Reimbursement Cuts: Protect Access and Staff

A payer rate cut can change a clinic's finances almost overnight. This autumn, autism therapy providers in two US states are living through exactly that.

What's happening

New York cut Medicaid reimbursement for one-to-one applied behavior analysis (ABA) delivered by a behavior technician by 50%, effective 1 October 2026. According to the Council of Autism Service Providers, that would give New York providers the lowest publicly available Medicaid rate for one-to-one services in the US (WRVO).
Georgia's leading Medicaid insurer, Amerigroup, cut autism therapy rates by 30%, with providers given about a month's notice. Families and providers protested at the state Capitol on 22 October (GPB).

Providers in both states have warned of staff reductions and disrupted care. And while these cuts hit ABA, any therapy clinic that depends heavily on one payer faces the same risk.

Step 1: Know your real numbers

Before making any decision, get clear on:

Revenue by payer: what share comes from each one?
Cost per session: clinician pay, supervision, room, admin and overhead
Margin per service type at the new rate
Capacity use: how many available hours are actually booked and attended?

Many clinics find that unfilled and missed sessions cost them more than they realised. That's often the fastest money to recover.

Step 2: Recover lost capacity first

Before cutting services, make sure you're using the hours you already pay for:

Reduce no-shows and late cancellations with confirmations, easy rescheduling and same-day follow-up.
Fill cancellations from a waitlist instead of leaving the slot empty.
Cut scheduling gaps. Small unbookable gaps between sessions add up across a week.
Match sessions to authorisations so approved hours are actually delivered before they expire.

Step 3: Review your service and staffing mix

Which services still cover their costs at the new rate, and which don't?
Is supervision time structured efficiently, within clinical and payer rules?
Could some goals be met in a group or parent-training format where clinically appropriate?

Any change must stay within clinical best practice and payer requirements. The goal is efficiency, not lower-quality care.

Step 4: Spread your payer risk

Relying on one payer leaves you exposed. Over time, look at:

Commercial insurance contracts
School or district contracts
Self-pay or sliding-scale options, where appropriate
Partnerships with paediatric practices or other referral sources

Step 5: Be honest with families and staff

Uncertainty drives people away. Tell families early what may change and what you're doing to protect their child's care. Tell staff what you know, what you don't, and when you'll update them. Clinics that communicate clearly tend to keep both clients and clinicians through hard periods.

Step 6: Advocate

Rate decisions can be reversed or softened when payers and policymakers hear from providers and families. Join your state provider association, document the impact on access (waitlists, staff losses, families affected), and support families who want to speak up.

The bottom line

You can't control payer rates. You can control how well your clinic uses its capacity, how exposed it is to any one payer, and how clearly it communicates. Those three things decide whether a rate cut is a setback or a crisis.

This article is general information, not financial or legal advice.