Safety net un­der threat for dis­abled stu­dents

At a school where Med­i­caid fills a fund­ing gap, staff mem­bers keep one eye on the Hill

The Washington Post Sunday - - METRO - BY MANDY MCLAREN

With a mail­bag slung across his small frame and a wide­brim hat perched atop his head, Ma­son Wade stepped up to the cat­walk. Clasp­ing his aide’s hand for sup­port, he sashayed across the gym, a sprawl­ing red car­pet un­der his feet.

For the 6-year-old dressed as a mail car­rier, his fa­vorite com­mu­nity helper, the end-of-year fashion show at St. Co­letta Spe­cial Ed­u­ca­tion Pub­lic Char­ter School in South­east Wash­ing­ton was a chance to strut his stuff. For the school-based ther­a­pists look­ing on, it was a mo­ment years in the mak­ing.

Ma­son, who has a de­vel­op­men­tal de­lay, used a wheelchair when he started at St. Co­letta in 2015. Hun­dreds of phys­i­cal ther­apy ses­sions and oo­dles of en­thu­si­asm later, Ma­son is walk­ing, able to tra­verse the school’s black-and­white-tiled hall­way with the sup­port of an adult.

At St. Co­letta, where all stu­dents have spe­cial needs, tiny pieces of progress can add up to life-changing tra­jec­to­ries. The school re­lies on fund­ing from Med­i­caid to em­ploy a cadre of ther­a­pists. But with each twist in the health-care de­bate on Capi­tol Hill, staff mem­bers won­der whether their Med­i­caid dol­lars could be at risk.

Pride for stu­dent achieve­ment is shad­owed by anx­i­ety over the un­known.

“We would not rest easy if we knew we couldn’t pro­vide the ap­pro­pri­ate ser­vices for our kids,” said Loni Licua­nan, who di­rects the school’s ther­a­peu­tic ser­vices.

The fed­eral gov­ern­ment al­lows pub­lic schools to re­ceive Med­i­caid re­im­burse­ment for school­based health ser­vices re­quired through stu­dents’ spe­cial ed­u­ca­tion plans. Although fed­eral law man­dates that schools pro­vide these ser­vices, Congress has never au­tho­rized the amount of fund­ing it pledged when the law was passed decades ago. To make up that bud­get gap, schools have turned to Med­i­caid.

The District, which ex­panded Med­i­caid cov­er­age in 2010 un­der the Af­ford­able Care Act, re­ceived more than $40 mil­lion in Med­i­caid re­im­burse­ments for spe­cial-ed­u­ca­tion ser­vices dur­ing the last fis­cal year, ac­cord­ing to the Of­fice of the State Su­per­in­ten­dent.

Cuts to Med­i­caid would af­fect schools across the District, but St. Co­letta would be es­pe­cially hard­hit. Each of the school’s 250 stu­dents is in­tel­lec­tu­ally dis­abled, and most re­quire mul­ti­ple types of ther­apy.

Dur­ing fis­cal 2016, St. Co­letta pro­vided more than $1 mil­lion in spe­cial-ed­u­ca­tion ser­vices to Med­i­caid-el­i­gi­ble stu­dents. The school was re­im­bursed for 70 per­cent of the cost through Med­i­caid, which helps pay the salaries and ben­e­fits of 35 ser­vice providers, in­clud­ing phys­i­cal ther­a­pists, oc­cu­pa­tional ther­a­pists and speech-lan­guage pathol­o­gists.

Over­all, Med­i­caid re­im­burse­ments ac­count for only 5 per­cent of St. Co­letta’s an­nual bud­get, but the school says those funds — more than $750,000 an­nu­ally — make it pos­si­ble to pro­vide ser­vices not avail­able at other D.C. pub­lic schools.

In ad­di­tion to weekly one-onone ses­sions, St. Co­letta stu­dents have ther­apy as part of their daily rou­tines. Bath­room breaks are used as skill-build­ing op­por­tu­ni­ties, from sup­port walk­ing across the hall to guid­ance in us­ing a toi­let in­de­pen­dently. At lunchtime, where feed­ing and swal­low­ing can be ar­du­ous for some stu­dents, ther­a­pists as­sist.

An­toinette Davis of South­west Wash­ing­ton said school-based ther­apy has given her daugh­ter, Kamille, the con­fi­dence to make new friends and to climb the spi­ral stairs in the fam­ily’s du­plex.

