New York Unveils Bold Plan to Cut ABA Rates Below Zero by 2028 (SATIRE)

ALBANY, N.Y. – Fresh off a rate cut that sets Medicaid’s pay for technician-delivered ABA at exactly half of what it was a year ago, New York health officials on Thursday unveiled an ambitious plan to keep cutting until the rate drops below zero, at which point providers would begin paying the state for every hour of therapy they deliver.

“People told us we would never get from $19.26 to $9.63 in twelve months, and we did it in three easy steps,” said Doreen Faircloth, the Department of Health’s newly created Deputy Commissioner for Fiscal Imagination, gesturing at a line chart heading confidently toward the floor. “Why stop now? Zero is just a number that hasn’t been cut yet.”

The cut that takes effect Oct. 1 pays $9.63 per 15-minute unit, or $38.52 an hour, for one-on-one therapy delivered by a behavior technician. The state’s official notice says the change “ensures providers of ABA services are compensated equitably for their training and experience.” Faircloth said the department reached that conclusion after careful study. “We looked at what a technician’s training and experience is worth, and then we looked at what we felt like paying,” she said. “And wouldn’t you know it, they were the same number.”

Under the proposed Reverse Reimbursement Model, which officials said would be phased in “compassionately” starting at negative $2.10 per unit, providers would continue to submit claims exactly as they do now. The state would then mail them an invoice. “It’s the same form,” Faircloth said. “We just moved the minus sign. If anything, it’s a simplification.”

A spokesperson for the governor’s budget office said the plan would save “an estimated infinity dollars” and dismissed critics who warned of provider shortages as “thinking about this in a very old-fashioned, children-get-therapy kind of way.”

Across the state, ABA providers said they were embracing the new direction. “At $38.52 an hour we lose money on every child we see, which means the more children we serve, the sooner we reach our long-term goal of not existing,” said Brenda Oquendo, founder of Little Milestones Behavioral Collective of Greater Utica. “Profit was never the point. Neither, it turns out, is payroll.”

Todd Vanterpool, chief operating officer of Sunny Steps ABA, said his board voted unanimously to operate without profit “indefinitely, or until Tuesday, whichever comes first.” He added that the company’s BCBAs had graciously agreed to be paid in exposure and laminated token boards. “Once the rate goes negative, we’ll ask the kids to chip in,” Vanterpool said. “Several of them already have excellent coin-sorting goals.”

Registered behavior technician Kayleigh Dunmore, 24, of Rochester, said she appreciated the state’s confidence in her. “They said the rate reflects my training and experience, and they’re right,” Dunmore said on her way to her second job. “I have no training in living on this, and no experience doing it.”

To spare would-be providers any disappointment, the state has also barred new ABA providers from enrolling in Medicaid at all, part of a six-month enrollment freeze announced in July. “It’s a kindness,” Faircloth said. “You can’t lose money on a program you’re not allowed to join.” Asked whether any other state pays less, she noted that other states have, at various times, done things. “That’s our standard,” she said.

Families said they were adjusting. Denise Albrecht of Schenectady, whose son has spent 14 months on a waitlist, said the state had assured her the list was now “far more efficient,” since it no longer has an end.

At press time, officials confirmed that providers who cannot afford the cost of delivering therapy may apply for a hardship waiver through the state’s new enrollment portal, which opens to ABA providers in “Winter 2026,” and said the department had begun exploring whether children could be billed directly.

AT A GLANCE

The Garlic is the satire desk of BreakingNewsABA. Doreen Faircloth, Brenda Oquendo, Todd Vanterpool, Kayleigh Dunmore, Denise Albrecht, Little Milestones Behavioral Collective, Sunny Steps ABA, the Reverse Reimbursement Model, and every quote in the article are fictional. The illustrations are original. Any resemblance to a real person or company is coincidental; any resemblance to real policy is the point.

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