New York's Third ABA Rate Cut: What's Left After Payroll at $9.63 a Unit

On October 1, New York Medicaid will pay $9.63 per unit for CPT code 97153, the code billed when a behavior technician delivers direct ABA therapy. That works out to about $38.52 an hour.

It is a 33% reduction from the current $14.45 and the third cut to direct ABA therapy in the past year. Taken together, the cuts reduce the rate by half compared with early 2025. New York will now have the lowest 97153 rate in the country, below West Virginia's $9.90, in a state with the fifth-highest cost of living.

Most coverage has focused on what the reduction could mean for access to care. That story is significant, but the underlying economics are worth looking at too. At $9.63 per unit, the question for providers is how much is actually left after paying for the labor required to deliver the service.

Payscale puts the national median base pay for an RBT at $20.66 an hour. Using that figure as an estimate, a 25% load for payroll taxes and benefits brings the cost to about $25.83.

RBTs also get paid for time that can't be billed, including drive time between home sessions, late cancellations, training and documentation. If 80% of paid hours turn into billable units, the estimated labor cost per billed hour rises to roughly $32.28.

At $38.52 in revenue, that leaves about $6.24 per billed hour. That $6.24 has to cover clinical oversight, rent, intake, scheduling, billing, compliance and management.

At the April rate of $14.45 per unit, the same hour brought in $57.80 and left about $25.52 after labor. A 33% rate cut therefore takes out roughly 76% of what remains after paying the technician. When labor is a relatively fixed cost per hour, the rate reduction comes directly out of what is left to cover the rest of the business.

The $6.24 assumes every claim gets paid. In New York, that assumption is difficult to make. Plans in the state are aggressively reviewing individual claims, auditing claim batches and clawing back payments over small procedural errors, according to one provider CEO.

Camber's claims data shows that about 72% of ABA claims are paid cleanly on the first submission. The other 28% require rework, most often because of documentation gaps. After one resubmission, clinics recover about 48% of the original claim value; after three or four rounds, that falls to about 25%.

An hour billed at $38.52 brings in about $18.49 after one resubmission, leaving nearly $20 unrecovered. The loss is roughly equivalent to the margin from three clean hours. After three or four rounds, the clinic collects just $9.63, or the value of one 15-minute unit, leaving $28.89 unrecovered. Recovering that amount requires the margin from more than four clean hours.

Across a full caseload, the impact is even more significant. If 28% of hours require rework and those claims ultimately recover 48% of their original value, average revenue falls to about $32.91 per billed hour, leaving roughly $0.63 after the $32.28 labor cost. If recovery falls to 25%, average revenue drops to about $30.43, or $1.85 below the labor cost. At that point, the provider is losing money on the hour before accounting for overhead.

New York was relatively late to covering ABA, and the reimbursement rate has changed significantly since coverage began.

The $9.63 rate dates back to the governor’s proposal in early 2025. The legislature reduced the size of the cut at the time, but this year’s budget brings the rate back to $9.63.

The state describes the change as a methodology update intended to pay ABA providers based on training and experience, with technician-delivered care placed in a lower tier. But New York Medicaid does not require behavior technicians to register with a credentialing body. Several industry sources also told BHB that state officials do not appear to understand the tiered model, in which trained staff deliver care under credentialed supervision.

The cut applies only to 97153. As of April, 97151, 97152, and the other ABA codes were paid at $19.26 per unit. Providers should confirm current rates on the eMedNY fee schedule before modeling the impact.

The fee-for-service (FFS) rate changes first and managed care may follow later. When the first cut took effect, managed care plans followed FFS by two months. Whether that happens again will depend on each plan's contract. Some MCOs may make their own adjustments, although CASP's Mariel Fernandez told BHB those changes are unlikely to make up for a cut this large.

Provider exits will shrink access statewide. In CASP's early survey, 97% of New York providers with Medicaid patients said they can't continue serving them or aren't sure they can; the rest plan to reduce Medicaid hours. One provider executive described this as a situation with no real transition option for families.

Audit pressure will continue alongside the cut. Lower rates haven't come with lighter oversight. Plans are still auditing, and denials matter more at thinner margins.

The next budget cycle is the advocacy window. The rate lives in the enacted budget. Any reversal would likely come through the FY 2027-2028 process, which starts with the governor's executive budget in January.

Other states are watching. State Medicaid programs are dealing with exploding costs, low confidence in documentation quality, and federal pressure to stop fraud in high-risk service areas, and federal reforms will require a cumulative $665 billion in state Medicaid cuts. Indiana is stepping down from $17.06 to $15.39 by 2027. New York is the most severe example so far, but the pattern is national.

Claims for sessions delivered before Oct. 1 should still pay at $14.45 per unit, since Medicaid rates generally apply by date of service. Check your plan contracts to confirm. If that's the case, work your pre-October AR first. Those claims are worth more than anything you bill after the cut.

Next, figure out what rate each site needs to cover labor. Take your fully loaded technician cost per billed hour and divide it by four. In the example above, $32.28 an hour comes to $8.07 per unit before rent, supervision, or billing. Add your overhead, account for rework, and compare that number to $9.63. For some sites the math will still work for now. For others it won't.

Contact each managed care plan and get written answers. Find out whether your rate is tied to the FFS schedule and when a change would take effect. Last time, managed care rates changed two months after FFS. Ask whether the plan will offer single-case agreements for current clients. Also confirm how much notice your contract requires if you scale back.

If you're reducing Medicaid services, sort out your contract notice periods, the plan's continuity-of-care rules, and the BACB ethics code standards on transitioning clients before you notify families.

If you're continuing with Medicaid, getting the claim right the first time matters more. The rework math above shows how quickly the economics deteriorate after a denial.

Watch your state's budget proposals and Medicaid public notices. Budget proposals often come first: New York's $9.63 rate appeared in the governor's February 2025 proposal. Assign someone on your team to check both regularly.

For each site, model what a 15% or 30% cut to 97153 would mean using your actual labor costs, overhead, and denial rates.

Keep your supervision and credentialing records up to date. New York tied its cut to who delivers care. If your state does the same, you'll need those records to challenge its assumptions.