New York Medicaid ABA Rate Cut: How the Lowest Rate in the U.S. Could Affect Providers

Veronica Cruz

3 hours ago

4 min read

New York ABA providers have already seen two Medicaid rate cuts in the past year. Now, a third one is coming.

Starting October 1, 2026, New York Medicaid fee-for-service will pay $9.63 per 15-minute unit for CPT 97153. Four units come to $38.52 an hour. The rate is dropping from $14.45 to $9.63, which is another 33% reduction.

And this cut is aimed specifically at technician-delivered direct ABA treatment. The state describes it as a change in reimbursement methodology for ABA services provided by unlicensed individuals or technicians. New York says the change is meant to align payment with providers' training and experience.

How did 97153 fall from $19.26 to $9.63

October 2025: first reduction

Cuts 1 and 2 were announced together in the August 2025 Medicaid Update (Volume 41, Number 8). Both were authorized under the FY 2025-2026 enacted budget.

Cut 1 took effect October 1, 2025. The rate dropped from $19.26 to $16.85, a 12.5% reduction. Most practices absorbed it and kept their Medicaid panels open.

April 2026: second reduction

Cut 2 hit April 1, 2026. Another 12.5%, down to $14.45. CASP testified before the New York State Senate in February 2026. An Action Network petition circulated. Neither stopped it.

After the second cut, Autism Learning Partners closed all of their New York Medicaid and Child Health Plus panels to new patients. They were serving 523 children, 480 on Medicaid. 118 more were on the waitlist. Planned centers in Albany and Yonkers were cancelled.

October 2026: third reduction

Cut 3 was announced September 17, 2026, in the August 2026 Medicaid Update (Volume 42, Number 9). Authorized under the FY 2026-2027 budget. About two weeks' notice for a 33% drop.

Effective date	97153 rate/unit	Hourly (4 units)	From original
Before Oct 2025	$19.26	$77.04	Base rate
Oct 1, 2025	$16.85	$67.40	-12.5%
Apr 1, 2026	$14.45	$57.80	-25%
Oct 1, 2026	$9.63	$38.52	-50%

The $9.63 rate was actually proposed before

This is the part a lot of people miss. The $9.63 rate didn’t suddenly appear in September 2026.

Back in early 2025, the governor’s executive budget proposed using different ABA rates based on provider credentials. In a February 2025 letter, CASP warned that setting the 97153 technician rate at $9.63 would make it the lowest in the country and could seriously damage provider networks.

The legislature didn’t approve that approach. Instead, it moved forward with a 25% cut across the board.

Then, during the February 2026 budget hearing, the Department of Health said, “Last year we had made a proposal. But I think this proposal gets back to what the executive proposed last year.”

So the $9.63 rate wasn’t really a new idea. The state proposed it once, faced pushback, and brought it back a year later.

Why is New York cutting 97153 instead of every ABA code

The state calls this a "reimbursement methodology change," not a rate cut. Their reason is that unlicensed technicians shouldn't be reimbursed at the same level as licensed behavior analysts.

At first, that seems like a reasonable distinction. In practice, 97153 carries most of the billable hours and most of the revenue for any ABA practice in the state. You can't replace that volume with supervision or assessment codes. The clinical model doesn't work that way.

What does $38.52 an hour actually mean for an ABA practice

Autism Care Partners says technician wages in Brooklyn, the Bronx, and Long Island run north of $30 an hour. Nationally, the norm is closer to $25. New York isn't a $25 market.

Take an RBT at $30 an hour fully loaded. The state pays $38.52 for that hour. That leaves $8.52 before supervision, rent, admin, insurance, training, or anything else.

Some practices were already struggling at $14.45. At $9.63, the math doesn't close. Andy Lopez-Williams told Behavioral Health Business his practice will discontinue ABA services on September 30. He serves roughly 40 children, primarily on Medicaid.

What should ABA practices check before October 1, 2026

Three rate changes in twelve months break billing workflows. Here's what to check before the new rate takes effect.

Update the 97153 fee schedule

Your fee schedule needs to reflect $9.63 for 97153 while keeping every other ABA code at $19.26. If your billing software doesn't handle code-level rate splits, claims go out wrong.

Separate FFS from managed care

The $9.63 rate applies to fee-for-service. Managed care organizations may implement a different rate on a different date. Track which payers have updated and which haven't.

Check October ERAs for underpayments

Once October claims start processing, compare ERA payments against the correct rate for each payer. Underpayments at $9.63 are money you won't get back unless somebody catches them.

Review authorizations and units

Authorization rules can shift alongside rate changes. Sessions that auto-approved at $14.45 might need extra documentation at $9.63.

Work old AR before margins get tighter

If you've got outstanding Medicaid AR from the $14.45 or $16.85 rate periods, chase it now. Those dollars are worth more per claim than anything you'll bill at $9.63.

We've got billing teams matched to specific states, and New York is one of them. They track rate changes, MCO implementation dates, and fee schedule splits every day. If your billing team is trying to keep up with all of this at once, give us a call.

Are other states cutting ABA Medicaid rates too

Medicaid rate cuts are moving through ABA in multiple states. But a 50% cut in twelve months, in a state where $30 an hour barely covers an RBT's wages, is a different scale of damage.

How could the ABA rate cut affect families

Your child qualified for ABA. You found a provider. Sessions started. Progress started.

Then the provider tells you they can't keep seeing your child at this rate. You go back on a waitlist that's longer now because fewer providers are accepting Medicaid patients. And with new provider enrollment frozen, the pipeline isn't adding capacity.