New York Medicaid’s Latest ABA Rate Cut: What It Means for Providers and Families
New York Medicaid’s latest reimbursement cut for applied behavior analysis is now in effect. For dates of service beginning October 1, 2026, New York’s Medicaid fee-for-service program pays $9.63 per 15-minute unit for technician-delivered ABA billed under CPT code 97153—just $38.52 per hour in gross reimbursement.
This is the third reduction to CPT code 97153 in 12 months, cutting the rate in half from where it stood one year ago. Providers across the state question how that reimbursement can sustain the workforce and operating costs required to continue serving Medicaid members.
What Changed on October 1, 2026?
According to the New York State Department of Health, New York Medicaid fee-for-service reduced reimbursement for technician-delivered ABA services billed under CPT code 97153 to $9.63 per 15-minute unit effective October 1, 2026.
This is the amount paid to the provider to reimburse the service, not the behavior technician’s hourly wage. From that revenue, the provider must cover technician wages, employer payroll taxes, benefits, recruiting and training, billing and administrative work, insurance, practice-management technology, and other operating expenses.
How Does the New Rate Compare With Earlier Reimbursement?
The October 2026 change is the third reduction to New York Medicaid’s fee-for-service reimbursement rate for CPT code 97153 within 12 months:
October 1, 2025: $19.26 decreased to $16.85 per unit.
April 1, 2026: $16.85 decreased to $14.45 per unit.
October 1, 2026: $14.45 decreased to $9.63 per unit.
Taken together, the reductions cut reimbursement for technician-delivered ABA services by 50%. Before the first cut, four units of 97153 generated $77.04 in gross hourly reimbursement. Under the current rate, the same four units generate $38.52.
The rate changes are particularly notable because New York’s Medicaid ABA benefit is relatively new, as it was one of the last states to implement ABA coverage. Fee-for-service coverage began on August 1, 2021, with reimbursement initially set at only $7.25 per 15-minute unit, or $29 per hour. In April 2022, the state substantially increased the rate to $19.07 per unit.
In a little more than five years, New York moved from launching and expanding its Medicaid ABA benefit to cutting reimbursement for its primary direct-treatment code by half.
How Does New York’s Reimbursement Rate Compare With Other States?
According to the Council of Autism Service Providers’ 50-State ABA Medicaid Benefit Comparison, the average among comparable state Medicaid reimbursement rates for CPT code 97153 is $63.80 per hour. New York’s current rate of $38.52 is $25.28 lower—or approximately 40% below that benchmark.
The disparity is especially notable because New York is also one of the country’s highest-cost states. Providers must recruit and retain technicians while managing wages, benefits, insurance, supervision, facilities, and other operating expenses that may be substantially higher than those in lower-cost states.
Why the 97153 Rate Matters So Much
Many ABA programs use a tiered service-delivery model. A behavior analyst assesses the client, develops and updates the treatment plan, and provides clinical oversight. Trained behavior technicians then implement that plan during face-to-face treatment sessions billed under CPT code 97153.
Because 97153 can account for a substantial portion of a client’s treatment hours, reductions to this code can have an outsized effect on a provider’s operations. Each hour now generates half the gross reimbursement it did one year ago, even though the costs of technician wages, supervision, training, documentation, scheduling, and administration haven't fallen alongside it. For many providers, technician-delivered services were already operating on narrow margins, leaving little room to absorb a reimbursement reduction of this magnitude.
The New York State Department of Health describes the revised rates as a way to compensate providers equitably based on their training and experience. Providers and advocacy organizations, however, have questioned how the new rate adequately reflects the cost and importance of technician-delivered care within the tiered model.
If providers cannot sustain technician-delivered services at the new rate, they may have to reconsider staffing, organizational structure, service areas, schedules, acceptance of new Medicaid referrals, or participation in Medicaid networks altogether. The resulting loss of provider capacity creates concerns regarding access to medically necessary services.
Medicaid programs and other payers are increasing their scrutiny of ABA providers. Brellium’s AI-powered platform reviews every clinical note before billing, helping your team identify documentation gaps, reduce manual chart-review time, and stay prepared for payer audits.
Strengthen your compliance program without adding more manual work. Explore Brellium.
New York Is Not the Only State Reducing ABA Rates
New York’s cuts are part of a broader national shift as state Medicaid programs reevaluate ABA spending, reimbursement methodologies, utilization controls, and provider oversight.
Nebraska revised its Medicaid ABA payment rates effective August 1, 2025. The state set its rate for CPT code 97153 at $18.70 per 15-minute unit and described the broader changes as an effort to align reimbursement with surrounding Medicaid programs while maintaining fiscal sustainability.
Indiana adopted phased ABA rate reductions, lowering its maximum fee for CPT code 97153 from $17.06 to $16.04 per unit on April 1, 2026. The rate is scheduled to decrease again to $15.39 on April 1, 2027.
Even after these changes, both states reimburse 97153 at rates considerably higher than New York’s $9.63 per unit.
Advocacy Efforts Are Underway
Professional associations, providers, and families are urging New York officials to reconsider the rate and pursue Medicaid reforms that protect program integrity without jeopardizing access to care. The New York State Association for Behavior Analysis and the Council of Autism Service Providers have opposed the reductions throughout the state’s budget process.
CASP is now collecting updated information from organizations that provide ABA services in New York through its New York Medicaid Access to Care & Provider Enrollment Survey. The survey focuses on how the rate changes and Medicaid provider enrollment moratorium are affecting provider participation, service capacity, and access to quality care. Organizations can submit feedback through CASP’s survey. CASP intends to use the findings in its advocacy with the New York State Department of Health, the governor’s office, and key legislative offices.
Will This Affect Service Availability for Families?
Potentially. The reimbursement reduction doesn't eliminate the Medicaid ABA benefit or directly impact a client’s authorized hours. It could, however, reduce the number of providers willing or able to serve Medicaid members. If reimbursement no longer covers the cost of delivering care, coverage on paper may not translate into access in practice.
The rate may also affect providers’ ability to offer competitive compensation to behavior technicians, including RBTs. When less revenue is available to cover wages, benefits, supervision, and overhead, organizations may face greater difficulty recruiting and retaining qualified staff. This could contribute to vacancies, turnover, and reduced service capacity.
The Bigger Picture
New York’s latest reimbursement reduction highlights the tension between controlling Medicaid spending and maintaining a provider network capable of delivering covered services. Although the full effect will take time to measure, the size of the cut raises legitimate concerns about whether providers can continue technician-delivered care at the current rate. Ultimately, a Medicaid benefit can only serve families if qualified providers are available to deliver it.
This article is for general educational purposes and should not be considered legal, billing, coding, contracting, or reimbursement advice. Medicaid policies and managed-care requirements may change. Providers should consult current state guidance, payer contracts, and qualified advisors when making operational or clinical decisions.
Partnership & Transparency Disclaimer
The content we share on ABA Resource Center is reader-supported. This means that if you click on certain links and make a purchase, we may earn a small referral fee. Rest assured, we only recommend tools, resources, and services that we genuinely believe add value to the ABA field. See more of our partners here.
Comments