Q: Can parents legally be charged a fee for therapist no-shows or late cancellations in ABA services?

A: You're right to be cautious, especially when Medicaid is involved. Medicaid typically only pays for services that are actually provided, so it won't cover fees for no-shows or late cancellations. However, that doesn't automatically stop you from establishing a separate financial agreement directly with the parent or guardian—if done transparently and legally. You’ll need to make sure these fees are clearly outlined in your intake paperwork and signed by the parent, confirming they understand and accept the policy.

That said, when Medicaid is the funding source, you must ensure that any private charges to the family don’t conflict with Medicaid rules. Some states may have restrictions on charging Medicaid recipients directly, even for missed appointments. Before including this policy, you should check with your state’s Medicaid office or licensing board to confirm that you’re not violating any conditions tied to Medicaid reimbursement or beneficiary protections. Also, be mindful of how these policies might be perceived in terms of access to care.

If the rules allow it, a no-show policy can support staff retention and consistency for the child. Just be sure the policy is reasonable, flexible, and clearly communicated to families upfront. Giving one free cancellation per month shows you’re trying to balance fairness and practicality. It’s a good idea to also track missed appointments to identify patterns and work collaboratively with families to reduce disruptions. You're trying to build a sustainable model, and thoughtful planning like this helps get you there.