The Second Cut Landed. Then the Largest Provider Left.
On April 1, 2026, New York Medicaid implemented its second consecutive 12.5% reduction to ABA reimbursement rates. CPT code 97153 — technician-delivered behavior treatment — dropped to $14.45 per unit, completing a 25% total reduction from pre-cut levels.
Sixteen days later, on April 17, 2026, Autism Learning Partners issued a public announcement: it is closing all New York Medicaid and Child Health Plus panels to new patients, effective immediately.
The company’s statement was direct: two consecutive rate reductions “have materially reduced reimbursement and rendered continued Medicaid services financially unsustainable.”
ALP is one of the largest ABA providers in the country, operating six locations across New York — in Buffalo, Albany, Rochester, Westchester, and the Bronx. Currently serving 523 children in the state (480 of them Medicaid or Child Health Plus members), the company says the rate environment will prevent it from serving an estimated 425 additional children in 2026. A new Albany center and a planned Yonkers location have been halted.
This is what the end of a rate-cut cycle looks like.
How New York Got Here
The cuts were not a surprise. They were written into the state budget.
New York’s enacted 2025-26 budget included $9.6 million in ABA Medicaid savings for the fiscal year — achieved by phasing in a 25% total rate reduction across two installments:
- October 1, 2025: First 12.5% cut. CPT 97153 dropped to $16.85 per unit.
- April 1, 2026: Second 12.5% cut. CPT 97153 dropped to $14.45 per unit.
The state’s FY26-27 budget projects $19 million in ABA savings — the full annualized impact of the 25% reduction now in effect.
Before the cuts, New York’s ABA rates were not exceptional, but they were defensible for a high cost-of-living state. After both cuts, they are not. ALP’s announcement includes a specific comparison: New York’s ABA reimbursement rates are now lower than Texas, despite substantially higher costs of operating in New York.
That comparison matters. Texas is not known for high Medicaid generosity. When a state with New York City-area labor costs and real estate is paying less per unit than a state with Dallas-area costs, the rate signal is telling providers something clear: you cannot make the economics work here.
What ALP’s Exit Actually Means
Autism Learning Partners’ panel closure applies to new Medicaid and Child Health Plus patients as of April 17. Existing clients — the 480 Medicaid and CHP members ALP currently serves — are not being discharged. The company is managing continuity of care for its current population.
But 523 children served means roughly 523 families who found a provider willing to take them. The waiting list alone stands at 118. And the 425 future children ALP projects it will not be able to serve in 2026 are children who will call providers and find no Medicaid capacity — or will be told to get on a list and wait.
ABA therapy is not a commodity where one large provider’s exit simply redirects clients to equivalent alternatives. ALP’s six New York locations have trained staff, clinical infrastructure, and community relationships built over years. When that capacity exits the Medicaid market, it does not get immediately replaced.
The remaining Medicaid-participating providers in the markets ALP serves — Buffalo, Albany, Rochester, Westchester, the Bronx — will face increased demand at the same rates ALP determined it could no longer sustain. The arithmetic does not work in their favor either.
This is the access consequence that rate cut advocates rarely model. The policy analysis focuses on spending reduction. The operational reality is that reducing rates below a sustainability threshold doesn’t save money by serving fewer people efficiently — it saves money by not serving people at all.
New York Used a Blunt Instrument
The way New York structured its ABA rate reduction differs from what other states are doing, and that distinction matters for how to think about what comes next.
Indiana, North Carolina, and Colorado responded to ABA spending growth with a mix of tools: accreditation requirements, prior authorization, hour caps, and for Indiana, an enforcement infrastructure that includes rate phasedowns and a temporary moratorium on new provider enrollment. Georgia’s CareSource used its managed care contract authority to cut rates unilaterally below the state fee schedule. The OIG used claims-level documentation audits to identify specific improper payments.
New York used a line item in the state budget. No audit findings, no quality metrics, no accreditation requirement, no differentiation between providers with strong outcomes and providers with documentation problems. Every ABA provider billing Medicaid in New York had their rate cut 25% because the budget needed $9.6 million in savings.
