New York Is Cutting 97153 to $9.63 a Unit on October 1. Here's What $38.52 an Hour Actually Buys.

Third Cut, Biggest Cut

New York Medicaid is cutting direct ABA therapy again. Effective October 1, 2026, fee-for-service reimbursement for CPT 97153 drops to $9.63 per unit. That’s $38.52 per billed hour.

The current rate is $14.45, so this cut alone is 33%. It is the third reduction in twelve months. The first two, 12.5% each, landed October 1, 2025 and April 1, 2026. We covered those, and Autism Learning Partners closing its New York Medicaid panels, back in April.

Stack the three together and 97153 goes from $19.26 to $9.63. Exactly half.

Per MediRate data cited by Behavioral Health Business, $9.63 makes New York’s fee schedule the lowest in the nation. The previous floor was West Virginia at $9.90. New York has the fifth-highest cost of living of any state.

Providers aren’t softening their reaction. “It is a death sentence of a rate cut — meaning that we will no longer be able to operate and provide services to children with Medicaid,” Dr. Andy Lopez-Williams, CEO of Utica-based ADHD & Autism Psychological Services and Advocacy, told BHB. About 90% of his direct-therapy patients are on fee-for-service or managed Medicaid.

Early CASP member survey data shows 97% of New York providers serving Medicaid patients either cannot continue or don’t know whether they can. The other 3% said they would cut back.

You have about a week. Here’s the math, and here’s what to do with it.

What the Notice Actually Says

The change ran in the New York State Medicaid Update (August 2026, Volume 42, Number 9), under the heading “Reimbursement Change for Unlicensed Individuals Providing Applied Behavior Analysis Services.” BHB reports the program announced it September 17.

Four details matter:

1. It’s authorized by the FY 2026-2027 enacted budget. This isn’t a draft or a proposal. It’s law.
2. It targets 97153 only. The notice describes the code as ABA “provided by unlicensed individuals/technicians.” It says nothing about any other code.
3. It’s written as a fee-for-service change. The text says “NYS Medicaid fee-for-service (FFS) will decrease the fee.” It is silent on Medicaid Managed Care.
4. The state’s rationale is that the new methodology “ensures providers of ABA services are compensated equitably for their training and experience.”

Point 2 is where the rest of the fee schedule matters. The current eMedNY ABA fee schedule, effective April 1, 2026, pays $19.26 per unit for 97151, 97152, 97155, and 97156, with group codes 97154, 97157, and 97158 at $3.31 per unit per member. The October notice doesn’t touch those. After October 1, an LBA-delivered 97155 unit pays exactly twice a technician-delivered 97153 unit.

That’s the logic the state is signaling: pay for licensure, not for hours. The trouble, as several industry insiders told BHB, is that state officials don’t seem to understand the tiered model ABA runs on. The technician hours are the treatment. The LBA hours plan and supervise it. Cutting the tier that delivers most of the dosage doesn’t make it cheaper to deliver. It makes it unprofitable.

The Math: A Worked Example

Everything below is an illustrative example with stated assumptions. Swap in your own numbers. The structure is the point.

Assumptions:

• RBT wage: $22.00/hour. Downstate New York’s minimum wage is $17.00 (New York City, Long Island, Westchester) and $16.00 elsewhere as of January 1, 2026. $22 is a plausible competitive wage, not a sourced average.
• Paid-to-billed ratio: 1.25. For every billed hour, the RBT is paid for 1.25 hours once you count drive time between home sessions, same-day cancellations you still pay for, note-writing, and training. That’s 80% billable utilization, which is good.
• Employer taxes and workers’ comp: 10% of wages. Employer FICA alone is 7.65% (6.2% Social Security plus 1.45% Medicare). Unemployment insurance and workers’ comp make up the rest.
• Supervision: 5% of RBT service hours at $60/hour fully loaded LBA cost. New York Medicaid requires LBAs to supervise technicians for at least 5% of their service hours each month. We treat it as unbilled here. LBA time isn’t getting cheaper, either; our BCBA hiring and retention playbook covers why.
• No benefits. Many RBTs are part-time. If yours get health insurance or PTO, your cost goes up.

Cost per billed 97153 hour, downstate:

That $5.27, about 14% of revenue, has to cover rent, the billing team, schedulers, intake, the clinical director, liability insurance, recruiting, RBT certification, software, and any margin at all.

Now run it backward. With these assumptions, the RBT wage at which 97153 covers the technician and supervision and literally nothing else is $25.83/hour. Pay above that and every direct therapy hour loses money before a single overhead dollar.

Upstate at the $16.00 minimum wage, the same structure costs $25.00 per billed hour and leaves $13.52. That looks better on paper. It also assumes you can staff a caseload at the legal minimum wage in a job that requires certification and a background check, at the same time every other Medicaid provider in your region is trying to do the same.

Mariel Fernandez, CASP’s vice president of government affairs, put it more bluntly than a spreadsheet can: “Anybody who’s continuing to participate either is being subsidized in some way, or I would question if they’re really providing the service because I don’t see how this is possible.” Her summary: “The math doesn’t math.”

What it costs you in dollars: Compared with the current $14.45 rate, you lose $19.28 per billed hour. An RBT billing 25 hours a week for 48 weeks is 1,200 hours, or about $23,100 a year in lost revenue per technician. One client authorized for 20 hours a week of 97153 costs you $385.60 a week.

If you haven’t built your revenue model by CPT code and payer, our walkthrough on how to calculate ABA practice revenue covers the structure. Plug $9.63 into it.

