The Brownsville Herald: State aid cuts could devastate Early Childhood Intervention program
MISSION — When two-year-old Aaron Benavidez took his first steps, grandma and grandpa brought over a cake and the entire family celebrated amid laughter and tears.
Venturing out into the world of the walking is a huge universal milestone for children and their families, but for Aaron it was especially sweet. The now four-year-old was born with Down syndrome, which requires rigorous work to meet developmental milestones.
“It’s something that these children have to work really hard to do,” his mother Angie Hernandez said. “Typical children get there in their own time, but they get there and it’s not so much of a struggle. But kids with special needs really have to work to get to the next step.”
They often require help from professionals to learn a variety of skills, including how to walk, talk and even swallow. Muscular weakness comes hand-in-hand with Down syndrome and it affects those born with it throughout their lives.
For Aaron, its effects became apparent within his first days of life. The newborn would spill about half of the milk fed to him because the muscles in his mouth were too weak to latch on correctly. A speech pathologist who made weekly house calls to the home, however, taught his mother how to fix the problem through oral motor exercises.
The therapist — who also stepped in when Aaron started pocketing solid food in his cheeks — was provided to the family through a state program facing major budget cuts. About a year ago Texas legislators slashed $350 million in state and federal funding for pediatric therapy services for children like Aaron. The cuts are scheduled to begin next week.
Texas lawmakers cut $150 million in state funds from the budget in 2015, and as a result lost $200 million in federal funding. The Texas Health and Human Services Commission plans to cut Medicaid payments made to home health agencies and providers of speech, occupational and physical therapy by about 20 percent, state Rep. Terry Canales said.
Canales is one of the many lawmakers and healthcare professionals worried about the impact the cuts will have on some of the state’s most vulnerable. He penned an op-ed in The Monitor last month, blasting the Republican-led legislature and calling for the Center for Medicare and Medicaid Services to review the cuts and step in to save the “vital services.”
The state lawmaker attributed the cuts to several factors, including fraud and the decrease in oil and gas prices.
‘DIDN’T SEE THAT COMING’
For over 30 years, the Early Childhood Intervention (ECI) program has helped over 800,000 families across Texas learn how to be their children’s best teacher at home. ECI is designed to assist families of children up to three years old with developmental delays — a key period in a child’s development.
A service coordinator typically visits a child’s home, assesses their needs and creates a program tailored specifically for the child’s needs. It often calls for regularly scheduled home visits with a variety of therapists.
More than 1,500 children in the Rio Grande Valley receive assistance from ECI through the two host agencies in the area — Region One and Easter Seals — said Patricia Rosenlund, executive director at Easter Seals.
Rosenlund has been urging lawmakers to reconsider or intervene. She lobbied in Washington last week, where she met with U.S. Reps. Ruben Hinojosa, Lloyd Doggett and Henry Cuellar.
Like Canales, she believes the cuts were triggered by fraudulent charges made to Medicaid.
“We understand that there was abuse in the Medicaid program, but it certainly wasn’t in the early intervention program,” she said. “We don’t make money. It’s impossible. Even if we ended up with dollars, it would go back into the system.”
Fraud is prevalent throughout society, Canales said, but it should not be used as an excuse to wipe out a whole sector of services.
If their target was specific areas of Medicaid fraud, what they did was use a carpet bomb instead of a rifle,” he said. “The answer to Medicaid fraud — or any other type of fraud — is not taking funds from the operating system, it’s enforcing the law that exists.”
Rosenlund believes legislators did not have enough information to foresee the potential disaster created by the cuts.
“I think the problem started with the outpatient (services), and there was some abuse within that arena, but I also think that no one realized that cutting Medicaid rates would hurt and hit a program like Early Childhood Intervention,” she said. “They didn’t see that coming.”
TIME IS OF THE ESSENCE
Rosenlund is not sure how the cuts will impact the Rio GrandeValley, where about 46 percent of children live in poverty and depend on Medicaid for services.
“Kids are expensive, but really, what family can then on top of that afford the wheelchair and the special therapy services that are needed,” she asked. “Families are suffering. Families are going to have a lifetime of expenses and additional worries — all that goes with having a child with a disability.”
The cuts might also mean a reduction in services at a critical developmental time, Rosenlund said. Children have a small window of opportunity from birth to three years to establish the foundation for speech and other essential basic life skills. It is the age in which neural circuits — which create the foundation for learning, behavior and health — are the most flexible.
“We have a very time-sensitive opportunity to really change the path of a child’s life and improve their function and abilities,” Rosenlund said. “If they don’t get good quality services at this opportunity, then they’re going to hit school age, they’re going to need a lot more. They’re going to be behind, and that isn’t helping the state save dollars.”
Critics of the budget reduction argue schools will end up paying for more expensive special education services as children with disabilities who can’t access therapy start to fall even further behind. Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later.
An article published by the Council on Children with Disabilities states that studies found that children who participate in these programs tend to have less need for special education and other remedial work; greater language abilities; and improved nutrition and health.
“Starting at age three or four is too little, too late, as it fails to recognize that skills beget skills in a complementary and dynamic way,” the document states.
It goes on to calculate that for every dollar spent on ECI programs, the return of investment ranges from $2.50 to $17.07.
“At the end of the day, the one who is suffering is the child,” Aaron’s mother said. “It’s not the rehabs that are losing money, the home healths. It’s not the therapist who might get his hours cut — they can always move and work somewhere else. It’s the child. The child is the one at the disadvantage and that’s just not fair.”
Canales said Democrats fought hard against the budget cuts, but were ultimately defeated by fears that the drop in oil and gas prices would equate less money for Texas to work with during the next legislative session.
“It’s easy to be a legislator when oil and gas prices are high because there’s money,” Canales said. “The most brutal fights take place when there is no money.”
Oil and gas taxes account for about 40 percent of the state’s revenue and legislators are bracing for a shortfall. In the Rio Grande Valley, Fourth of July gas prices were 53 cents per gallon lower than the same day last year and are almost 10 cents per gallon lower than a month ago , according from information from Gasbuddy.
Canales, however, argued the state has a comfortable surplus and should not be cutting services for children with disabilities, but instead increasing them.
“This cut in relation to the surplus that we have is minuscule,” he said. “Not that the cut is minuscule. It’s minuscule in relation to the amount of dollars we have in the surplus, which I believe is $18 billion.”
Canales said there is a resonating tone amongst conservatives that this is the age of entitlement and not everyone can be helped.
“I don’t know whether that’s wrong or whether that’s right,” Canales said. “But I can tell you that when it comes to children, we need to do everything possible to make sure that we provide for them.”
Gov. Greg Abbott, Lt. Gov. Dan Patrick and Speaker of the House Joe Strauss are telling legislators to brace themselves for the upcoming cuts, Canales said.
Strauss, who visited the Valley last month, said he had four priorities for the legislature come January: fix the economy; education; mental health and government transparency. He also indicated the legislature would revisit the cuts for children with disabilities.
Rosenlund worries it might be too late.
“Right now we’re enjoying quality therapists, but if we can’t pay them, they’re going to go out of state,” Rosenlund said. “They’re going to leave and look for work somewhere else. And if that money is reduced, I’m not going to be able to provide the level of therapy that kids need.”
Hernandez cannot imagine what other families will go through if they can’t obtain the services her son did.
“His therapists have taught me so much. They’ve taught him so much,” she said. “I don’t know what we would do without them, really. I don’t know what would have happened if we hadn’t gone through the ECI program.”