May 24, 2017
Concerned about planned cuts in Medicaid therapy services for disabled children, throngs of parents and therapists pleaded on Wednesday with state officials to reverse course.
In the latest pounding for home health care aides and therapists, the Texas Health and Human Services Commission proposed the cuts after the Legislature in 2015 directed the agency to save money by reducing rates for Medicaid acute care therapy.
The hearing comes as lawmakers grapple in the last week of the legislative session with whether to hold fast to those cuts or restore some funding.
Two years ago, the Legislature approved $350 million in Medicaid cuts spread over two years — $150 million in state money and $200 million in matching federal funds — to therapy providers, primarily those serving children.
Opponents of the cuts have argued that the reduced rates would cut revenue for providers by 18 to 28 percent and force physical, occupational and speech therapists to close their doors, interrupting vital services to an estimated 60,000 disabled Texas children.
“This shortage of therapists has created access to care issues such as interruptions in vital therapy services, long wait times, and crowded waitlists for disabled and medically fragile children,” J.R. Top, a policy specialist with the Texas Association for Home Care and Hospice, which represents therapists, told staff members of the state health agency at a hearing Wednesday.
“It is deeply troubling the commission would proceed forward with more reductions,” he said.
The Texas Supreme Court declined in September to hear a lawsuit challenging the cuts. The court didn’t explain its decision.
Lawmakers had based the cuts last legislative session on data that showed that Texas reimbursed therapists at higher rates than other states and commercial insurance programs
Although the lawsuit had stalled the cuts, managed care organizations have already passed on cuts to the therapists.
Testimony on Wednesday focused on cost-cutting measures contemplated in the 2015 legislation but not yet implemented, including reimbursing assistant therapists 70 percent the rate of licensed therapists and paying lower fees for a speech therapy re-evaluation than an initial evaluation because “it requires less time and effort,” according to information from the agency.
Samantha Romero came from Houston to tell the agency that her 7-year-old son. Jaime, who has an intellectual disability, was unable to communicate before therapy, other than pulling or crying.
“Since therapy Jaime is now able to have a basic conversation with you and is able to express his wants and needs,” she said. “My son Jaime needs all the help he can get not only for me as his mother but for his future.”
Jennifer Friedrich, a speech pathologist in Magnolia, testified that her son, 9-year-old Nicholas, was born three months premature and has cerebral palsy.
“We were told that the likelihood of him developing functional cognitive or physical skills such as walking and communicating were very slim due to the extent of brain damage he suffered at birth,” she said. But “because of his ongoing therapies he is able to walk and communicate with us using sign language and his iPad.”
Tyler therapist Bonita Keeling testified that the rate cuts have led to a cascade of consequences: Before the rate cuts, she said, her business was able to provide roughly 400 pediatric physical therapy visits a month. Last month, they provided about 250.
“Those kids didn’t go anywhere, and they didn’t get better,” she said. “They just became harder to reach.”
“Special needs children are losing the opportunity to learn to move and to communicate at an alarming rate due to changes” made by the state, she said.
Carrie Williams, a Texas Human and Health Services Commission spokeswoman, said agency officials “listen to families and take their experiences to heart.”
“We want kids to get the therapies they need while we continue to be responsible with taxpayer dollars and follow the budget,” she said.
She said the 20 managed care organizations that contract with therapy providers reported a total of two providers terminating due to rate reductions, one serving 16 clients and another serving four.
House Speaker Joe Straus, R-San Antonio, said before the legislative session that the Medicaid cuts were a mistake and would be addressed in the House’s proposed supplemental budget.
“I don’t think it was ill-intentioned. It was not an initiative of the Texas House, and I think you’ll see us address it,” Straus said last year.
Some Senate Republican leaders, however, have stood by the cuts.
In the final 2018-19 budget, the Legislature restored 25 percent of the cuts to therapy rates.
A House version of the supplemental budget for the rest of 2017 would further restore therapy money, but the Senate version does not. A conference committee will work out the differences between the House and Senate plans.