Blocking recovery

The Legislature’s decision to reduce pay to therapists needs to be revisited and fast.

Even though there was enough to go around to triple spending on border security, the state Legislature directed the Texas Health and Human Services Commission to slash Medicaid reimbursement rates for therapists who work with Texas’ most vulnerable children. Legitimate questions are percolating about the reasons for the jump in the number of Medicaid clients now served by therapists. Nevertheless, there exists a very real likelihood that the extreme cuts proposed will be catastrophic for many Texas families.

The $150 million reduction in state funding over the biennium represents nearly a quarter of the overall budget for acute care — or outpatient — therapy, and it will trigger an estimated additional loss of $200 million in federal funding over the biennium. Acute care therapy can help ensure some children who receive the services will not require state aid for the rest of their lives and instead will be able to lead self-sufficient, productive lives.

While the cuts will primarily affect children, they will also affect adults. Of the seniors who need therapy, many have experienced strokes and need to re-learn to walk or speak.

In an attempt to stave off the “potentially catastrophic” cuts, 28 state representatives wrote to Health and Human Services Commissioner Chris Traylor after the legislative session ended. They shared the dire prediction that “providers estimated that if these rate reductions are implemented statewide, 60,000 pediatric patients will lose access to care and 7,500 therapists will be unemployed.”

In effecting the massive cuts, lawmakers relied in part on a summary provided by the health commission contending that Medicaid therapy payment rates in Texas were higher than those paid by other states and even by some private insurers. Therapy providers dispute those findings.

There has been a dramatic increase in the cost of pediatric acute care therapy as well as a jump in the number of clients since 2009. The growth in the industry along with the summary by lawmakers relied on raise legitimate questions that should be investigated to determine possible abuses.

But the magnitude of the cuts casts doubt on whether persons needing the therapy will continue to have access to care. “The question is whether the Texas Legislature is identifying the pockets of waste and corruption and going after them — or simply trying to limit the growth in spending in Medicaid … and doing it in a fairly meat cleaver kind of way,” Cal Jillson, a Southern Methodist University political scientist, recently told the Dallas Morning News.

Lawmakers owe it to the taxpayers as well as these vulnerable Texans and their families to delay the cuts until they have completed a thoughtful analysis of their impact on the health and well-being of people needing therapeutic services. Sixty lawmakers wrote Friday to ask Lt. Gov. Dan Patrick and Speaker of the House Joe Straus, as joint chairmen of the Legislative Budget Board, to give the health commission the flexibility to lessen the scope of the reductions, a request we support.

A group of home health providers and parents of disabled children, meanwhile, has sued the health commission seeking to block the cuts and has asked the court for an injunction to keep the rates from going into effect (“Lawsuit targets cuts in Medicaid therapy rates” Page B3, Aug. 12).

This isn’t the first time that the state has been sued over an alleged failure to provide needed services to poor children with disabilities. Ten years ago, the state settled a class-action suit, and Texas lawmakers ended up raising Medicaid rates.

When children with developmental delays and disabilities aren’t treated until later in life, their challenges grow more difficult and costly to treat over time. Even interruptions in service can cause long-term harm, according to Rachel Hammon, executive director of the Texas Association for Home Care & Hospice.

With hundreds of thousands of Texans potentially affected, lawmakers should not implement these drastic cuts without further study.