That approach doesn’t distinguish between a practice with rigorous supervision, strong RBT retention, and measurable clinical outcomes and one with none of those things. It cuts everyone the same.
The practical effect: the providers with the most operational discipline — those with the infrastructure to survive a 25% rate cut — will absorb some of the remaining Medicaid population. The ones operating on tighter margins, often smaller practices that serve underserved communities, may not survive it. New York will spend less money and serve fewer children in the Medicaid population. Whether it gets better ABA outcomes per dollar spent is a question the budget process didn’t ask.
What New York ABA Practices Should Do Now
This week:
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Recalculate your Medicaid revenue at $14.45 per 97153 unit if you haven’t already. If your cost per technician-delivered session isn’t covered at current rates, you need to know that now — not at the end of Q2.
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Audit your payer mix. What percentage of your revenue is NY Medicaid fee-for-service versus commercial insurance, managed care plans, or other Medicaid products? Different managed care organizations may have rate structures above or below the state floor — but many are pegged to it.
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Assess your capacity decisions. ALP just pulled 425 future slots from the Medicaid market in New York. If you have Medicaid capacity and want to fill it, now is the time to be visible to families who would have gone to ALP. If you cannot sustain Medicaid at current rates, a transparent decision now is better than a crisis decision later.
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Document your cost per session by CPT code. If you engage with your state association or advocacy organizations — and you should — you need actual numbers: cost per delivered session against current reimbursement, broken down by code. Anecdotal impact statements don’t move budget conversations. Documented unit economics do.
This month:
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Connect with the New York State Association for Behavior Analysis. NYSABA submitted formal comments opposing the budget cuts before they were implemented. The advocacy infrastructure exists. If the rate environment is untenable, that case has to be made through organized channels — and made with data.
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Evaluate the viability of your Medicaid program honestly. If a 25% rate cut makes your Medicaid program structurally unsustainable, planning for an orderly transition is better than waiting until the crisis forces one. Orderly means maximum notice to families, connection to remaining providers, and retention of your commercial-payer population. ALP is doing this correctly — existing clients maintained, new intake suspended, announcement public. That’s a model, not a failure.
The National Picture
New York’s situation is part of a pattern that is accelerating across states.
The HHS OIG’s multi-state audit series found documentation problems in effectively 100% of sampled ABA claims in Colorado, Indiana, Wisconsin, and Maine. The political conclusion many state legislatures drew from those findings: ABA spending grew faster than oversight grew, and the federal government is now finding systemic problems. The policy response has been varied but the direction is consistent — contain costs and increase accountability.
New York chose cost containment through rate cuts. Indiana chose rate cuts plus accreditation mandates plus hour caps plus a moratorium. North Carolina chose accreditation enforcement plus a pending prior authorization framework. Georgia’s CareSource chose a 20% MCO-level cut with a take-it-or-leave-it contract structure.
None of these approaches have been evaluated for whether they actually improve outcomes per dollar spent. They are all reactions to spending growth, audit findings, and political pressure. They are being implemented at different speeds with different tools, but they are converging on the same structural conclusion: the ABA reimbursement environment that existed in 2022 is not returning.
The practices that will survive this cycle are the ones that can answer the question every payer and every state budget office is now asking: What outcomes are you producing, at what cost, with what documentation?
That’s not a compliance question. It’s an existential one.
Questions about modeling Medicaid rate scenarios or building the documentation infrastructure that holds up under payer and state scrutiny? Reach out at [email protected].
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Sources
- Autism Learning Partners Closes New York Medicaid Panels as Reimbursement Falls Below National Benchmarks | PR Newswire (April 17, 2026)
- States Refine ABA Coverage: New Hour Caps, Age Limits, Rate Cuts | Behavioral Health Business (January 22, 2026)
- Behavioral Health Predictions for 2026: Autism Rate Cuts, TMS on the Rise | Behavioral Health Business (January 7, 2026)
- New York State Medicaid Update — August 2025, Volume 41 Number 8 | NY DOH
- New York State Association for Behavior Analysis Legislative Comments | NY Senate
