Important Texas Legislative Update: Rate Reductions for Pediatric Therapy

 In Special Needs Planning


July 15th came and went with no Medicaid funding reductions to children’s therapy. The legal battle has continued since an Appellate Court ruled in favor of the State last April, and now, an order has come from the top: The Texas Supreme Court has issued a temporary injunction to the proposed funding cuts.  What does this mean?  While the Supreme Court’s recent decision does not address the substantive arguments of either side, it does benefit the cause of the medical providers and families who initiated the lawsuit by giving them more time to lobby for cause with the legislature.  Read more

Rate Reductions for Pediatric TherapyTexas State Capitol building located in Austin, Texas, USA.

The Law

In 2015, the Texas legislature approved a two-year budget that included a $350 million cut to Medicaid funding for pediatric therapy services.  The cuts have been delayed for months, but after a failed attempt at judicial intervention by therapy providers, the cuts will take effect in just a few weeks in the form of rate reductions for therapy services.  The services at issue include speech therapy, occupational therapy and physical therapy – and these are vital to many families.

The Controversy

Since 2009, Texas has seen an increase of roughly 40% in the number of Medicaid patients receiving therapy services, and costs climbed by 65% during the same time period.  Arguing that our state pays more than three times for therapy than other states, the legislature felt the cuts were appropriate and fiscally responsible. Providers argued the study that produced those findings was flawed and that decreased reimbursements will not only put them out of business, but also deprive children with disabilities much needed therapy.

The Impact

It’s still too early to know exactly how all of this will filter down and how quickly.  Therapy providers are still waiting to see the new fee schedule from the state, but maintain that the cuts will force some of them to stop treating Medicaid patients, and cause other providers to close their doors.  The state insists that children will still be able to receive therapy services.

It seems like a political tug-of-war with families smack in the middle, not sure who to believe, and left to grapple with all of the ramifications of these decisions.  Unfortunately, Texas ranks second to last in providing Medicaid services and quality of life to individuals living with disabilities*, so the state has some work to do if it hopes to earn the trust of the disability community (*according to an annual report, The Case for Inclusion, by United Cerebral Palsy/U.S.).

What Next?

If you, or someone you know, are likely to be impacted by all of this, stay informed.  Talk to your child’s therapy providers and find out how they are preparing to handle these changes and what you can expect from them.  Also, if possible, sit down with a financial planner to see if there are some creative ways to fund additional services in case that becomes necessary.  Parents and caregivers of children living with a disability already have to battle insurance companies and cover more bills than the average family, and we are saddened to know that these legislative changes are going to mean a greater burden to some of them and the potential loss of needed therapy for their young ones.

The Weeks Law Firm is here to serve you; we work to stay informed and pass along information that we think is valuable to our clients and the community.  If we can assist you or a loved one with special needs planning, please give us a call to schedule an appointment at 214-269-4290.


Recent Posts