Viewpoints: Texas needs to help — not pick on — children with disabilities


Picking on the most vulnerable is not the Texas way. Yet, it is exactly what state lawmakers do each time they take aim at programs that serve children with disabilities. It’s no surprise then that in its quest to change how it handles Medicaid, Texas has hurt more than helped hundreds of children with disabilities.

The list of hurt caused by cuts and the privatization of Medicaid is long. Families report less access to much-needed medical services, such as life-altering therapies and critical prescription drugs for children, the American-Statesman’s Julie Chang reported. Less timely access to services has created life-or-death situations for some children and regressed hard-fought progress for others.

This can’t continue. The Legislature needs to help Texas find its way back to standing up for these children, not knocking them down.

SPECIAL REPORT: How Texas Medicaid is failing children with disabilities.

Lawmakers can start by reinstating funds for therapy services and to early intervention programs that help improve the quality of life for children with disabilities. State leaders should also demand transparency from organizations managing Medicaid programs and set aside enough resources to properly supervise those contracts.

For years now, a Republican-dominated Legislature has cut programs that serve the state’s poor and vulnerable. That includes the Legislature’s steady course to the privatization of Medicaid, a state and federally funded program that has successfully served children with disabilities from families of all economic statuses. Cuts to such programs, lawmakers say, save us money. Meanwhile, the state’s most vulnerable continue to pay the price.

Consider that in 2011, a tough budget year for the state, lawmakers cut costs by limiting eligibility for Early Childhood Intervention services to children with the severest disabilities. Such services for children up to 3 years old help kids with developmental delays and disabilities prepare for kindergarten while saving the state money on costly special education services down the road.

Since the state’s narrower eligibility requirement, enrollment for Early Childhood Intervention services has dropped 14 percent statewide to 59,000. Funding for services has declined 11 percent to $142 million in 2017, Chang reported.

In 2015, the Texas Legislature lowered Medicaid reimbursement rates to physical, occupational and speech therapists that serve children with disabilities by $350 million. Lawmakers restored a quarter of the cuts this year, but health commission officials made more reductions in September.

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Without proper therapy, progress a child has achieved can stall or reverse. Legislators should reinstate those funds.

Then last year, Texas turned over Medicaid services for children with disabilities to private companies and hospitals, called managed care organizations.

The move was part of a multiyear transition into the state-created STAR Kids managed care program approved by the Legislature in 2013. Now, instead of handling the medical services for 164,000 children with disabilities, Texas pays managed care organizations by the patient, not the services delivered. The program is expected to save the state hundreds of millions of dollars.

As many suspected, the move has been anything but smooth.

Between February and May, 12 percent of children with the severest disabilities were denied Medicaid services, triple the overall rate of 2016, according to the Texas Health and Human Services Commission.

Under STAR Kids, surgeries previously approved are now being denied; access to critical medication and medical supplies has become difficult; patients are waiting longer periods between appointments and receiving less time with specialists and therapists; and children are being denied coverage and services without explanations.

It’s not surprising. Less services mean more profits for managed care organizations.

Texas’ least fine hour came when the Legislature chose to continue with a managed care model knowing it would be riddled with problems. State leaders know that health insurers cut corners and can inflate diagnoses to maximize profits. Still, they proceeded.

Shameful.

As expected, grievances have been plentiful. Since last November, more than 2,500 complaints from providers and families have been lodged against STAR Kids, according to the health commission.

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The commission is addressing the increase in denials by analyzing whether the STAR Kids assessment tool used by managed care organizations to determine services is accurate. The commission should mandate that no child with a disability be denied service or coverage until all necessary fixes to the assessment tool are complete.

Legislators must demand transparency and appoint resources to ensure that, in this case, managed care organizations deliver on contract expectations.

Texas once placed importance on investments that help our most vulnerable. We need to get back to those values.



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