The Texas Tribune - May 3, 2016
by Edgar Walters
Lauretta Jackson spent an hour on a recent Friday morning in the home of Bushra, an Iraqi refugee, trying to help Bushra teach her seven-month-old daughter, Sara, how to gain control of her muscles and live a normal child’s life.
Jackson monitored while Bushra grabbed a miniature plastic train engine and placed it about a foot away from Sara, who was lying on her stomach. The secondhandtoy, a language-learning tool for infants, lit up, and a recorded voice offered a congratulatory phrase in Spanish. Bushra helped her daughter roll toward the toy and watched as Sara extended her arms to grab it. Again the train engine lit up and offered a second phrase in Spanish. Sara smiled.
As a newborn, Sara had trouble swallowing food and keeping it in her stomach, Jackson said. She struggled to gain weight, and a doctor recently diagnosed her with failure to thrive. He referred Bushra to Any Baby Can, a nonprofit provider in the state’s Early Childhood Intervention program, which serves children with disabilities and developmental delays until they are three years old.
After a little more than a month of weekly therapy sessions, the muscles in Sara’s neck and torso are rapidly strengthening, Jackson said, but she still cannot roll over on her own. Bushra has been practicing this exercise and others with her daughter every chance she gets: when they are alone together in the living room, with Sara’s siblings when they return from school, or while the family waits for the bus. This she told Jackson through a translator, Sonia Elo, who looked on from the couch.
In-home therapy providers have warned for nearly a year that the work they do for families like Bushra’s could be in jeopardy because of severe budget cuts ordered in 2015 by state lawmakers. Sara has health insurance through Medicaid, the federal-state insurer for the poor and disabled, and the state’s two-year budget includes a roughly 25 percent reduction in Medicaid payments to pediatric therapists. (Bushra spoke on the condition that her last name be withheld.)
Conservative lawmakers slashed those payments in the hopes of saving about $150 million in state revenue — forfeiting roughly $200 million in federal matching funds — because, they argued, Texas Medicaid overpaid home therapy providers when compared to other public insurance programs. A group of for-profit home health agencies filed suit, saying the cuts would put them out of business and thereby endanger children’s health. A Texas appeals court last month ruled the lawsuit had no standing.
Now, with the cuts all but certain to take effect, nonprofit providers are speaking out about the challenges on their own — and appear to be distancing themselves from the for-profit providers state officials challenged in court. Specifically, nonprofit providers are warning about the dangers the payment cuts would put on the state’s Early Childhood Intervention program, which is distinct from other in-home pediatric therapy services paid for by Medicaid.
The program pays for caseworkers and encourages therapists to teach family members how to work with children. It typically pays for fewer individual therapy sessions. And its services are only available until a child turns three years old.
Early Childhood Intervention, which serves approximately 50,000 children in Texas each year, also has its own dedicated stream of federal and state funding, but nonprofit providers say they must bill Medicaid to pay for the bulk of the program’s services. Child welfare advocates have warned that the Medicaid cuts will cause providers to drop out of the program.
"As ECI services take a hit, our elementary schools should plan on providing expensive special education to more students,” said Stephanie Rubin, the chief executive of advocacy group Texans Care for Children, in a recent statement after the for-profit providers lost in court.
"We remain hopeful that a solution can still be reached to protect children from these cuts, whether it’s through the courts, federal officials, the Health and Human Services Commission, or the Legislature,” she added.