New York Now Pays $38.52 an Hour for ABA. We Checked the Federal Number Behind the Cuts.

On October 1, 2026, New York Medicaid began paying $9.63 for fifteen minutes of ABA delivered by a technician. Four units make an hour, so an hour of direct therapy now collects $38.52 in fee-for-service. In September 2025 the same hour collected $77.04.

That is the third cut to the same code in twelve months, and it is the one that has providers using the word structural rather than tight. A month earlier and 900 miles south, Georgia’s managed care plan for foster children cut ABA rates 30%, with the notice arriving in August for a September 1 effective date.

Both decisions point at the same justification: Medicaid spending on ABA has grown fast. The number carrying that argument is 421%, and it comes from a CMS toolkit published in August. We read the toolkit. The figure is real and the growth is real. But the comparison CMS drew in its own press release is not the comparison its data supports, and the difference matters if you are a clinic owner being handed that number across a negotiating table.

What New York actually did, in its own words

The authority is the New York State Medicaid Update for August 2026 (Volume 42, Number 9), under the heading “Reimbursement Change for Unlicensed Individuals Providing Applied Behavior Analysis Services.” Three details in that notice get lost in the retelling.

It is one code. The cut applies to CPT 97153, technician-delivered treatment. Codes 97151, 97152, 97155, and 97156 remain at $19.26 per unit. Calling this an across-the-board New York ABA rate cut is wrong, and it has been wrong all three times. It is a targeted cut, repeated, to the single code that carries the most volume in a comprehensive program.

It is fee-for-service. The notice addresses NYS Medicaid fee-for-service and says nothing about managed care. If your New York book is mostly managed care, your rates are set by contract, and the state notice does not change them by itself. It also does not stop a plan from following.

The state says this is deliberate pricing, not austerity. The notice says the change “ensures providers of ABA services are compensated equitably for their training and experience.” Read against a cut that touches only the unlicensed-technician code, that is a statement that New York thinks technician time was overpriced relative to licensed time. Whatever you make of it, it is not a temporary budget patch, and it tells you which direction the next proposal will come from.

$19.26

Per-unit rate for 97153 before October 2025, which is $77.04 for an hour of technician time.

$16.85

Effective October 1, 2025, under the enacted FY 2025-2026 budget. The first of three cuts.

$14.45

Effective April 1, 2026. Cumulatively about 25% below the starting rate at this point.

$9.63

Effective October 1, 2026, under the enacted FY 2026-2027 budget. This is $38.52 an hour, and a 50% reduction in twelve months.

The arithmetic problem nobody can staff around

We built the wage-against-reimbursement model for our BCBA and RBT salary reference earlier this year, and New York was already the worst cell in the table: the highest technician-proxy wage median of the ten biggest markets paired with the lowest technician reimbursement of the fee schedules we mapped. That was at $14.45 a unit.

At $38.52 a collected hour, a technician paid $25 an hour consumes 65% of the revenue that hour produces. That is before payroll taxes, before benefits, before the supervision the code set requires, before documentation time, and before every cancelled session that pays nothing and still costs a scheduled wage. Clinics do not have a 35% overhead structure. Nobody does.

This is why the New York cut reads differently from a 6% trim. A 6% cut is a margin problem you solve with scheduling discipline and better authorization management. A 50% cut to your highest-volume code is a question about whether the payer is viable at all, and the honest answer for some clinics is no. That is a different decision, and it belongs to the owner, not the billing department.

Georgia: the cut came from the plan, not the state

Georgia is the more instructive case, because watching the state fee schedule would not have warned you.

Amerigroup, part of the Elevance family, is the sole care management organization for Georgia’s Medicaid foster children. In August it sent clinics notice of a 30% ABA reduction effective September 1, 2026. Dr. Michelle Zeanah, who runs a clinic in southeast Georgia, told the Georgia Recorder she doubted it would move that fast until September remittances arrived cut by 30%. Her assessment was blunt: “From a business perspective, we’ll be too far in the red.”

Amerigroup’s notice described the change as intended to better align reimbursement across autism services, and in an email to the state obtained by the Recorder it said it would raise rates for caregiver-training work instead, calling the structure “a more targeted and clinically defensible approach.” That is the same logical move New York made: price technician delivery down, price professional and caregiver-facing work up.

Two things make the foster-care population a harder case than a commercial panel. These families cannot switch plans, because Amerigroup is the only option for foster children. And Georgia sets no managed care rate floor for ABA, so there is no state minimum the plan had to respect. The state’s stated position is that where no in-network provider is available, Amerigroup must arrange out-of-network care case by case. That is a real protection and a nearly useless one, because it depends on a foster parent knowing to ask for it.

