Attempts by Texas budget writers to cut $100 million in Medicaid payments for physical, occupational and speech therapy for needy children have turned into a real mess less than a year after they were approved.
Legislative leaders are clearly trying to shave expenditures from very expensive programs, but they’ve also tried to avoid responsibility for negative consequences.
Normally, courts shouldn’t get involved in shaping the state budget. But this effort has been bungled so much that courtroom arguments and judicial rulings are the only way to straighten it out.
A group of therapy providers and families of children with disabilities sued the state to block the cuts, saying they will deprive children of services they need.
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A state district judge temporarily blocked the cuts, but the state has argued before an appeals court that it should be allowed to move forward.
More than 60 legislators wrote Health and Human Services Commissioner Chris Traylor saying he should not allow children to be harmed.
The legislation itself, Rider 50 attached to the Health and Human Services Commission budget, says the cuts should be done “while considering stakeholder input and access to care.”
Consider the lawsuit from therapy providers and families to be strongly negative input.
Lt. Gov. Dan Patrick and Flower Mound Republican state Sen. Jane Nelson, the chairman of the budget-writing Senate Finance Committee, told Traylor he had “the flexibility to strive for achieving $100 million in savings in Medicaid therapy services while preserving access to services.”
That reads like an attempt to shift responsibility to Traylor. But he didn’t take the bait.
“I understand your letter to direct HHSC to preserve access to care even if it means the full rate reductions contemplated by Rider 50 cannot be achieved,” he wrote back to Patrick and Nelson.
That’s a gutsy move by an agency head.
Last week, a lawyer for one healthcare insurer said in court that the rate reductions could be carried out without a reduction in services.
But an attorney for therapy providers said they would be put out of business. Payments to providers for Medicaid patients would drop by as much as 28 percent.
Nelson has said rates paid in Texas are well above those in other states and above in-state commercial rates.
State District Judge Tim Sulak of Austin, who temporarily blocked the cuts from going into effect, has called the state’s rate study “seriously flawed.”
Sulak has set a hearing next Monday on permanently blocking the cuts. That won’t end the court action, but it’s the logical next step.