Fee-for-Service vs. Managed Care: Find Out, Don’t Guess

The DOH notice says fee-for-service. It doesn’t say managed care. That doesn’t mean your Medicaid Managed Care plans won’t follow.

BHB’s reporting notes it is possible some MCOs may adjust their reimbursement, but likely not enough to offset a cut this deep to the base fee schedule. We’ve seen how this plays out elsewhere. In Georgia, CareSource cut ABA to 80% of the state fee schedule on its own authority. Managed care rates can move with the state fee schedule, against it, or independently, depending on how your contract is written.

So read your contracts. If a plan pays you “100% of the NYS Medicaid fee schedule” or a percentage of it, your rate moves on October 1 whether anyone sends you a letter or not. If a plan pays a fixed dollar amount per unit, it moves only when the plan amends the contract.

Then ask each plan in writing: what will you pay for 97153 on dates of service on or after October 1, 2026? Get the answer in an email you can find in six months.

What to Do Before October 1

1. Split your 97153 exposure by payer type. Pull the last 90 days of billed 97153 units and sort them into three buckets: NY Medicaid FFS, each Medicaid Managed Care plan, and everything else. The FFS bucket takes the cut for certain. The managed care buckets depend on the answers from the section above. That’s your real exposure, in units and dollars.

2. Load the new rate by date of service. Claims for dates of service on or after October 1 should expect $9.63. If your system prices claims from a fee schedule, add the new rate with an October 1 effective date now, so September sessions billed in October don’t get priced wrong and October sessions don’t show phantom underpayments you’ll waste time chasing.

3. Triage the caseload honestly. Look at each Medicaid client’s authorization: hours, code mix, setting. Home-based cases with long drive times are the most expensive to deliver per billed hour. Clinic-based cases with tight scheduling are the cheapest. If you have to cap Medicaid intake or reduce Medicaid capacity, decide on criteria before October, not case by case after. And if you do close intake, do it the way ALP did in April: existing families kept, new intake paused, clear notice.

4. Get your supervision billing right, not bigger. New York’s supervision rules already let part of the 5% minimum be met with 97155, which now pays twice what 97153 pays. But the August 2025 Medicaid Update is specific: 97155 counts toward supervision only “when the LBA joins the patient and the unlicensed individual/technician during a treatment session to direct the unlicensed individual/technician in implementing a new or modified treatment protocol.” Protocol modification that actually happens and is documented is billable. Relabeling routine observation as 97155 to recover lost revenue is how practices end up in audits, and New York plans are already clawing back claims for small procedural errors, per Lopez-Williams. Bill what happened.

5. Look at 97156. Caregiver training pays $19.26 per unit and wasn’t touched. If your treatment plans underuse parent training relative to what’s clinically indicated, this is a good time to fix that, for the kids’ sake first.

6. Send your numbers to people who can use them. Advocacy only works with data. Put your cost per billed 97153 hour, your Medicaid caseload, and your intake plans in a one-page summary, and send it to:

• The New York State Association for Behavior Analysis (NYSABA), which opposed the earlier cuts, and CASP, which is surveying New York members now
• Your state senator and assemblymember; the cut was authorized in the budget, and the budget is where it gets reversed
• The DOH Office of Health Insurance Programs, Division of Program Development and Management: [email protected], (518) 473-2160, the policy contact listed on the notice

The same Medicaid Update issue is recruiting members for the state’s new Medicaid Advisory Committee. If you want a seat at a table where Medicaid policy gets discussed, it’s in the same PDF as the cut.

Why Practices Outside New York Should Care

New York didn’t use audit findings, outcomes data, or accreditation to get here. It used a rate line. Parnes, of Yellow Bus ABA, warned BHB that other states watching New York “will see issues as well because the federal government’s looking to cut.” With CMS’s August ABA toolkit already giving states a template for tightening the benefit, a technician-code-only rate cut is an easy lever for any budget office to copy.

If your 97153 rate dropped by half tomorrow, would you know within a day which clients, payers, and staff it hits? That’s the question New York providers are answering this week.

Where Software Fits, Honestly

No software makes $38.52 an hour cover a $33.25 direct cost plus overhead. The rate is the problem.

What a system can do is make the decisions faster and the claims cleaner. In StreamABA, payer fee schedules carry effective dates, so a new rate applies by date of service instead of by the day someone remembered to update it. Billing and AR reporting break out by payer, so your FFS-versus-managed-care exposure is a report, not a spreadsheet project. Authorizations are tracked through unit burn-down, and supervision notes live next to session data, so every 97155 you bill has the documentation behind it.

When the rate floor falls, the practices that last are the ones that know exactly where they stand before the first remit arrives at the new price.

Need help modeling what $9.63 per 97153 unit does to your New York caseload? Reach out at [email protected].

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Sources

• Behavioral Health Business: ‘It Is a Death Sentence of a Rate Cut’: NY Medicaid Rolls Out 3rd ABA Rate Cut (September 23, 2026)
• NY DOH: New York State Medicaid Update, August 2026, Volume 42, Number 9: Reimbursement Change for Unlicensed Individuals Providing Applied Behavior Analysis Services
• NY DOH: New York State Medicaid Update, August 2025, Volume 41, Number 8: ABA Supervision and Reimbursement Reduction
• eMedNY: NYS Medicaid Applied Behavior Analysis Services Fee Schedule (effective April 1, 2026)
• Acuity News: NY Medicaid ABA Rates 2026: 25% Reduction & Centers of Excellence (April 23, 2026)
• Office of the Governor: Governor Hochul Reminds New Yorkers of Minimum Wage Increase on January 1 (December 22, 2025)
• IRS: Topic No. 751, Social Security and Medicare Withholding Rates