An ECI patient at the Easter Seals clinic in Houston, in December. His mother said she was concerned the Medicaid therapy rate cuts would put her son's therapy at risk.
Photo by Meagan Flynn

Amid State Cuts, UTMB Creates Its Own Program for Children in Need

Dr. Oscar “Skip” Brown, a pediatrician at the University of Texas Medical Branch, got tired of seeing kids turned away.

As with the vast majority of Early Childhood Intervention programs across the state, UTMB’s had been treading water for the past six to eight years, trying to stay afloat as the state inundated the disabled children’s therapy providers with repeated financial cuts. To make things worse, Brown said, the state had also developed increasingly restrictive criteria that developmentally disabled children would have to meet in order to qualify for services. Children with mild speech delays were considered not developmentally delayed enough — they needed a 33 percent delay, not 25 percent. One-year-old babies who appeared off the mark with developmental milestones were turned away because there was still time to wait and see if they would catch up.

For Brown, this type of approach no longer seemed right. The state-contracted ECI, he said, had become a program that was continually allotted fewer resources while also benefiting fewer children — a lose-lose situation.

“Here’s the catch,” Brown said. “If you look at the literature on early intervention and who benefits from that, it will clearly show you that people with mild to moderate delays benefit the most. You’re spotting it early, giving the therapy to them early. We’re in a program that is not adhering to that. Some of that’s been budgetary restrictions — in fact a lot of it has been. It’s become gradually more restrictive over time, and if you look at what we’re able to do now, it’s increasingly later or more severe [developmental delays] that the child has to manifest in order to qualify for services — it’s completely backwards.

“As time went on,” he said, ‘we’ve looked at this and said, there’s gotta be a better way to do this.”

UTMB informed the Texas Health and Human Services Commission in May that it had decided to pull out of the Early Childhood Intervention contract, with services continuing through this August. The Galveston-based hospital is the 14th ECI provider out of 58 to cut the cord with the state since 2010, and the sixth since July 2015, when the commission announced that it was slashing $350 million in Medicaid therapy reimbursement rates over the next two years, at the Legislature’s direction. The rate cuts have affected not just ECI providers but all occupational, speech and physical therapy providers for children struggling with conditions such as autism, spina bifida and traumatic brain injuries.

Lawmakers, some of whom admitted the cuts were a mistake, sought to undo some of the damage this session by giving ECI providers an additional $4.5 million in supplemental funds to close out the fiscal year and restoring 25 percent of the slashed reimbursement rate funds for the next biennium. Just this week, a special-session bill filed by Representative Sarah Davis (R-West University Place) that would fully restore the funding soared out of committee with a 21-0 vote — although it has yet to be placed on the calendar for a House vote. And it’s not on Governor Greg Abbott’s list of 20 priorities. Davis told the Houston Chronicle she didn’t care.

"If the governor is going to bring us back here to talk about what bathrooms people can use or what we can do with our trees, then surely the disabled kids should take priority and hopefully we add this to the call,” she said.

Brown, however, said that the funding restorations made in the regular session were only a drop in the bucket, and even if Davis’s bill does somehow pass, he’s unsure it can undo the damage already done. “Everybody suffered through a year and thought, maybe we can fix this,” he said. “Then we get into year three and realize we can’t.”

So Brown said UTMB started thinking outside the box: If it couldn’t fix what had happened, why not just start over?

The result — or work in progress, rather — is what UTMB will call Kids Launch: its own version of the ECI program without the budgetary constraints or restrictions on kids who qualify. The goal, Brown said, is to help more of the mild to moderately developmentally delayed children who otherwise would have been turned away from ECI. While UTMB’s current ECI program helps about 300 kids — about 55 percent of whom are on Medicaid — Brown said he is certain the number of children who need services is far higher.

He expects to begin rolling out Kids Launch this fall, but says the program is still largely in the works and that it may take the next year to get where it needs to be. Currently, UTMB’s ECI program finishes about $200,000 in the hole, he says, but he expects to finish with just a $100,000 loss after breaking away from the state’s contract. (The goal is not to make money, he said.)

"There may be some bumps in the road, but if this model works," Brown said, "we hope it's a model that can be applied elsewhere too."

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