Texas pays companies billions for ‘sham networks’ of doctors

Texas pays companies billions for ‘sham networks’ of doctors

Managed-care companies overstate
the number of physicians available
to treat the state’s sickest patients

By J. David McSwane and Andrew Chavez | Staff Writers

Photos and video by Tom Fox | Senior Staff Photographer

Published June 4, 2018

Marta Whitworth’s 12-year-old foster son needed antipsychotic drugs to tame the violent outbursts that doctors attributed to fetal alcohol syndrome.

When the boy’s psychiatrist retired last summer, Whitworth looked for a replacement within driving distance of her home in Kosse, a small town about 45 miles southeast of Waco. Because the child is in the Texas foster-care program, a company paid by the state must handle all of his health care.

A Superior HealthPlan “service coordinator” gave Whitworth a list of about a dozen psychiatrists the boy could go to — the only ones he could go to. But when she called, not one would give him an appointment within six months, she says. Several said they don’t accept Superior patients.

Years of poor state oversight have allowed companies to skimp on essential care for sick kids and disabled adults. Catch up.

Off his drugs for weeks, the boy threatened a sibling with a knife, shouting and repeating phrases over and over. Then he had a mental breakdown at school, Whitworth says. He screamed, threw chairs and ended up in a psych ward.

“He was hospitalized for four days,” says Whitworth, a school bus driver. “We could have avoided it if a doctor would have seen him.”

Her family’s experience is a symptom of a much larger problem with what’s known as Medicaid managed careThe Dallas Morning News found.

The companies Texas hires to care for its sickest citizens — foster children, chronically ailing kids, elderly and disabled adults — have been vastly overstating the number of doctors and specialists available to treat them.

In their published networks, the companies include many physicians who aren’t taking new patients, don’t accept government-funded health plans, or aren’t even treating Texans anymore. And state health officials know it.

In February, we tried to contact every psychiatrist Superior listed as available to help foster kids.

We called the main phone number in the company’s online directory for each doctor and asked the staff if they could schedule a new-patient appointment for a foster child. Only 9 percent could.

In the end, we found just 34 psychiatrists across the state who could take a foster child as a new patient. There are more than 30,000 foster kids — more than a third of whom need counseling, according to state data.

In Dallas, just seven out of 119 psychiatry offices we called within an hour’s drive of downtown said they were actually accepting new patients. Not one was within the city limits.

Marta Whitworth struggled to find a psychiatrist for her foster son (not pictured) who has severe behavioral issues. Superior HealthPlan gave her a list of about a dozen doctors; none could get her son in within six months.

“Some of these networks are really, truly a sham,” says Dr. John Burruss, chief executive of Metrocare Services, a nonprofit mental health clinic in Dallas.

Superior disputed our findings.

“We do not believe that the method you followed for selecting providers on our website is representative of the approach our members would follow,” said Jane Hardey of Marathon Strategies, a New York public relations firm representing Superior.

The state has done little to verify the accuracy of managed-care companies’ network directories, and when it has found problems, it has often given the companies a pass.

Nor have state officials addressed a primary reason networks are so limited: low pay for doctors and their staffs.

Meanwhile, many children can’t get hearing aids, or allergy treatments, or drugs to treat depression and mood disorders.

The state says it is cracking down on companies that don’t have enough doctors. It has told at least 16 health care groups, including Superior, to submit plans for how they’re going to fix holes in their networks, said Carrie Williams, a spokeswoman for the state health commission.

“Having an adequate network of providers is a longstanding challenge for Texas that predates managed care,” Williams said in a statement.

After more than 450 phone calls, we found only 34 psychiatrists who could see foster children for routine treatment.

Failed networks

Federal regulators require states that hand off Medicaid to private companies to hire outside researchers to study, among other things, how hard it is for patients to get the care they need. Since 2002, Texas has used a team at the University of Florida to do its quality assessments.