Georgia now has two of its three Medicaid plans cutting ABA independently of the state: CareSource moved its network to 80% of the state fee schedule earlier in the year, and now this. The operational lesson generalizes past Georgia. If you track state fee schedules and not plan amendments, you are watching the wrong document. Our state-by-state Medicaid rule tracker follows both, and every entry is sourced to the bulletin, statute, or fee schedule it came from.

The 421% figure, and what CMS left out of its own press release

On August 4, 2026, CMS published a 173-page ABA toolkit for states alongside a press release. The release says ABA spending in Medicaid and CHIP rose 421% between 2021 and 2025, “far outpacing the 67% growth in the number of children with an autism spectrum disorder (ASD) diagnosis receiving services.”

That sentence has been repeated in trade coverage, state presentations, and plan notices for two months. It is also the wrong pairing, and the toolkit says so on its own pages.

Here is the same data expressed the way a clinic owner would want it. Spending rose to 5.21 times its 2021 level. Children receiving ABA rose to 2.89 times theirs. Divide the first by the second and spending per child receiving ABA rose roughly 80% across those four years. That arithmetic is ours, derived from CMS’s two published percentages rather than from a third CMS figure, so treat it as a derived estimate. But an 80% rise in cost per child over four years is a very different policy problem from a 421% one, and it is the one the states are actually responding to.

One more number in that toolkit deserves more attention than it has had. In 2025, $1.47 billion, or 14.5% of all Medicaid and CHIP ABA spending, paid for ABA delivered to children without an ASD diagnosis, for conditions including ADHD. That is a seventh of national ABA spending sitting outside the diagnosis the entire coverage framework is built around. Whatever your view of ABA for other presentations, that is the line item most likely to attract the next round of utilization management, and almost nobody is talking about it.

What the toolkit does and does not do

Worth being precise here, because it is being described as a crackdown. CMS states that the toolkit is not a restriction on autism services. It establishes no new federal requirements, does not reduce states’ EPSDT obligations, does not endorse any single approach to ABA, and does not direct states to limit medically necessary care. It is a menu of suggested practices across provider qualifications, benefit design, payment, utilization management, and program integrity, plus a self-assessment checklist.

That makes it more consequential rather than less. A rule can be challenged. A menu of options handed to fifty state agencies, each under its own budget pressure, produces fifty separate decisions on different timelines, and no single one of them is big enough to organize against. That is roughly what 2026 has looked like already: North Carolina rewrote supervision and reauthorization rules, Indiana added a lifetime hour cap and ended adult coverage, New York cut one code three times, and two Georgia plans cut outside the fee schedule entirely.

What to actually do with this

Reconcile a remittance, not a fee schedule. Georgia clinics learned about a 30% cut from September benefit statements. Pull one month of remittances per payer and compare the paid amount per unit against what you believe you are contracted for. Plan amendments arrive by letter and take effect in weeks.

Model each payer separately at the code level. Your blended rate hides the problem, because these cuts are landing on single codes. Work out, per payer, what one hour of 97153 collects and what it costs you to deliver with wages, burden, and required supervision included. Some of those cells will be negative, and you cannot make that decision without seeing them.

Know the objection window before you need it. Managed care amendments typically carry a contractual objection period and a termination clause. CareSource’s Georgia amendment ran 45 days to object with termination 90 days after. Those dates are in your contract, and they are the only real leverage you have once a notice arrives.

Separate the state story from the plan story. They move independently and the plan usually moves faster. Watching only one is how clinics get surprised.

And one piece of timing worth putting on next year’s calendar: the entire ABA code set changes on January 1, 2027, with six new codes and a redefinition of 97155. CMS extended contractor pricing through 2027, which means the new codes arrive with no national rate attached and every payer negotiating separately. Walking into that conversation during a cutting cycle is the position most clinics will be in. Our 2027 ABA CPT code reference maps the new set against the one you bill today.

Citing this page

Suggested citation: ABA Clinic Marketing, “New York Now Pays $38.52 an Hour for ABA. We Checked the Federal Number Behind the Cuts,” October 16, 2026, abaclinicmarketing.com/blog/aba-medicaid-rate-cuts-october-2026. Rate figures come from the New York State Medicaid Update for August 2026; spending and utilization figures from the CMS Applied Behavior Analysis Services Toolkit for States, August 2026; Georgia reporting from the Georgia Recorder. Cite those sources for the underlying numbers. If you find an error here, tell us and we will fix it and say so.