New York Cuts Medicaid Payments for Autism Therapy: What Families Should Know
New York has reduced Medicaid fee-for-service payments for certain applied behavior analysis, commonly called ABA, services delivered by unlicensed individuals or technicians. The change took effect October 1, 2026, according to the New York State Department of Health’s official reimbursement notice.
For families, the immediate question is whether their child’s provider will continue offering the same appointments.
The notice changes provider reimbursement. It does not announce the elimination of ABA coverage.
What exactly changed?
The state’s notice identifies CPT code 97153, used for certain technician-delivered ABA services, and sets Medicaid fee-for-service reimbursement at $9.63 per unit, effective October 1.
The Department of Health explains that the budget-authorized change is intended to align compensation with providers’ training and experience. Providers can review the notice in the August 2026 Medicaid Update.
The Times Union’s October 1 reporting describes technician reimbursement falling from approximately $77 to $38 per hour. Provider advocates warn that the reduction could disrupt treatment access.
These figures describe payments to providers. They do not establish a new hourly charge for families.
Why ABA technicians matter
ABA services can involve several professionals with different responsibilities.
New York’s ABA provider policy manual describes technicians as supporting a service team under a licensed behavior analyst. Their tasks may include carrying out scripted treatment activities and recording observations. The licensed professional develops and oversees the treatment plan.
A technician is distinct from a licensed behavior analyst or certified behavior analyst assistant.
Families can ask their provider:
Who develops my child’s treatment plan?
Who delivers the scheduled sessions?
How is that person supervised?
Who reviews progress and adjusts treatment?
Understanding these roles can help parents discuss any proposed staffing or scheduling change.
Will my child’s therapy stop?
The payment notice alone does not establish that your child’s appointments, approved hours, or coverage will change.
The concern raised by advocates is whether providers can maintain staffing and services at the lower payment level. Longer waits or fewer appointments are possible consequences to monitor, rather than confirmed outcomes for every clinic.
Ask your provider directly whether your child’s existing schedule will continue.
If the provider anticipates a disruption, request a written explanation and discuss a transition plan with the supervising clinician. Ask whether the problem involves staffing, payment, an insurance authorization, or a change in the clinical recommendation.
Does this apply to every insurance plan?
The state’s reimbursement notice specifically addresses Medicaid fee-for-service.
For Medicaid managed-care members, New York’s ABA policy manual directs providers to the member’s specific plan for coverage, billing, and reimbursement guidance.
Families should not assume that every managed-care contract pays the same rate or changes on the same date.
If your child has Child Health Plus or commercial insurance, ask the insurer and provider what applies to that coverage. A headline about Medicaid payments does not, by itself, establish a change to your child’s benefits.
Questions families should ask now
A clear conversation can prevent confusion. Ask:
Will my child’s appointments continue?
Are staffing or scheduling changes expected?
Will the provider continue accepting my child’s insurance?
Is there a change to the treatment recommendation or insurer’s authorization?
Who will help coordinate care if this provider cannot continue?
Can I receive copies of the current treatment plan and authorization?
Keep notes of the answers, including the date and the person you spoke with.
What if your provider cannot continue?
Contact your health plan and explain the service your child needs, your location, and the expected interruption date.
Ask for help finding an appropriate provider with actual appointment availability. A directory listing alone does not tell you whether an office is accepting new patients.
Keep a record of the providers contacted and their responses. If the listed offices cannot accept your child, share that information with the plan and ask what other arrangements it can offer.
If you receive a written reduction or denial of services, request an explanation of the review and appeal options for your coverage. Read the notice carefully and respond within its stated deadlines.
What providers should review
Providers should check the current fee schedule and their payer-specific instructions before changing billing practices.
The Department of Health lists:
800-343-9000 for Medicaid fee-for-service claims questions.
518-473-2160 for Medicaid fee-for-service coverage and policy questions.
Current manuals and fee schedules are available on the eMedNY ABA provider resources page.
Marton Care’s perspective
Payment policies should support appropriate oversight and dependable access to care. Families deserve clear communication about any disruption and practical assistance finding continuing services.
We encourage parents to ask questions early, keep treatment records organized, and work with their child’s clinician and health plan on a coordinated next step.
Information reviewed October 4, 2026. Check current official guidance and your child’s health plan for applicable coverage, payment policies, and requirements.