 A managed care program for people who have disabilities or are age 65 or older. Many of these patients need nursing-facility-level care in their homes such as hospital beds and breathing machines.

In 2016, the group began conducting “secret shopper” calls, in which academics pose as patients trying to arrange doctors appointments. When the undercover callers tried to get mental health care through the state's program for the elderly and disabled, only about 1 in 5 accepted the plan and were able to schedule an appointment, according to public documents The News obtained through open-records requests.

About 27 percent of the doctors they called said they didn’t take Medicaid. The next year, researchers found that trend had gotten worse — 38 percent of doctors said they weren’t taking the government program.

But the state gave several health care companies passing grades for appointment availability. How? It just didn’t count all the doctors whose phone numbers didn’t work or who didn’t accept Medicaid.

Without those doctors in the sample, it appeared that more than 88 percent of doctors listed in company networks could see a patient within days or weeks. But in reality, only 14 percent of doctors were taking appointments.

Specialists are most likely to care for extremely sick Texans. For a decade, health officials collected data tracking how many of them, including heart and lung doctors, dotted the state’s 254 counties.

But the state failed to analyze the data until late last year, when regulators found large swaths of Texas without available specialists.

The state has no idea how many Texans can’t find specialists, though. That’s because the health commission never asked researchers to do the “secret shopper” study for most specialties.

So The News did its own study. We called a random sample of the specialist providers listed in networks for three managed-care companies: Superior, Amerigroup and United Healthcare. We made almost 300 calls and tested six key specialities.

Of the offices we reached, 2 out of 5 of them said they either didn't accept the Medicaid plan for which they were listed or the specialist was no longer at the office. That suggests 8,000 to 11,000 of the 25,000 specialist listings would lead patients to a dead end.

Those barriers can have devastating consequences.

Velma Castillo carefully gets out of her daughter's car after picking up her granddaughter from school in San Antonio. Castillo couldn’t get help from Superior HealthPlan when she needed treatment for bipolar disorder and schizophrenia.

Velma Castillo, a San Antonio woman in the health program for the disabled, couldn’t get help from Superior when she needed treatment for bipolar disorder and schizophrenia, conditions that caused her to lash out at her family and disappear for days.

“Just to get her medicine, she would go to the hospital for two weeks,” says her daughter, Sofia Reyes. “More than a hundred times.”

In May 2016, after Superior failed to help a different patient find psychiatric care in the same county where Castillo lives, state employees called 33 different offices, according to state records.

They found only one that would see the patient.

Foster children at risk

The state never conducted a secret shopper study for the network charged with taking care of the state's foster children.

So, we did.

We called all 377 psychiatrists listed in the STAR Health program, the Medicaid managed-care plan for foster kids, and asked if the doctor listed in the directory was seeing new patients. Almost 45 percent of our calls reached a wrong number, or we were told the psychiatrist was no longer at the office we phoned.

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Telephone numbers were disconnected or rang in hospital emergency rooms or were answered by fax machines.

Seven psychiatrists listed at UT Southwestern Medical Center in Dallas were not affiliated with the hospital, according to a spokesman.

Some offices said they hadn’t accepted Medicaid patients in years — or they never did — including Psymed Solutions and Aesthetics, a boutique firm in Plano whose services include Botox injections and cellulite removal for adults.

Almost 14 percent of the providers we called didn’t accept Superior’s plan for foster kids; 9 percent weren’t accepting new patients.

A decade of evidence

Network problems are not a surprise to the state. As early as 2008, auditors had warned that there were “significant deficiencies” with Amerigroup’s.

In 2011, auditors looked at a tiny piece of Superior’s specialist network and found the company had only 712 specialists in Lubbock, not the 1,554 it listed, according to state records.

Just last year, state regulators found that at least a dozen children in Bexar County — the San Antonio region — couldn’t get hearing aids. Superior didn’t have a single audiologist there.

