This week marks the beginning of the most important month for Medicaid therapy in Texas and possibly in the nation. At stake is the very fiber of the therapy industry in Texas Medicaid and hence for most other payor options. The amended injunction that now includes Superior Healthplans as a co-defendant will be ruled on by the injunction presiding state district judge, Tim Sulak tomorrow. On April 25, the injunction will be finally ruled on as well.
At this point, in a united front, therapists and therapy businesses in Texas should consider the uniform support of this injunction. There is a website dedicated to the support of Texas Medicaid children receiving therapy and the injunction. Visit the website HTTP://PROTECTINGTEXASKIDS.COM to support this cause.
Texas legislators, including state Sen. Jane Nelson, R-Flower Mound and state Sen. Charles Schwertner, R-Georgetown who have supported the Tx HHSC and managed care MCOs to reduce the reimbursement rates for Medicaid therapy services, have justified these actions as being a stop-gap effort to curb state overspending on an increased number of therapists in the state. Additionally, they remain defiant in their claim that therapists in Texas are overpaid – this despite the debunking of the Texas A&M study that the school itself has distanced itself from and is now in the midst of proving the opposite in another study.
Consideration of the effect of the markedly increased Medicaid market in the state which would most assuredly have caused the increase in therapists was not investigated as a cause-and-effect by the Legislature nor in any of its healthcare subcommittees. Moreover, the loss of therapy services because of a reduction of therapists through the implementation of these rate reductions, either through Tx HHSC’s base rate reduction proposals or the discounted rates being offered by Texas MCOs for Medicaid therapy services, will mean only one thing – the future deterioration of the health of Texas Medicaid children and hence the long-term debt in spending to relieve that highly probable health epidemic. The so-called $135 million gap produced by the sustainment of the current Medicaid therapy rates would easily be paid by a small fraction of the Texas Rainy Day fund.
The underlying political question emanating from the microcosm of this reimbursement struggle appears to be the will of the legislators to continue to maintain and support the Medicaid therapy program in Texas, (i.e., reimbursing for any therapy services for Medicaid recipients).