GOP opposition emerges to huge cuts in Medicaid services for disabled Texas children

Note: This story by Emily DePrang originally appeared on The Quorum Report.

Now that a plan to slash state funding for a therapy program for severely disabled children has become better known, a growing number of Republicans – including the Texas Senate's Transportation Committee Chairman and a key House appropriator – have raised serious questions and asked the Health and Human Services Commission not to implement the changes until their impact has been fully studied.

Quorum Report learned late Wednesday that HHSC Commissioner Chris Traylor has so far received letters of concern from Republican legislators including Sen. Robert Nichols and state Reps. Four Price, John Zerwas, Brooks Landgraf, James Frank, Trent Ashby, and Charles “Doc” Anderson.

Rep. Dan Huberty, R-Humble, has publicly opposed the cuts since their inception at the end of the legislative session. Huberty voiced his concern on the House floor and the suburban Republican received no answer as to why the drastic cuts were targeted at a program that helps some of the most vulnerable Texans. Additionally, more than 60 Democratic lawmakers have signed letters asking Commissioner Traylor to delay and reconsider the changes.

The proposed cuts are scheduled to take effect September 1st, though a lawsuit has been filed and a hearing is set for Monday that could put the rate cuts on hold.

As proposed, the new rates would slash by 25 to 90 percent what the state pays providers of physical, occupational and speech therapy for poor children with severe disabilities. This would save the state $150 million on Medicaid spending over the next two years, satisfying a budget rider, but would also cause the state to lose $200 million in federal dollars, reducing total funding for the Medicaid Acute Care Therapy Program by more than half. Stakeholders say thousands of providers will be forced out of business, causing between 60,000 and 70,000 children to lose access to medically necessary care, particularly in rural areas.

“I am writing to ask that HHSC ensure consideration of all aspects of this proposed adjustment prior to implementation of any change,” wrote Rep. Price, who led the Sunset Commission report on HHSC. “I ask that your ultimate decision carefully weighs the needs of patients living in rural communities,” he said.

Rep. Zerwas echoed Price’s sentiments and added that the state risked economic damage if providers close, possibly sacrificing long-term savings for short-term.

It was Sen. Nichols, though, who offered the most powerful letter from a Republican about this, questioning not only the potential loss of access for needy children but the legitimacy of the data on which HHSC based their new rates. It was a hybrid analysis of commercial rate data and pay rates of other states.

“The HHSC analysis” used to justify the cuts, Nichols wrote, “may not fully reflect an equitable comparison of states’ Medicaid rates.” “Furthermore,” Nichols said, “the Texas Administrative Code… makes no reference to consideration of commercial rates.”

In written responses to Nichols and Price, Commissioner Traylor said the senator's assertions were incorrect and that the HHSC is moving forward with the new reimbursement rate that would have the least negative impact. The agency is acting under the direction of The Legislature, Traylor noted. He said a hearing was held by the agency and all points of view are being considered.

That’s not good enough for Rep. Huberty and others.

Huberty told QR that it appears the huge cuts were passed without due consideration.

“Now I think we’re finding out this is really a problem,” Huberty said. “So what are we going to do about it? Hopefully there’s a way to get enough people who have constituents in their district that are going to stand up and say, we can’t allow this to happen.”

Although Commissioner Traylor is on the receiving end of the concern, he shouldn't be the target of criticism, said Republican consultant Ted Delisi.

"When acute therapy providers have requested meetings with the commissioner, he has been accessible." Delisi said. But, “it is clear from the rate hearing and from the fact that the cuts total $350 million, all funds, that we are going to have a significant access problem,” he said.

Delisi said lawmakers and Traylor are doing the best they can to strike a difficult balance. "You want to make sure that therapy is provided for the medically fragile children in Medicaid that receive these services," he said, "and at the same time you want to make sure taxpayer dollars are used in the most efficient way possible."

"We’re a very tight-fisted state" Delisi said. "We’re not a state that’s going to expand access to care or Medicaid eligibility under ACA (Obamacare). That’s a policy judgment. People understand that."

But occasionally, the Texas tendency to save money anywhere it can may be counterproductive.

"This is one of those times when I think it puzzles the provider community that a cut this severe would happen," Delisi said, "given that the state is in such a robust economic position."

Copyright August 19, 2015, Harvey Kronberg,, All rights are reserved. Reprinted with permission.


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