Kamille, 6, has Smith-Ma­ge­nis syn­drome, a rare ge­netic dis­or­der that can cause de­layed speech. As a toddler, she was non­ver­bal. Un­able to ex­press her­self, she re­sorted to self-harm, scratch­ing her arms and bang­ing her head, Davis said.

“She would get mad and frus­trated be­cause we didn’t know what she wanted,” she said.

Since en­rolling at St. Co­letta two years ago, Kamille has learned to use a spe­cial­ized tablet to com­mu­ni­cate her needs and to show what she’s learned.

“She knows her col­ors, the al­pha­bet, how to spell her name,” Davis said. “I can see the dif­fer­ence in her.”

Lo­cated across from the D.C. Ar­mory, St. Co­letta ed­u­cates stu­dents un­til they turn 22. Be­cause of the sever­ity of stu­dents’ dis­abil­i­ties, there are no grade lev­els. Stu­dents are sep­a­rated by age.

Brandon Walker, 20, is a mem­ber of the school’s old­est group. A stu­dent at the school for more than a decade, he is un­able to walk or speak. It took a team of ther­a­pists years to find a com­mu­ni­ca­tion sys­tem that worked for him, said Kather­ine Short, the school’s ther­apy co­or­di­na­tor.

Walker uses eye-track­ing tech­nol­ogy to com­mu­ni­cate. A cam­era in­side a tablet-like de­vice mounted to his wheelchair mon­i­tors his eye move­ments back and forth, as one might a cur­sor mov­ing across a com­puter screen. When his eyes dwell on an im­age for one-sixth of a sec­ond, the ma­chine says the cho­sen word for him.

Us­ing the de­vice, Walker can tell his teacher when he’s hun­gry, tired or in the mood to lis­ten to his fa­vorite jazz mu­sic. And, for the first time, he can en­gage so­cially.

The tech­nol­ogy, pur­chased by his fam­ily through Med­i­caid, “gives him ac­cess to his world, ac­cess he never had be­fore,” said Short, a speech lan­guage pathol­o­gist.

Ac­cord­ing to a re­port from the Of­fice of the D.C. Au­di­tor, the District would lose $563 mil­lion in fed­eral funds for Med­i­caid in the first year and up to $1 bil­lion an­nu­ally by 2028 if Congress were to re­peal the Af­ford­able Care Act.

If the fed­eral gov­ern­ment re­duces its share of Med­i­caid spend­ing, schools might have to com­pete with other med­i­cal providers, in­clud­ing hos­pi­tals and nurs­ing homes, for lim­ited re­sources, said John Hill, ex­ec­u­tive direc­tor for the Na­tional Al­liance for Med­i­caid in Ed­u­ca­tion.

“There’s go­ing be losers, and it will be up to the states to de­cide who those losers are go­ing to be,” he said.

For Sharon Raimo, St. Co­letta’s chief ex­ec­u­tive, that prospect can be mad­den­ing.

Raimo, who helped found the school in 2006, said any threat to her stu­dents’ safety net is wor­ri­some. Med­i­caid cuts, in par­tic­u­lar, would be short­sighted, she said.

“When these kids at­tain these goals, it makes them eas­ier to take care of at home, rather than be­ing placed out­side of the home, which is much more ex­pen­sive,” she said.

St. Co­letta al­ready fundraises for many of its needs and would seek ad­di­tional sup­port from donors if nec­es­sary.

“These are the peo­ple who make my heart beat faster,” she said. “Ev­ery­body here who does this work, we do it be­cause we care about them and we re­ally think they have po­ten­tial.”


TOP: Ther­a­pist Lauren Fery as­sists Kamille Davis, 6, Wed­nes­day at Wash­ing­ton’s St. Co­letta school, where all the stu­dents have spe­cial needs. ABOVE: Sharon Raimo, the school’s chief ex­ec­u­tive, fears fed­eral health-care cuts will jeop­ar­dize St. Co­letta’s abil­ity to pro­vide ap­pro­pri­ate ser­vices to its stu­dent body.


Speech ther­a­pist Sherelle Smith works with Kamille Davis, 6, at St. Co­letta. Since en­rolling, Kamille, who is non­ver­bal, learned to ex­press her­self with a tablet de­vice.

Phys­i­cal ther­a­pist Keith Al­bar­illo works with Ma­son Wade, 6. In his time at St. Co­letta, Ma­son has moved from us­ing a wheelchair to walk­ing with min­i­mal help.

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