Texas Medicaid cuts leave special needs kids without therapy

AUSTIN, Texas -- Stacey English has modest desires for her 7-year-old daughter, Addison: be able to eat without gagging and move both her arms.

But since Addison's occupational therapist went out of business this winter, the child with a rare genetic disorder has regressed in her fight to do even that much.

"I don't know where to go from here," said English, who has been unable to find a replacement therapist in their Texas college town of College Station. "How do you continue to help her make progress when you don't have someone to teach her?"

Some Texas children with special needs such as Addison have lost critical services since the state implemented $350 million in Medicaid cuts to speech, occupational and physical therapy in December.

In Texas, reimbursement offered to providers fell up to 50 percent for certain therapy procedures, said Rachel Hammon, president of Texas Association of Homecare and Hospice. Clinics closed, and therapists quit.

The Texas cuts are separate from Republican proposals before Congress, which academics say could cut federal Medicaid spending as part of a law to replace the Affordable Care Act.

But the fallout could be similar if some form of what's been approved in the U.S. House and is under consideration in the Senate becomes law, said Elizabeth Burak, senior program director of Georgetown University's McCourt School of Public Policy's Center for Children and Families

The Texas Legislature voted in 2015 to cut the state's Medicaid reimbursement for pediatric acute-therapy services, which capped how much providers can be paid. Proponents of the cuts argued Texas' previous reimbursement rates were too high, sometimes encouraging fraud.

In a 2015 letter, Lt. Gov. Dan Patrick and state Sen. Jane Nelson, the chamber's chief budget writer, argued costs for acute-care services to Texas' Medicaid program had risen 66 percent from 2009 to 2014. They also said nearly one in seven of the state's Medicaid legal sanctions cases for fraud were for therapy providers.

Relatives of children with disabilities and providers sued unsuccessfully to block the cuts. Republican House Speaker Joe Straus vowed to restore the lost funding during this year's legislative session that ended May 29 -- though lawmakers approved a budget replacing only about a quarter of what was cut.

Nelson said she supported the original cuts as a way to prevent taxpayers from being overcharged for services. She said a Texas A&M University study found the state's pediatric-care providers received higher pay than in other states.

"These are vital services, and we remain in close contact with the agency to ensure that access to care is preserved as rates are adjusted to align with rates being charged to other payers," Nelson said in an email.

But those opposing the cuts counter the study didn't research the effect of reimbursement reductions on access to therapy.

Texas' Health and Human Services Commission hasn't seen a drastic decrease in therapy providers because of the cuts, said spokeswoman Carrie Williams. She said three agencies terminated contracts with Medicaid networks for that reason, and "all clients are receiving assistance finding new providers."

"We want children to get the care and therapies they need while we continue to be responsible with taxpayer dollars and follow the budget," Williams said by email.

Providers say since Texas' cuts, they've struggled to stay afloat financially. Kathi Strawn, owner of Therapy Options Texarkana, which served 130 children with special needs on the Texas-Arkansas border, closed her clinic June 1.

"I couldn't get any therapists to keep working for me who were registered or licensed," said Strawn, who had to cut pay for her therapists by about 30 percent.

She began referring her patients to the two other nearby clinics -- but one was too booked for new cases, and many therapists at the other had stopped taking children, citing low compensation rates.

"We've had quite a few patients not able to get service," Strawn said.

Hammon, of the homecare and hospice association, said Texas has no accurate way of tracking children deprived of services, calling them "the hidden victims" in the Medicaid cuts. Children relying on home care therapists have the most severe disabilities, and those agencies have been hit hardest, she said.

"These are children who may have been born prematurely and who can't eat because they were fed through tubes as a baby and if your swallowing reflex is interrupted you have to have therapy to relearn that," said Hammon.

For 15-year-old Maile Houston, with a rare chromosome deletion that has caused sensory issues and developmental delays, the recent loss of her home care occupational therapist set her back to behaviors her mother "forgot existed."

"She slaps things in front of her face and bangs things, and the therapy she was doing calmed a lot of those behaviors down," said Maile's mother Megan Houston.

English said her therapist introduced Addison to basic life skills and even new foods "like smashing up crackers into a little bit of peanut butter."

"Of all the things to cut," she said "they're taking away care from those who truly need help the most."