Courts should back disabled children of Texas, restore funding

Occupational therapist Amanda Halbert works with Brianna Dupuie, teaching Brianna how to get through her morning routine, like making toast with peanut butter. When Brianna was a year old, a babysitter shook her so hard she had a stroke. The stroke resulted in Cerebral Palsy, and she has had to re-learn how to walk, talk and do basic daily chores. Medicaid has helped pay for the weekly physical, occupational and speech therapy sessions because she was a foster child. But cuts to Medicaid could cause an access to care issue that would affect Brianna and 60,000 other Texas children with disabilities, impacting their progress. LAURA SKELDING/AMERICAN-STATESMAN
Occupational therapist Amanda Halbert works with Brianna Dupuie, teaching Brianna how to get through her morning routine, like making toast with peanut butter. Medicaid has helped pay for Briana’s weekly physical, occupational and speech therapy sessions because she was a foster child. LAURA SKELDING/AMERICAN-STATESMAN

 

What a mess. That’s what you get when Texas lawmakers call for millions in cuts, as they did in 2015,  to therapy services for disabled children. Now, the courts are left trying to sort out the muddle.

Last session, Texas lawmakers approved a two-year budget that ordered a roughly 25 percent cut to the amount of money some pediatric therapists were paid by Medicaid. The cuts equal $150 million in state funds and $200 million in matching federal funds. Answering to the legislature call, Texas Health and Human Services Commission officials targeted the funding cuts around physical, occupational and speech therapies that affect an estimated 60,000 disabled children, including foster children. With any luck, the courts will find that funding should be restored and see that the commission’s decision to cut these particular funds is short-sighted.

Yes, short-sighted. The services targeted are long-term therapies that help children with limited abilities become more independent and self-sufficient to the best of their abilities. Studies show that greatest results are achieved when therapies begin at a very young age and continue into adulthood, if necessary. To cut or limit those therapies and services dramatically decreases the chances of these children to grow and be productive citizens.

Understandably, a group of in-home therapy providers and families of children with disabilities immediately sued the state in August to prevent the payment cuts from taking effect. Advocates and families argue that payments to providers for Medicaid patients would drop by as much as 28 percent. Such a steep reduction in payment would force some providers out of business and leave many children without much-needed therapies. It should be noted that these arguments were countered last week by a lawyer for one healthcare insurer who said in court that rate reductions could be carried out without a reduction in services.

Still, there has to be a better solution than to take aim at services that benefit the most vulnerable Texans: Children with severe disabilities with no money to pay for the services they need. Yet, the commission refuses to see it that way, even when many have said that state’s proposed cuts are based on faulty information.

The Legislature based the cuts on single independent study from Texas A&M Health Science Center researchers — parts of which state District Judge Tim Sulak, in signing a temporary injunction to the cuts in September, said were “seriously flawed.” Like I said: It’s a mess.

Yet, on Wednesday, during oral arguments in the Texas 3rd Court of Appeals, the attorney for the state’s health commission, Kristofer Monson, said the appropriations bill passed by the Legislature in 2015 mandated the cuts and left the commission with no choice but to carry them out. “The commission followed the rules,” Monson has said.

Numerous letters and comments made by at least 60 legislators, show that the lawmakers don’t agree with Monson.

In fact, Lt. Gov. Dan Patrick and Flower Mound Republican state Sen. Jane Nelson, the chairman of the budget-writing Senate Finance Committee, told Health and Human Services Commissioner Chris Traylor he had “the flexibility to strive for achieving $100 million in savings in Medicaid therapy services while preserving access to services.” The key here is access to care.

No one argues that identifying corruption and pockets of waste is a bad idea — that, after all, was the initial intent for the legislative bill. Looking for ways to make the best of taxpayer money should be a priority.  However, what we are dealing with here is not comparable to unnecessary dental services for a healthy kid, but  limiting the life-altering therapies of a disabled child. Hopefully, the courts will see on April 25 that the commission was short-sighted in their call for these particular cuts and restore funding for Texas disabled children.

 

 

$1,000 to fix a broken bone? Try $25,000

10557787_10153743513238617_3292451984978331063_oThe world of medical bills can be bewildering, even for those of us with good health insurance. The Affordable Care Act, aka ObamaCare, has meant more people are covered in Texas than ever before, but it is not a stretch to say the billing is just as confusing, and depending on the size of your deductible and your paycheck, an unexpected medical expense can still be a substantial hit to the family’s pocketbook.

A story in today’s Business section cites a national study by Bankrate.com that 66 percent of Americans can cover a $500 crisis a car breakdown or a trip to the emergency room would wipe out nearly tw0-thirds of Americans’ savings. The statistic was not as startling as the estimated cost of treating a broken bone, which Bankrate put at about $1,000.

I know a little something about broken bones and hospital bills, because my two daughters, ages 6 and 8, have managed to have three between them in the last two years (jumping on the bed, bike accident, and falling off a chair.) The last of which happened on Christmas Day and ended in emergency orthopedic surgery. The bills are still coming in on that one, but the total if I were uninsured would be in excess of $25,000. By virtue of the fact that I have pretty reasonable insurance through the Statesman and the fact that my daughter had already maxed out her medical deductible earlier in the year, we will be on the hook for about $1,000 of that cost. We can afford to pay it, but others are not so fortunate.

For those Texans who fall in the Medicaid gap — those whose incomes are below the poverty level but are ineligible for Medicaid and do not qualify for the federal health insurance subsidies — $25,000 might as well be $250,000. That fact alone would explain why unpaid medical bills are considered the No. 1 cause of bankruptcy. Nationally, nearly 3 million people are in the coverage gap; a quarter of those live in Texas, according to the Kaiser Family Foundation.

In my time on the editorial board, I’ve heard various groups attempt to explain that rising medical costs are due to a failure of families to research the costs or an inability to prioritize their spending. But when your child falls and her bone is unmistakably broken, there is no time to go online and compare costs for orthopedic surgery, there is no form to sign to require hospitals to use only “in-network” specialists, and I dare anyone to suggest that perhaps you cut back on the pain medication to cut costs. Saying “Nevermind, let’s not fix this arm today” is not an option.

With the deadline for signing up for health insurance on the federal exchange on Sunday, those who qualify for ACA should absolutely take advantage of it — regardless of how young or healthy you may be. A single, freak accident or unexpected medical diagnosis can be a financial catastrophe.

Republicans in Congress have spent years trying to repeal a law that is needed for American families, although currently imperfect. A family should not have to take on the equivalent of a car loan to fix an 8-year-old’s broken arm.