ratio documentation, and state-license footprint. A single-location $2 million EBITDA practice clears closer to the 5x to 8x range. Premium platform trades (Behavioral Innovations June 2024 at high-teens) are not benchmarks for smaller books.
NY’s 97153 rate fell from $16.85 per 15-minute unit (October 1, 2025) to $14.45 per unit (April 1, 2026), a 14.2% compression in six months per the August 2025 NY Medicaid Update. Because 97153 is the largest billable-hour line on every ABA P&L and ABA platforms run on 8% to 15% EBITDA margins, a 10% rate cut translates to a 30% to 50% EBITDA sensitivity. NY-heavy platforms are pricing in meaningful multiple compression in 2026 trades.
HHS-OIG began a multi-state Medicaid ABA audit series in January 2022 under Work Plan SRS-A-25-029. As of November 2025, approximately $200 million in improper payments have been identified across 4 audited states (Indiana approximately $56 million December 2024; Wisconsin approximately $18.5 million July 2025). The audit recurring-finding profile centers on supervisor-to-RBT ratio violations, documentation failures, and 97153 sessions billed without 97155 supervision present. The series is planned to cover seven states total. Most QofE diligence under-prices this regulatory tail.
Behavioral Innovations is held by Tenex Capital Management, which acquired the platform on June 6, 2024 from Shore Capital Partners at approximately $300 million / high-teens EBITDA multiple. The transaction was the biggest 1H 2024 platform deal in autism services. Some legacy coverage still attributes Behavioral Innovations to Shore Capital, but Shore exited via the June 2024 sale.
No. As of June 2026 there is no BCBA interstate compact, and the BACB does not run one. A BCBA practicing across state lines must obtain individual state credentials in each delivery state, including for telehealth-only delivery. 40 US jurisdictions (39 states plus DC) require BCBA licensure or registration; Illinois began issuing licenses on January 15, 2025; Colorado licensure takes effect in 2026. Telehealth-led ABA platforms cannot scale on a single BCBA roster.
The TRICARE Comprehensive Autism Care Demonstration was extended through December 31, 2028 by the August 4, 2022 Federal Register notice. The September 2024 National Academies report recommended converting ABA into a permanent TRICARE basic benefit. Continuation locks in DoD-anchored ABA spend at scale and de-risks the platforms with disproportionate military-family books. For M&A, ACD continuation is the cleanest federal-pillar story in the sector and helps support multiples on platforms with confirmed TRICARE participation agreements (DHA required new agreements by December 1, 2024; non-signatories were terminated effective January 1, 2025).
ABA Centers of America is self-funded with no PE sponsor. It is the most important non-PE entrant in the top growth cohort, ranked #5 on the Inc. 5000 in 2024 and #25 in 2025, and #1 on Inc. Regionals Southeast in both 2024 and 2025. It operates approximately 30 centers across 40-plus markets with approximately 40 new centers planned for 2025. The competitive significance is structural: a non-PE operator can match scale growth without sponsor capital, which breaks the standard PE rollup pitch that capital is the gating constraint on center expansion.
Quarterly at minimum, with ad-hoc refreshes on material platform-level transactions (sponsor changes, sub-segment exits, bankruptcies, large take-privates). Major regulatory events (state Medicaid rate changes, OIG audit publications, TRICARE policy actions) trigger updates within seven days. This version was last verified on June 16, 2026.
CT Acquisitions is a buy-side and sell-side advisory practice focused on lower-middle-market healthcare services, with deep specialization in behavioral health, ABA therapy, home health, and adjacent multi-site outpatient platforms. We work with founders, family offices, and PE sponsors on platform formations, add-on acquisitions, and sponsor-to-sponsor exits. Our trackers (this ABA tracker, the behavioral health tracker, the home health tracker, and the cross-sector platform tracker) are maintained as primary-source-anchored references for the investing and operator community.
Christoph Totter, managing director, leads the firm’s healthcare practice. For deal inquiries, diligence support, or tracker-related questions, reach the team at /contact/ or on LinkedIn.
Disclosures: CT Acquisitions does not hold a position in any of the platforms listed in this tracker. Platform ownership data is anchored to primary sources where available; GAP designations reflect where current sponsor identity could not be verified to a Tier 1, 2, or 3 source within the verification window. The information in this tracker is not investment advice and is provided for informational purposes only.
Last updated: June 16, 2026.