‘WHY ... TARGET THE KIDS?’
Medicaid cuts could affect many ill, disabled children in Texas
ROSHAUNDA Jones was standing in line at the bank a few weeks ago, trying to ignore what she was hearing.
“These people, they don’t want to work. They’re lazy,” loudly declared one of the older women in front of Jones.
“They’ve always got their hand out. They have all these babies and then they want the government to do everything for them,” agreed the second woman in disgust.
That did it.
“Excuse me, ma’am,” said Jones, a 38-yearold single Houston mother of three. “I’m one of those people who gets some of that assistance you’re talking about. I work, sometimes seven days a week, and I pay taxes. My son uses Medicaid because he has an illness.”
The women immediately muttered embarrassed apologies.
“Don’t be sorry,” Jones told them. “Just
choose your words carefully because you never know people’s situations.”
In Texas, the face of Medicaid might not be what you think. Of the roughly 4 million Texans who currently receive Medicaid, 70 percent are children from low-income families who rely on the program for routine medical care.
The remainder are pregnant women who are dropped two months after giving birth, the elderly poor, including those with serious conditions such as Alzheimer’s disease who have exhausted their savings and are in Medicaid nursing homes, and the disabled.
The fate of many Medicaid recipients in Texas and across the nation is now in the hands of the U.S. Senate as lawmakers attempt to repeal the Affordable Care Act and replace it with their version of health care reform. In this bitterly politicized debate, the two sides throw out numbers.
In Texas, those include about 160,000 children and young adults who have profound disabilities. It is those Medicaid recipients who are often seen as the most vulnerable of the vulnerable, said Adriana Kohler, senior health policy associate for Texans Care for Children, a child advocacy group.
They are medically fragile children whose parents say would not be alive today but for the complex surgeries, the specialized therapies and equipment, and the day-to-day care paid for by Medicaid.
Some are poor, but others dwell in the culs-de-sac of middle class whose parents may have traditional insurance but their policies do not or will not cover all of the ancillary support and programs their disabled children need. Love not always enough
“There are all of these things we need to help him in life,” Jones says of her 17-year-old son, Rashad, who was diagnosed with sickle cell anemia as a baby. “I need help. I can love him, but I can’t do it all.”
Every four weeks, the slightly-built teenager with shoulder skimming dreadlocks and oversized hornrim glasses goes to Texas Children’s Hospital for a blood transfusion. He has had them since he was 2.
“They take my old blood out and put new blood in,” he explains. He does not remember any other life.
His mother does, though. From ages 2 to 5 he would suffer repeated strokes. “His whole face turned to the left and he would be drooling and his speech was slurring,” she said, tears falling even now at the memory.
In 2005, she and Rashad fled to Houston from New Orleans after Hurricane Katrina. It was here that 5-year-old Rashad underwent brain surgery to curb some of the damage the strokes had done.
Next fall, Rashad will be a senior at Davis Senior High School. He receives special education because his short-term memory is wrecked and he has some learning difficulties. He gets help with reading and writing from a specialized computer. He used to get speech therapy paid through Medicaid.
At first glance, he could be any teenage boy. He shoots hoops with his cousins, plays video games on his PlayStation with his younger brothers, and listens to rapper Meek Mill.
But some things elude him. Last year, he finally learned to tie his shoes.
Jones earns $11.45 per hour as a package handler for FedEx. She works full time and will soon be eligible for a health plan through work when the next enrollment period opens. But she doubts it will pay for all of her son’s needs. She hears talk of big cuts possibly coming to Medicaid out of Congress and fears for Rashad.
Her mother, Cassandra Jones, brushes off such concerns. “Trump isn’t going to let them do that,” she said. Changing by the hour
Under the U.S. Senate’s health care plan, unveiled two weeks ago and evolving constantly, states could face $772 billion in reduced federal funding to Medicaid over the next decade, according to the Congressional Budget Office.
While much of the political clamor has been around the impact to the 31 states that expanded Medicaid as part of the Affordable Care Act, non-expansion states like Texas will feel the bite as well. It just might not be as obvious.
Texas could face a $9.1 billion reduction in federal Medicaid money between 2020 and 2026 under the Senate bill known as the Better Care Reconciliation Act of 2017, according to an analysis released last week by Avalere, a leading national health care consulting firm, which was commissioned by the Children’s Hospital Association, a group representing 220 children’s hospitals nationwide.
Conservatives decry the use of the word “cuts” when discussing the Senate’s plan to revamp the nation’s Medicaid program, saying the proposal instead sets limits on the amount of future dollars going to states based on current costs.
“Medicaid reform is urgently needed,” said Betsy McCaughey, the former lieutenant governor of New York and a senior fellow for the London Center for Policy Research, a New Yorkbased Conservative think tank.
She said in an interview on Friday that the Senate bill had been “demagogued” and argued that the Medicaid funding recalculations are merely curbing future growth.
But critics aren’t buying such hair-splitting semantics.
“We are a very lean program in Texas already. Make no mistake, this is a cut,” Kohler said.
Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, agreed. “Our person spending in Texas is already low. We will be locked in at a cost per person that is already inadequate.”
Much of the concern comes from the unknowns.
If federal funding becomes insufficient, states will have to make up the shortfalls. In Texas, it is widely expected those could come in one of three ways: Through less reimbursement to providers who could in turn stop seeing patients; reductions in services or tightening of eligibility.
Texas is already tied with Alabama as having the strictest eligibility threshold in the nation. Children’s health advocates worry there is no fat to be trimmed.
“Health and Human Services Commission is going to be faced with some extraordinarily difficult decisions. Who do you choose?” asked Stacy Wilson, president of the Children’s Hospital Association of Texas.
She and others said to view a sneak peek of what that future could hold under the Senate bill, look no further than what happened in the state when Texas lawmakers cut $171 million in Medicaid reimbursement for pediatric services such as speech, occupational and physical therapy.
Lt. Gov. Dan Patrick argued for the cuts because of rising costs for such services and incidences of fraud within the therapy provider ranks.
The Legislature approved the cuts in 2015, but implementation was delayed until late last year. In this year’s session, about a quarter of the cuts were restored. Still, some providers have stopped offering services because they say they cannot financially stay afloat.
“That was $171 million in cuts per year,” said Kohler, “Congress is asking for $1.5 billion each year in Texas.” Born too soon
Nicholas Cantu was born Dec. 26, 2007 — 12 weeks early.
He spent 110 days in neonatal intensive care. Today, he has been diagnosed with cerebral palsy and epilepsy. Developmentally, he is at the level of a 2-year-old.
“I used to think Medicaid was for poor people,” said Angela Cantu, who lives a middle-class life with her husband and two sons on a block of tidy brick homes in Spring.
Both she and her husband, James, work full time and get insurance through their jobs. But their policies come nowhere near covering all that Nicholas needs.
“Medicaid has been able to sustain our daily life,” she said.
There is the equipment needed for his daily feedings through a tube, the private duty nurse, the cabinet full of medicine and his specialized bed, wheelchair and car seat.
For instance, her private insurance allows only 15 minutes of nursing help per day and denied her son’s wheelchair.
She has watched what the Texas cuts in reimbursement have done. In June, she got a letter from Nicholas’ physical therapist who said she would no longer be able to accept Medicaid.
“I cried myself to sleep that night,” Cantu said.
Nicholas defies the odds every day. As she watches the unfolding drama in Washington over Medicaid she wants to scream at the television. It’s not politics. It’s personal.
“When they make it political they take away the faces of those who are benefiting from these services and put dollar signs in front of them,” she said, her voice tinged with fear but also bewilderment.
“Why do they have to target the kids?”