Your service model shapes your costs, your staffing, and the families you can serve. With rates under pressure, it’s worth revisiting the decision.
Many ABA clinics started with whatever model the founder knew best. A BCBA who trained in home-based programs opened a home-based practice. Another built a center because that’s where she did fieldwork. Years later, those early choices still drive the economics of the business.
In 2026, with Medicaid rates falling in several states and staffing still tight, owners are taking a hard look at how and where services are delivered. There is no universally right answer, but each model comes with clear trade-offs.
| Factor | Center-based | In-home | Hybrid |
|---|---|---|---|
| Startup cost | High (lease, build-out, equipment) | Low | Moderate |
| Staff drive time | Minimal | High, often unpaid or low-billable | Mixed |
| Scheduling efficiency | High; easy to cover cancellations | Low; gaps between clients | Moderate |
| Supervision | Easy, in person | Harder; requires travel | Moderate |
| Generalization to home | Needs planning | Built in | Strong when well-designed |
| Family convenience | Requires transport | High | Flexible |
| Peer and social opportunities | Strong | Limited | Moderate |
Center-based: efficiency at scale
Centers concentrate staff, clients, and supervision in one place. RBTs can work a full day without driving between homes. BCBAs can supervise several sessions in an hour. When a client cancels, a tech can be reassigned in minutes.
The trade-offs are fixed costs and access. Leases and build-outs require capital, and a half-empty center loses money fast. Families without reliable transportation may not be able to attend. And skills learned in a clinic room don’t always carry over to home, so strong caregiver training becomes essential.
In-home: flexibility with hidden costs
Home-based services meet families where they live and make generalization easier. They’re often preferred for young children and for goals tied to daily routines like meals and bedtime. Startup costs are low.
The hidden costs are time and turnover. Drive time between clients eats into billable hours and wears down staff. Supervision is harder to schedule. Cancellations leave techs with unpaid gaps. Safety and professional boundaries in homes also need clear policies.
Hybrid: the growing middle
Many clinics now combine models: center-based hours for intensive skill building and social groups, plus home or community sessions for generalization, caregiver training, and specific routines. Telehealth can support caregiver training and some supervision where payers allow it.
Hybrid models can capture the efficiency of a center and the real-world value of home services. They also require more coordination, including scheduling systems, clear rules on who travels, and payer approval for each service location.
Questions to guide your decision
- What do your payers reimburse, and at what rates? Some payers have location restrictions or different rules for home, center, school, and telehealth services. Check before you build.
- Where do your families live? Map current and waitlisted clients. A dense cluster may justify a center. A spread-out rural area may favor home services.
- What does your staff want? Many RBTs prefer center-based work for its predictability. Offering it can be a recruiting advantage.
- What is your cancellation rate by setting? Compare billable hours per scheduled hour for each model you currently run.
- What does the research and your clinical team say for your population? Age, intensity, and goals all matter. Service model decisions should be clinically sound, not only financially driven.
Watch the policy environment
Rate cuts and hour caps change the math. Nebraska, for example, added a 30-hour-per-week cap alongside its rate reductions. When hours per client are capped, efficient scheduling and low overhead matter even more. Owners considering a new center should stress-test the lease against lower rates and fewer authorized hours.
The bottom line
The best service model is the one that delivers quality care to the families in your area at a cost your payer mix can support. Revisit the decision every year or two with real data on utilization, drive time, cancellations, and margin by setting. The model that worked when you opened may not be the one that carries you through the next five years.