New York Medicaid halves the technician rate for ABA

Three cuts in twelve months

The August 2026 New York State Medicaid Update confirmed what the state budget had authorized: for dates of service on or after October 1, 2026, Medicaid fee-for-service pays $9.63 per unit for CPT 97153, adaptive behavior treatment by protocol delivered by an unlicensed individual or technician. The notice cites the Enacted Budget for State Fiscal Year 2026-2027 as its authority.

This is the last step of a schedule the state published a year earlier. The August 2025 Medicaid Update set 97153 at $16.85 from October 1, 2025 and at $14.45 from April 1, 2026. The October 2026 step takes the rate from $14.45 to $9.63, a further 33% reduction, and 43% below the October 2025 level.

The eMedNY ABA fee schedule, now dated October 1, 2026, shows the shape of the change. 97151, 97152, 97155 and 97156 stay at $19.26 per unit. 97153 alone drops to $9.63. The three group codes, 97154, 97157 and 97158, are listed at $3.31 per unit per member.

The schedule now prices technician time at half of analyst time

The state's stated rationale is that the change ensures ABA providers are compensated equitably for their training and experience. In practice the fee schedule now separates two kinds of time that most New York agencies staffed and priced as one blended service: RBT time on 97153 and LBA time on everything else.

Per hour, 97153 now pays $38.52 against $77.04 for 97155. Under the April 2026 rate the technician hour paid $57.80. Note that 97152, the technician-administered supporting assessment, was not cut and still pays $19.26.

What it means in dollars per child

Take a child authorized for 20 hours a week of 97153 under fee-for-service. That is 80 units a week. At $14.45 those units paid $1,156.00; at $9.63 they pay $770.40. The difference is $385.60 a week for one child, before any change in the analyst codes.

The arithmetic matters because RBT wages, travel and supervision time do not fall when the rate does. An agency that kept its staffing model will see the margin on direct therapy shrink first, and will see it first in the fee-for-service share of its book, which is where the notice applies.

The notice is written for fee-for-service. Medicaid managed care plans in New York pay under their own provider contracts, so the question for each plan is contractual: does your 97153 rate reference the state fee schedule, and if so from which date of service? Get that answer in writing for every plan before you forecast the fourth quarter.

Supervision rules did not get lighter

The rate cut sits on top of the supervision standard that took effect on October 1, 2025. Licensed Behavior Analysts must supervise unlicensed individuals and technicians for at least five percent of the hours the technician provides behavior analysis services each calendar month, with at least two face-to-face, real-time contacts per month and at least one observed session. The state said this standard also applies to Medicaid managed care providers.

97155 can count toward the five percent only when the LBA joins the patient and the technician to direct a new or modified protocol. So the cheaper technician hour still carries a fixed supervision cost at the higher analyst rate, and the documentation that proves it is now worth more, not less, in an audit.

The enrollment door is closed for now

In August 2026 the Department of Health added ABA to a temporary enrollment moratorium. Pending applications were discontinued at any stage of review, and the moratorium covers new enrollments, reinstatements and changes of ownership. Existing enrolled providers are not affected and must revalidate when notified; ABA is listed in the Phase 2 high-risk revalidation group, with notifications beginning in Winter 2026.

Two consequences follow. A group that planned to open a new New York entity or buy one cannot complete that enrollment while the moratorium stands. And an enrolled group that misses its revalidation deadline faces termination, which in this environment means no easy way back in.

What to do this quarter

• Load $9.63 for 97153 fee-for-service dates of service from October 1, 2026 and set expected-payment variance alerts, so a plan still paying the old rate, or an underpayment, is visible on the remit.
• Ask every New York managed care plan, in writing, whether its 97153 rate follows the state schedule and from which date.
• Re-forecast fourth-quarter cash by payer class using units already authorized, not last quarter's average rate.
• Audit the five percent supervision file now: two real-time contacts, one observation, documented in the member record.
• Confirm every group NPI and location is current in the Provider Services Portal and watch the LISTSERV for your revalidation notice.
• If a transaction or new location is planned, assume no new New York Medicaid enrollment until the moratorium is lifted.