I graduated with my master’s degree in speech-language pathology in 2001. I worked for one year in the public school district, but felt a personal disconnect with my ability to provide the best, most thorough services to my patients when I carried a caseload of over 80 students. In 2002 I began working for a pediatric home healthcare agency in the Dallas area, and as early as the first day on the job I knew I had found the field that fit my true professional calling.
On my first day, I’ll never forget walking into the house of my first patient with all the excitement and certainty of a new therapist who was going to take on the world.
I had absolutely no idea what to expect, and I quickly found out that cases presented in textbooks were nothing like the reality I would find.
My first patient on my caseload was a beautiful, Hispanic, 6 year old little girl named Sara*. On my first day I walked into her bedroom full of self-confidence, however, I took one look and knew at first glimpse that school had not prepared me for a client like her. Sara was lying in a hospital bed, connected to a ventilator, had a trach tube in place, and a Passy Muir valve helped her vocalize. She was fed through a gastrointestinal tube but was able to tolerate minimal amounts of mechanical soft textures (similar to that of a pudding consistency). Sara wore glasses and could visually track objects, watch tv (she LOVED Barney), and had a smile that lit up a room.
Sara was born a perfectly happy, healthy, “normal” child.
However, one tragic, horrible day during the first year of her life everything her family knew was changed forever. Sara’s mom, Linda (a single mom), was driving her to an appointment and, against her better judgment, had put Sara’s car seat in the front passenger seat of her car. They were on the highway and involved in front-end collision—a hit and run accident—which deployed the airbags. Sara cried, but initially did not show any signs of blood or resulting trauma. Sara was taken to the hospital. It was soon determined that she had severe damage at her C3 vertebrae. She would be a quadriplegic for the rest of her life. Sara’s therapy sessions typically focused on increasing oral tolerance of foods and having her choose objects using eye gaze.
After Sara’s sessions, I would leave the area where she lived. I would then drive over 20 miles to my next patients’ house in the South Dallas projects. This was my absolute favorite area to see patients. My next patients, Erin (8 years old) and Jackie (7 years old), were sisters that were born 10 months apart. Their mom had been diagnosed with “MR”, mental retardation. The girls had not been formally diagnosed, but I knew that they had severe learning issues. Neither of them were able to retain or recite their phone number or address. We worked on that consistently, as well as other issues that could potentially compromise their safety.
These are just three of the many faces and stories that benefited from speech-language therapy services in a pediatric home healthcare.
These are REAL lives—real stories of Texas children with disabilities who lived below the poverty level. These children wouldn’t have had an opportunity for help for a better future if their services had not been paid for through Medicaid. These children are the citizens in our society that are known as the “least of these.”
It’s hard to discuss the Texas Medicaid program without bringing politics into the conversation. Therefore, I am not going to attempt to skirt the issue, as I see it. I am definitely not one to sugarcoat reality, either.
Last year Texas lawmakers approved $350 million budget reductions for the Medicaid program.
This includes speech, physical, and occupational therapy services for Texas’ most vulnerable population—children with disabilities. These cuts were blocked once before by a district court. However, an appellate court ruled in April that Texas could proceed with the drastic reductions. The cuts were scheduled to take effect July 15, 2016. They would result in payment reductions of nearly 30 percent to pediatric home care providers. I know because I am one of them.
I own KidsCare Therapy, a pediatric home healthcare agency that provides speech, physical, and occupational therapy services to over 2,200 children all across the state. KidsCare Therapy has the privilege of providing employment to more than 300 hard-working Texans. Budget reductions of close to 30 percent would put providers out of business. They would leave fragile children without care—it would decimate the industry.
On Friday July 8, 2016, the Texas Supreme Court reacted to a request for a temporary injunction.
They ordered Health and Human Services Commission (HHSC) to delay these cuts. Since the budget was originally passed in 2015, several lawmakers who originally voted for the reduction have asked HHSC to conduct a study to analyze the projected effects of such cuts. To my knowledge, this study has not been initiated by HHSC.
Presently, the future of the pediatric home healthcare industry in Texas remains uncertain.
Although it has been ordered that cuts of that magnitude cannot be implemented now, the fate of the industry is in the hands of a study that has not been started, or even had the parameters of the requirements of such a study defined.
What is needed is for all parties to sit down together in a collaborative effort. They need to begin looking at ways to achieve consensus. However, during the futile attempts at negotiations, reality has gotten distorted. Facts have been skewed, and the future of children’s healthcare has gotten lost in the balance.
It is still a very scary, unsettling time.
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