By Sydney Stuhrenberg M.Ed., Product Specialist
A Major Shift for New York’s ABA Community
New York’s behavioral health landscape is facing significant change. The state’s budget proposals for 2025-2027 include Medicaid reductions that directly impact Applied Behavior Analysis (ABA), a move that could reshape access, reimbursement, and operations for hundreds of providers serving children with autism. The proposed budget aims to reduce overall Medicaid spending by approximately $28.6 million across two years, with ABA services among the targeted areas. For providers who rely heavily on Medicaid reimbursement, these cuts signal a new era of financial and operational pressure.
The Numbers: What’s Being Cut and When
According to the New York State Association for Behavior Analysis (NYSABA), the reductions include $9.6 million in FY 2025–26 and $19 million in FY 2026–27 for the Medicaid ABA benefit. Additionally, the New York State Department of Health (DOH) announced a 12.5% reduction in reimbursement for CPT code 97153 effective October 1, 2025, bringing the rate to $16.85 per 15-minute unit. A second 12.5% reduction is scheduled for April 1, 2026. These adjustments significantly impact provider reimbursement levels.
Why These Cuts Are Happening
New York’s Medicaid program is one of the largest in the country, covering roughly one-third of the state’s population. Lawmakers have framed these reductions as part of broader cost-containment efforts to manage rising healthcare expenditures. However, behavioral health advocates, including Autism Speaks, NYSABA, and CASP, warn that these cuts could widen inequities in access to care and reverse recent progress in autism service coverage.
The Real-World Impact on ABA Providers
The planned rate changes will compress margins, increase workforce pressure, and potentially reduce access for families who rely on Medicaid. Smaller agencies may struggle to stay sustainable as reimbursement rates fall below service delivery costs. Provider groups have cautioned that workforce shortages, longer waitlists, and higher administrative burdens may follow if the reductions proceed as planned.
Strategic Steps to Stay Resilient
To remain financially resilient, ABA practices should monitor key metrics including reimbursement rate per CPT code, cost per delivered hour, accounts receivable days, denial rates, payer mix, waitlist size, and staff utilization. Tracking these key metrics on a monthly basis can help identify early financial or operational risks. Additionally, providers should consider doing the following:
1. Analyze profitability by payer and service type.
2. Strengthen billing and documentation accuracy.
3. Optimize staff scheduling and utilization.
4. Diversify referral pipelines and payer mix.
5. Engage in policy advocacy with NYSABA or CASP.
6. Communicate transparently with families about changes.
The Bigger Picture
These Medicaid reductions highlight a broader national challenge: balancing state budget pressures with equitable access to autism services. New York’s policy decisions may set a precedent for other states considering similar measures. Provider organizations continue to advocate for sustainable reimbursement that protects both care quality and financial stability.
New York’s Medicaid cuts represent a structural test for ABA providers. Agencies that rely on Medicaid must adapt quickly, tracking key metrics, improving efficiency, and staying engaged in advocacy. As of October 2025, provider coalitions continue to urge the state to reconsider the rate schedule to ensure children and families maintain access to essential ABA services.