If your ABA practice bills New York Medicaid, your revenue just dropped 14% and it’s not coming back.

New York Medicaid cut the ABA 97153 unit rate from $16.85 to $14.45 between October 2025 and April 2026. For a mid-size NY ABA practice billing 400 units per week per BCBA-supervised technician, that’s:

• Old revenue per BCBA/BT pair: $16.85 x 400 = $6,740/week
• New revenue per BCBA/BT pair: $14.45 x 400 = $5,780/week
• Delta: -$960/week per pair = -$49,920/year per pair

If you run 10 BCBA supervision teams, that’s -$500K/year in gross revenue you have to make up somewhere.

You have three choices: raise volume, cut costs, or fix the leaks in your billing that were tolerable at $16.85 but are lethal at $14.45.

Why New York Did This (and Why More States Are Coming)

New York’s ABA rate cut is not an isolated decision. It’s part of a nationwide pattern of state Medicaid programs responding to three converging pressures:

Pressure 1: OIG audit findings. The HHS-OIG has identified approximately $200 million in improper ABA Medicaid payments across four states. Every state Medicaid director now has political cover to cut rates and cite audit findings.

Pressure 2: PE roll-up scrutiny. After the June 2023 CARD bankruptcy, national media (NBC News, CEPR) framed PE-backed ABA consolidation as extraction of Medicaid funds meant for children. State attorneys general have increased ABA platform billing audits.

Pressure 3: Volume growth exceeded budget projections. Autism prevalence rose from 1-in-36 at CARD’s filing to 1-in-31 by April 2025 per CDC. State ABA line items are hitting caps.

Indiana followed New York’s lead: 97153 stepping down from $17.06 to $15.39 by 2027. Vermont went further, discontinuing 97153/97155 concurrent billing entirely January 2026. Michigan, North Carolina, Virginia, and Texas are each moving with different rules.

The lesson: rate stability is over. ABA orgs that assumed 2020s reimbursement patterns would continue are structurally exposed.

What NY ABA Orgs Must Fix This Week

At $14.45/unit, precision matters in ways it didn’t at $16.85. Three specific fixes that recover most of the lost margin:

Fix 1: Modifier stack optimization (recovers 3-5% of billable revenue)

Every 97153 line needs the correct modifier stack for the payer AND the state combination. New York Medicaid has specific modifier requirements that differ from NY commercial payers (Anthem, Aetna, United, Cigna). If your team is using a single template for all NY payers, you are losing 3-5% to denials that don’t get appealed.

Fix: build a payer/modifier decision matrix specific to New York. Every 97153 modifier requirement documented. Every denial trigger identified. Every appeal template pre-built.

Fix 2: BCBA supervision documentation precision (recovers 2-3%)

New York Medicaid audits BCBA-to-BT supervision ratios. If your 97155 (BCBA time) documentation doesn’t clearly delineate distinct clinical activity from concurrent 97153 (BT time), your 97155 is at risk of retroactive recoupment.

At $14.45/97153 unit, you cannot afford recoupment on the $110+/hour 97155 line.

Fix: session note templates that force distinct-activity documentation. Every 97155 minute justified with specific protocol modification or observation activity, not general “supervision.”

Fix 3: NY commercial payer contract renegotiation window (recovers 5-8%)

New York Medicaid rate cuts create precedent for commercial payers to argue for corresponding commercial rate cuts. Get your commercial payer contract renegotiations done before your commercial payers use Medicaid as leverage.

Anthem, Aetna, United, and Cigna each have different NY-specific ABA contract terms. Some allow renegotiation at 18-month intervals. Some at 24 months. Know your dates.

Fix: audit your 4 commercial payer contract renegotiation windows. Prepare data-first renegotiation packages showing your NY clinical outcomes and your BCBA-to-RBT ratios. Push for +8-12% commercial rate increases to offset Medicaid cuts.

2026-Specific Numbers Every NY ABA CFO Should Have on Their Whiteboard

• 97153 unit rate: $14.45 (down from $16.85 October 2025)
• 97155 unit rate: verify current NY Medicaid table (subject to same downstream pressure)
• Approximate BCBA-to-RBT ratio requirement: NY specific, verify with Medicaid provider manual
• MHPAEA 2025 final rule (enforced 2026): commercial denials disparate to physical health are appealable at parity
• OIG improper payment risk: approximately $50 million in NY-specific historical exposure

The Path Forward: Precision or Consolidation

New York ABA orgs at $14.45/unit will fall into three categories over the next 24 months:

Category 1: Practices that fix the leaks. Modifier precision, documentation tightness, commercial renegotiation execution. Recover 8-12% of billable revenue through operational discipline. Margins hold.

Category 2: Practices that don’t fix the leaks and consolidate. Sell to a PE-backed roll-up (BlueSprig, Centria, Action Behavior Centers, Behavioral Innovations, Proud Moments, Autism Learning Partners, Hopebridge, or Caravel). Get the exit while EBITDA is still defensible.

Category 3: Practices that neither fix nor sell. Shrink over 18-24 months. Some close.

The Category 1 practices are the ones that treat billing as a strategic function, not a back-office cost center.

When to Outsource NY ABA Billing

If any of these apply, specialty ABA billing outsourcing pays for itself within 90 days at the current NY rate structure:

• You bill 4+ NY Medicaid ABA contracts and your in-house team is running at capacity
• You bill both NY Medicaid and NY commercial payers and your denial patterns differ by payer
• Your BCBA-to-BT documentation is at scale where a shared template no longer works
• You operate multi-state with NY as one of your ABA states
• Your net collection rate on NY commercial payer ABA is below 96%

Cost benchmark: specialty ABA billing firms charge 4-8% of collections in 2026. Generic medical billing firms charge 8-12% for lower NCR. At NY’s new rate structure, the 4-percentage-point gap is often the difference between profit and loss on the account.

The Bottom Line

New York’s ABA 97153 rate cut is not going away. Michigan, Virginia, Texas, and Indiana are following. The states that haven’t cut yet are watching what NY does next.

Your practice can absorb this cut by increasing operational precision or by pursuing consolidation. Doing nothing is not a viable path forward.

We do a free 30-day denial and modifier audit for NY ABA practices. Data-first, no obligation. We’ll show you where you’re leaking revenue at the new rate structure.

Book 15 minutes: calendar.app.google/zF3c44hYGRjEf5U26

— KD, Founder, Revenant Care Group | Specialty BH/ABA/SUD RCM | revenantcare.com | (346) 476-4453