New York Medicaid ABA Therapy Rate Cuts: What the 25% Reduction Means for Families (2026)

What Changed for ABA Therapy Medicaid Coverage in New York

If your child receives Applied Behavior Analysis (ABA) therapy through New York Medicaid or Child Health Plus, you may already be feeling the impact of two rate cuts that took effect over the past year. Between October 2025 and April 2026, New York State reduced the Medicaid reimbursement rate for technician-delivered ABA therapy (CPT code 97153) by a total of 25 percent, and some providers have already stopped accepting new Medicaid patients as a result.

Here is what parents and caregivers in New York need to know about the cuts, why they happened, what the proposed "Centers of Excellence" framework could mean going forward, and how to keep your child's ABA services on track.

The 25% Rate Cut, Explained

New York's Medicaid ABA benefit is relatively new. The state mandated commercial insurance coverage for ABA back in 2012, but Medicaid did not begin reimbursing for ABA therapy until 2021, and the benefit was carved into Medicaid Managed Care starting January 1, 2023. As utilization grew quickly, the state's FY 2025-2026 enacted budget authorized a reduction to the reimbursement rate for CPT 97153, the code most commonly billed for one-on-one, technician-delivered ABA sessions.

The cut was phased in two steps:

• October 1, 2025: The rate dropped from $19.26 to $16.85 per 15-minute unit, a 12.5% reduction.
• April 1, 2026: A second 12.5% reduction brought the rate down to $14.45 per 15-minute unit, completing the full 25% cut.

Other ABA-related codes, including 97151, 97152, 97155, and 97156, remain at $19.26, and group codes (97154, 97157, 97158) are reimbursed at $3.31 per unit per member. But because 97153 covers the bulk of direct, hands-on therapy hours most children receive, the cut affects the core of most treatment plans.

Why New York Cut ABA Rates

New York's move mirrors a national pattern this year. States including Nebraska, North Carolina, Indiana, Colorado, Kentucky, and Minnesota have all reduced ABA Medicaid reimbursement in 2026 as spending on the benefit has grown far faster than the number of children being served nationally. The Centers for Medicare & Medicaid Services (CMS) has reported that national Medicaid and CHIP spending on ABA therapy grew roughly 421% between 2021 and 2025, far outpacing the growth in the number of children served, prompting states to look for ways to slow the growth in spending, sometimes through tighter medical necessity review and sometimes, as in New York's case, through direct rate cuts.

How Providers Have Responded

The cuts have already reshaped access for some families. A joint survey conducted by the New York State Association for Behavior Analysis (NYSABA) and the Council of Autism Service Providers (CASP) found that 74% of Medicaid ABA providers said they would leave the Medicaid program if the second rate reduction went through. Some already have. Autism Learning Partners, one of the larger multi-state ABA providers, announced it closed its New York Medicaid and Child Health Plus panels to new patients as reimbursement fell below what the company considered sustainable, citing that New York's rates had dropped below levels in states with a lower cost of living, including Texas.

For context, New York's post-cut rate of $14.45 sits below New Jersey ($18.10) and Massachusetts ($23.55), though above Connecticut ($14.00), according to state rate comparisons compiled by industry trade press.

What Is the "Centers of Excellence" Proposal?

Governor Hochul's FY 2026-2027 Executive Budget proposed an additional layer of change: a "Centers of Excellence" designation framework for ABA providers, alongside further proposed cuts totaling an estimated $28.5 million over two years. The stated purpose, according to the administration, is to "ensure ABA treatments are clear and appropriate."

As of the most recent budget hearings, several important details remain undefined publicly:

• What criteria a provider must meet to qualify as a Center of Excellence
• Whether families would need to use a designated Center to keep Medicaid coverage
• Whether the framework would add new pre-authorization steps before therapy can begin or continue
• A firm implementation timeline

Provider associations, including NYSABA, and U.S. Representative Ritchie Torres have publicly raised concerns that the framework, without more detail, risks adding administrative barriers and delays for families who are already navigating a complicated system. Families should watch for updates as the budget process moves forward, since a designation requirement could change which providers are in-network for Medicaid ABA services.

What This Means for Your Family Right Now

If your child currently receives ABA therapy through New York Medicaid or Child Health Plus, here are practical steps to protect continuity of care:

1. Confirm your provider is still accepting Medicaid

Rate cuts have led some agencies to close Medicaid panels or reduce the number of Medicaid clients they serve. Call your provider directly to confirm they are still in-network and accepting your child's plan, and ask whether they anticipate any changes to your child's hours or schedule.

2. Ask about your authorization and hours

If your provider reduces staff or restructures caseloads in response to lower reimbursement, your child's scheduled hours could be affected even if their authorization has not changed. Ask specifically whether your child's approved hours are being fully delivered.

3. Know your appeal rights

If your child's ABA services are reduced, denied, or terminated, you have the right to request a fair hearing through New York State Medicaid. CMS guidance issued in 2026 reinforces that states and managed care plans cannot use arbitrary hour caps as a substitute for individualized medical necessity determinations, and that a "plateau" in measurable progress is not, by itself, a valid reason to end services that help your child maintain skills or prevent regression.

4. If your provider closes its Medicaid panel, start looking early

Finding a new in-network ABA provider can take time, especially given New York's existing shortage of Board Certified Behavior Analysts (BCBAs). Do not wait until services actually stop. Start researching alternative providers as soon as you learn of any changes.

5. Explore your options if you lose Essential Plan coverage

Separately from the ABA-specific cuts, industry analysts have flagged that changes to New York's Essential Plan could affect coverage for hundreds of thousands of New Yorkers in the coming year. If your family's coverage is tied to the Essential Plan, check your renewal notices closely and ask your provider or a benefits counselor about your options if your plan changes.

This article is for general informational purposes only and is not legal or medical advice. If your child's ABA services are denied or reduced, consult your Medicaid managed care plan, a benefits counselor, or a licensed attorney about your specific appeal rights.

Finding an ABA Provider in New York

Even amid rate pressure, ABA therapy remains a covered Medicaid benefit in New York, and many providers continue to serve Medicaid families. If you need to find a new provider, or want to compare options near you, ABA Navigator's provider directory lets you search for ABA therapy providers across New York by location, insurance accepted, and services offered, so you can find a provider who is currently accepting your child's plan.

The Bottom Line

New York's 25% Medicaid rate cut for technician-delivered ABA therapy, phased in between October 2025 and April 2026, has already pushed some providers to stop accepting new Medicaid patients, and a proposed "Centers of Excellence" framework could bring further changes to how families access care. If your child relies on Medicaid-funded ABA therapy, stay in close contact with your provider, know your appeal rights if services are reduced, and start researching backup options early if your current provider signals any instability.

Search ABA Navigator's directory to find ABA therapy providers accepting Medicaid near you in New York.