Autism-service providers are concerned about a 50% cut in a Medicaid reimbursement to a treatment that helps youngsters with the condition. That cut went into effect Oct. 1.
New York's Medicaid program is cutting reimbursement rates for applied behavior analysis (ABA) by 50%. It's described as an effective evidence-based therapy for children with autism, and the rate reduction is leaving New York providers with the lowest publicly available Medicaid reimbursement rate for one-to-one services in the country.
That's according to the Council of Autism Service Providers (CASP). It held a media briefing last week with autism-service providers and parents discussing the imminent reduction and consequences for children and families.
The reductions are focused on one-to-one ABA delivered by a behavior technician and amount to half of what the state's Medicaid program paid in early 2025. Care providers warn the cuts will force staff reductions, disrupt care for children with autism, and limit access to needed care.
The speakers on the CASP media briefing included Bobbi Rogers, a parent advocate from Syracuse, who has a son with autism. While growing up, the boy had both good days and challenging days.
When her son was little, the biggest problem he had was head banging, which at times, was so severe that Rogers didn't leave the boy's side. She did recall one day when she had to check on her other children and returned to find him lying unconscious on the floor. She got the child medical attention and remembers asking a doctor if her son could possibly lose his vision.
"That was our life before we had ABA," Rogers said.
By age 18, the family had access to ABA everyday and no longer had hospitalizations for challenging behavior and the teen eventually learned to talk, she said.
As her remarks continued, Rogers provided this message: "And for all the families I've worked with over the years, the difference between their lives before having access to insurance-based ABA and after, is so dramatic. I can only just wish that you come spend one day with us and see what our life is like. Just one day. Because if you gave me the biggest skeptic ... the person that believes this is the way to cut Medicaid fraud, which it isn't, that biggest skeptic would say this is not the way. This isn't going to help. It's just going to hurt families that need help the most."
The Council of Autism Service Providers (CASP) is a nonprofit trade association based in Lexington, South Carolina, per its website. Founded in 2016, CASP's mission is to support its members by cultivating, sharing, and advocating for provider best practices in autism services.
What CASP hopes New York will do
As the media briefing continued, Mariel Fernandez, vice president of government affairs at CASP, was asked what CASP is asking New York to do to try to remedy the situation. Fernandez said CASP is looking for three different actions from New York officials.
CASP is asking the Gov. Kathy Hochul's office to "thoughtfully and carefully" consider the rate reduction, which was part of the governor's executive budget -- and if this is the most appropriate way to address any concerns the state might have related to program integrity and utilization, Fernandez said.
The organization is also asking state lawmakers to reach out to both the governor's office and the New York State Department of Health (NYSDOH) and Medicaid director Amir Bassiri to speak with them about whether this is the most appropriate way to address the concerns that the state has related to the utilization of this benefit and the growth in this benefit category since its introduction.
"And we are also asking ... director Bassiri to reconsider whether this is the most appropriate way to address concerns related to fraud waste and abuse. We do not believe that this is the most appropriate way to address those concerns," Fernandez said.
She went on to say that CASP believes program integrity is "incredibly important and paramount" and that everybody should be following the rules and delivering care according to the clinical coverage policy and guidance outlined by NYSDOH.
"We do not believe there's any room for fraud, waste, or abuse in the system, and if that is occurring, we want those providers out of the Medicaid benefit more than the state of New York does because we recognize the harm that is caused by bad actors in the space," Fernandez said.
