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Debate over Medicaid therapy cuts to be warm-up budget battle


The cuts lowered the rates at which therapy providers in Texas get reimbursed by Medicaid.

House Speaker Joe Straus hopes to lessen the burden of the cuts.

Advocates for the cuts estimate the lowered rates will reduce the program by $350 million over two years.

As Texas House and Senate leaders gird for a high-stakes fight over the state budget, a preliminary round of that showdown is taking shape over whether to partially undo cuts to a Medicaid program that reimburses therapists who serve low-income people with disabilities.

House Speaker Joe Straus, R-San Antonio, is hoping to lessen the burden of the cuts the Legislature adopted in 2015 through the coming supplemental budget, which plugs holes in the current budget, for 2016 and 2017, and is approved before the final negotiations for the next two-year budget take place in late May.

But Senate Finance Committee Chairwoman Jane Nelson, R-Flower Mound, has so far not given any indication that the upper chamber is interested in reversing the cuts, which lowered the rates at which therapy providers in Texas get reimbursed by Medicaid, the state-federal health care program for the poor.

The cuts, adopted in the 2015 Legislature, were delayed until December by a court battle that ended with the Texas Supreme Court declining to prohibit the state from cutting the reimbursement rates. Some health care providers have already stopped offering therapy services to Medicaid patients, primarily children with conditions like Down syndrome, shaken baby syndrome and hydrocephaly.

Advocates estimate the lowered rates and provider participation will result in a $350 million reduction in the program over two years, with $150 million coming from state coffers and $200 million from federal matching funds.

The fight over the supplemental budget will overlap with disputes over the 2018-19 budget, including decisions over how much the state should spend on public education, border security and Child Protective Services. Straus and Lt. Gov. Dan Patrick, who leads the Senate, are so far at loggerheads over many of the most vexing questions facing the Legislature this year.

The initial House and Senate proposals for the 2018-19 budget, released by Nelson and Straus two weeks ago, were $7.9 billion apart, with the House plan spending $221.3 billion and the Senate $213.4 billion.

Neither of the proposals anticipated changes to the Medicaid therapy program, but Straus spokesman Jason Embry said Tuesday they will be part of the House’s pitch for the supplemental and for the full 2018-19 budget.

“The House plans to adjust therapy rates in the supplemental budget bill that will soon be introduced,” Embry said in a statement. “Those revised rates will be reflected in the House budget for the next two years.”

At the Texas Tribune Festival in November, Straus described the cuts as “well intentioned” but said, “Maybe they were a mistake.” He said they were initiated by the Senate and would be addressed the supplemental budget.

Nelson declined to comment.

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