After Texas moved forward with cuts in Medicaid reimbursements to therapists who work with disabled children, providers in Bexar County are projecting losses in the hundreds of thousands of dollars.

The reimbursements under the state Medicaid program cover physical, occupational and speech therapy for poor children with disabilities. The state Legislature previously approved $350 million in cuts, though now some legislators, including House Speaker Joe Straus, are working on a plan to reverse them.

Kim Jefferies, chief executive officer of the Brighton Center, one of the three Early Childhood Intervention providers in Bexar County, said that out of 1,700 children served, 1,139 are enrolled in Medicaid. ECI provides free or discounted therapy for babies and toddlers with developmental disabilities, such as speech issues, Down syndrome and autism.

“(The cuts) will translate into a loss of revenue of about $250,000,” Jefferies said, starting from Dec.15, when cuts were enacted, through Aug. 31. “We have to find a way to make up that revenue, including community support, foundation support and individual support. We have to raise these funds in order to support that every child who qualifies gets the services that they need.”

The Medicaid reimbursement cuts went into effect in December, more than a year after lawmakers approved them. Some home health providers and parents sued to try to stop the cuts, which they said affect as many as 60,000 children statewide. Opponents say that the lower reimbursements will force some providers to curtail services or close, shifting more children to fewer therapists.

A court dismissed the suit, finding that the state acted within its authority to set the rates.

Regardless of how much reimbursement they get for services, Jefferies said, they still have to provide therapy.

“It puts us in a unique situation where we are required by the state of Texas in our contract to provide services for every child, yet the state is cutting our funding in order to do that,” Jefferies said.

State legislators have cut funding for ECI by 11 percent in the last seven years, according to a reportby the advocacy group Texans Care for Children. As a result, ECI enrollment has decreased, it found. Texas ranked 43rd nationwide in 2014 for the percentage of children enrolled in ECI, and since 2011, the number of ECI contractors in the state dropped from 58 to 47.

Another Bexar County ECI program is provided by the Center for Health Care Services, which serves about 700 children, including those who are in kinship or foster care. About 500 of those children are Medicaid recipients.

Zaida Yzaguirre, director of the program, projected a loss of revenue of $83,600 through Aug. 31 because of the cuts and said that layoffs were a possible way of dealing with the revenue gap.

“We’re running a very lean machine,” Yzaguirre said. “We are serving all the children that qualify with nothing fancy. We’re serving them all because we have to by law.”

With state revenues squeezed by the downturn in the oil and gas industry, House and Senate budget writers have taken largely different positions on the reimbursement rate controversy. Straus finalized a plan to reverse cuts in the supplemental budget for the legislative biennium, but Senate leaders have not.

At the Senate Finance Committee hearing Tuesday, where tearful parents of children with developmental delays testified, Sen. Jane Nelson, R-Flower Mound, said it was never the legislators’ intent to take away services.

She has said that the cuts were based on information showing that Texas’ rates were far above those in other states.

Marty Drake brought his 16-month-old daughter, Sully, diagnosed with Down syndrome. He said that he and his wife had been advised by one of the therapists in Livingston that if cuts were not reversed, the provider would not remain open and Sully would not receive occupational therapy.

Drake said that without services in Livingston, they would have to go to another center in downtown Houston, about 70 miles away.

Nelson said the Texas Health and Human Services Commission must consider access to care when implementing the rates. “We will make sure, in any case, no child is denied services,” she said.

“It makes me very sad that people are so frightened,” she said. “No service should be cut.”

After hearing from parents, State Sen. Carlos Uresti, D-San Antonio, vice chairman of the Health and Human Services Committee and a member of the Finance Committee, said: “I hope that the Legislature will acknowledge and agree that we need to put that money back into budget.”

San Antonio Express-News

February 4, 2017

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