ABA M&A in 2025: The End of Map Painting, The Return of Operating Discipline

Valuations have reset—and stories don’t clear IC anymore

The 2021 playbook of forward pro formas and map-painting is out. Buyers are underwriting LTM EBITDA, sometimes a lightly annualized recent period, and paying materially lower multiples than the peak. “Sophisticated buyers want proved unit economics, not promises,” Molko noted. Rubin echoed that the most generous adjustments and add-backs of the boom are gone. What moves the needle now is durable cash earnings and a repeatable growth engine.

Platform vs. tuck-in: It’s about engines, not headcount

The platform bar today is less about headcount and more about an operating engine—especially a de novo clinic-opening playbook with predictable payback and throughput. Verma framed the first two screens simply: (1) Can it scale here?—MSA size, referral density, BCBA supply, payer posture; (2) Do the unit economics clear? A practical rule he uses: for direct services, reimbursement-to-BT base wage near 3:1, enabling ~50% direct gross margins and high-30s overall when run well. Tuck-ins still matter, but only where there’s clear synergy (entry to a target market, compelling payer mix, or rate arbitrage) and low integration drag.

Depth beats breadth

The panel was blunt about “flag planting.” Thin footprints across many states rarely add value; they add regulatory and cultural complexity without EBITDA. Several big platforms that over-expanded have retrenched to core markets. If you want a higher exit, show share and depth: payer relationships, referral flywheels, BCBA pipelines—and the clinics to match.

Operating simplicity is a feature

Growth models that travel are simple: a disciplined center-based design (size tied to your leadership pyramid), or a home-based model that truly manages churn and staffing. Hybrid can work, but complexity taxes growth. Systems sprawl hurts too. As Rubin put it, many troubled assets “looked fine on a spreadsheet” but faltered where it counts: scheduling, supervision, and clinical fidelity at scale.

Clinical quality is the asset

If there was one theme Molko kept returning to, it was clinical integrity. Families vote with their feet; when quality slips, revenue follows. Serious buyers now diligence training systems, outcomes posture, and alignment between programs when rolling in tuck-ins. If a buyer isn’t probing clinical quality early, that’s a red flag for sellers—and a risk for buyers post-close.

What “deal-ready” really means (for sellers)

Choose advisors who live ABA deals (banker, counsel, QoE) and be honest about platform vs. tuck-in. Keep the core deal team tight (often CEO + CFO); protect operations from deal fatigue—sliding metrics can trigger a retrade. Third-party billing is fine if collections and clean-claim rates are strong. Some buyers view in-house RCM as upside. If you’re rolling significant equity, underwrite your buyer’s plan the way they underwrite you: fund size, capital earmarked for de novo/M&A, tech investment cadence, leadership stability.

The Monday-after problem

Post-close “handcuffs” are real—financial (rollover/earn-outs) and philosophical (board control, growth targets). Know which you’re accepting. As Molko warned, once the badge changes, founders often lose day-to-day say. If you care about the program and the people, make that a term—not an assumption.

Where this leaves the market

The frenzy has cooled, but not the thesis. Autism prevalence isn’t shrinking; payers still need capacity; families still search for reliable care. What’s changed is the discipline: Buyers want repeatable de novo machines with clean data and uncompromising clinical quality. Sellers who show depth over breadth, outcomes over optics, and a tight operating model will still find strong partners.