09/17/2026
An open letter from Blossom's founder
To our families, our staff, and our community,
I built Blossom on one belief: every child, from every background, deserves effective, high-quality ABA therapy. Not just the kids with the "right" insurance. That vision is why I opened these doors.
Today I have to tell you that New York State has made that vision impossible to sustain.
Effective October 1, NYS Medicaid is slashing reimbursement for direct ABA therapy (CPT 97153) to $9.63 per 15 minutes. That's $38.52 an hour. Out of that, providers are expected to meet every requirement the STATE ITSELF imposes: licensed BCBA supervision, credentialing, background checks, mandated training, documentation standards, audits, and compliance. All of that ON TOP OF a technician's wage, payroll taxes, travel, insurance, and keeping the doors open.
The state sets the bar, then pulls the funding to reach it. That's not a budget decision. That's setting providers up to fail and calling it policy.
Because of this, we have been forced to make the most painful decision of my career: Blossom has to close its doors to families with Medicaid and managed Medicaid plans.
I need you to hear me: this was not a choice I wanted, and it is not one I made lightly. I fought it. I ran the numbers every way I could. There is no version of $9.63 that lets us deliver the safe, ethical, quality care these children deserve, and I will not deliver less than that to any child.
To our Medicaid families: I am so sorry. You did nothing to deserve this. Your children are not a line item to be trimmed. We will be reaching out to each of you personally to support you through what comes next.
And here's the part that makes my blood boil. The state's bulletin calls the people who do this work "unlicensed individuals." It claims this cut makes pay equitable for their training and experience.
Equitable. $9.63.
Those "unlicensed individuals" are behavior technicians. Trained,supervised professionals. They teach children to communicate, to stay safe, to be independent. They get hit, bitten, and scratched, and they come back the next day. They're there for the first word, the first "I love you," the first day without a crisis. They carry the hardest hours of this field on their backs.
They are real people. They are the backbone of this profession. New York looked at their work and priced it at $9.63. That is an insult, and I won't dress it up as anything else.
To every BT: your work is not small, it has never been small, and I will not let anyone reduce it to a number like this without a fight.
Cuts like this don't save money. They close programs, grow waitlists, and abandon the kids with the fewest options. The families we can no longer serve are the proof. They won't be the last.
I refuse to be quiet about this. I'm asking you not to be either.
Call your NYS Senator and Assemblymember. Tell them to reverse the Medicaid ABA rate cut. Find yours at nysenate.gov/find-my-senator.
With a heavy heart and a lot of fight left,
Tia Palmer, BCBA, LBA đź’•
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