Occupational therapist Amanda Halbert works with Brianna Dupuie, teaching Brianna how to get through her morning routine, like making toast with peanut butter. Medicaid has helped pay for Briana’s weekly physical, occupational and speech therapy sessions because she was a foster child. LAURA SKELDING/AMERICAN-STATESMAN
What a mess. That’s what you get when Texas lawmakers call for millions in cuts, as they did in 2015, to therapy services for disabled children. Now, the courts are left trying to sort out the muddle.
Last session, Texas lawmakers approved a two-year budget that ordered a roughly 25 percent cut to the amount of money some pediatric therapists were paid by Medicaid. The cuts equal $150 million in state funds and $200 million in matching federal funds. Answering to the legislature call, Texas Health and Human Services Commission officials targeted the funding cuts around physical, occupational and speech therapies that affect an estimated 60,000 disabled children, including foster children. With any luck, the courts will find that funding should be restored and see that the commission’s decision to cut these particular funds is short-sighted.
Yes, short-sighted. The services targeted are long-term therapies that help children with limited abilities become more independent and self-sufficient to the best of their abilities. Studies show that greatest results are achieved when therapies begin at a very young age and continue into adulthood, if necessary. To cut or limit those therapies and services dramatically decreases the chances of these children to grow and be productive citizens.
Understandably, a group of in-home therapy providers and families of children with disabilities immediately sued the state in August to prevent the payment cuts from taking effect. Advocates and families argue that payments to providers for Medicaid patients would drop by as much as 28 percent. Such a steep reduction in payment would force some providers out of business and leave many children without much-needed therapies. It should be noted that these arguments were countered last week by a lawyer for one healthcare insurer who said in court that rate reductions could be carried out without a reduction in services.
Still, there has to be a better solution than to take aim at services that benefit the most vulnerable Texans: Children with severe disabilities with no money to pay for the services they need. Yet, the commission refuses to see it that way, even when many have said that state’s proposed cuts are based on faulty information.
The Legislature based the cuts on single independent study from Texas A&M Health Science Center researchers — parts of which state District Judge Tim Sulak, in signing a temporary injunction to the cuts in September, said were “seriously flawed.” Like I said: It’s a mess.
Yet, on Wednesday, during oral arguments in the Texas 3rd Court of Appeals, the attorney for the state’s health commission, Kristofer Monson, said the appropriations bill passed by the Legislature in 2015 mandated the cuts and left the commission with no choice but to carry them out. “The commission followed the rules,” Monson has said.
Numerous letters and comments made by at least 60 legislators, show that the lawmakers don’t agree with Monson.
In fact, Lt. Gov. Dan Patrick and Flower Mound Republican state Sen. Jane Nelson, the chairman of the budget-writing Senate Finance Committee, told Health and Human Services Commissioner Chris Traylor he had “the flexibility to strive for achieving $100 million in savings in Medicaid therapy services while preserving access to services.” The key here is access to care.
No one argues that identifying corruption and pockets of waste is a bad idea — that, after all, was the initial intent for the legislative bill. Looking for ways to make the best of taxpayer money should be a priority. However, what we are dealing with here is not comparable to unnecessary dental services for a healthy kid, but limiting the life-altering therapies of a disabled child. Hopefully, the courts will see on April 25 that the commission was short-sighted in their call for these particular cuts and restore funding for Texas disabled children.