There were hearing-aid specialists in the area, but state records show they refused to work with Superior because of “low reimbursement” and “difficulties in obtaining payment,” according to emails we obtained through open-records requests.

The problem could have long-term consequences, a state employee wrote in one of the emails: “Delay in receiving timely pediatric hearing aid services can affect the children's ability to speak.”

The state pays about 20 companies and nonprofits a flat fee to care for patients. That fee, paid for with state and federal money, is on a per-person, per-month basis and varies by the severity of patients’ conditions and needs. State actuaries determine this payment based on what they think healthcare will cost, plus 1.5 to 2 percent that can end up as profit or cover unexpected costs.

Companies like Superior and Amerigroup collect a set fee per patient, a payment known as a “capitation.” They get the money whether or not the patients visit doctors. When patients do seek treatment, the companies want to pay as little for it as possible.

“These companies are looking for physicians who are willing to take a lower rate,” says Dr. Linda Villarreal, a geriatrics doctor in the border town of Edinburg who sits on the board of the Texas Medical Association.

“Therefore, their network is very, very small.

“Their process of denials is deny, deny and deny until you just can’t anymore,” she says.

In San Antonio, Dr. Armando Garza says many of the children he sees have gotten worse as they waited months for physical and speech therapy, in limbo because of what he called Superior’s “stalling game.”

“It seems like it’s to try to save money on their end,” he says. “The kids are suffering.

“I can’t see the amount of Medicaid patients that I was seeing before,” Garza says. “I had to slow down because they’re not paying anybody, and all of our time is wasted on getting approvals,” or appealing denials.

A Superior spokeswoman called accusations that the company is denying care to save money “categorically false.”

‘Strategic narrowing’

State records suggest some companies may be intentionally thinning their networks in hopes of reducing doctor visits and bolstering their profits.

In Houston, Texas Children’s Hospital has accused Amerigroup of deliberately cutting back on its pediatric network to save money. The hospital didn’t join the company’s network because the payments were too low, an executive wrote to the state.

Yet its doctors were being inundated with Amerigroup’s most fragile children as though they “had nowhere else to turn for pediatric care,” hospital representatives wrote to the state health commission last year. They also accused Amerigroup of “strategic narrowing” of its networks to save money.

Texas Children’s Hospital in Houston has accused Amerigroup of cutting back on its network of doctors to save money.

The hospital continued to see severely sick children in Amerigroup’s plan on an “out of network” basis, a hospital spokeswoman said, because Texas Children’s employed the only specialists in the region who could treat certain conditions.

Instead of cracking down on Amerigroup, records show state regulators repeatedly gave the company a pass on its poor network in the Houston region.

Amerigroup’s plan for fragile children in the Houston area netted the company more than $3,400 per child in its first 10 months — one of the highest profit margins of any plan in any part of the state. Texas Children’s, meanwhile, lost $3,000 per child.

Olga Gallardo, an Amerigroup spokeswoman, blames Texas Children’s, which she says refused to accept the company's “fair” contract terms.

Nearby, in Jefferson and Orange counties, Amerigroup is responsible for 3,000 patients, but as of late last year there wasn’t a single ear, nose and throat doctor to serve them, according to state data.

The company is working to recruit more doctors and is expanding its telemedicine offerings, Gallardo says.

“Amerigroup is committed to maintaining a robust care provider network of more than 60,000 care providers across the state to ensure our consumers have access to high quality health care,” she says.


Jack Billingsley gazes at the 1950s Mexican guitar he sometimes plays at his ranch home near Llano. He had a stroke in 2001 that blinded him in one eye and impaired his brain function. Billingsley used to have a personal attendant, but managed-care companies are cutting those services systemwide. For a year and a half, he has struggled to get help preparing meals and cleaning his home. "I feel ashamed, living like this," Billingsley says.

Uncoordinated care

One of the main reasons Texas pays $22 billion a year to managed-care companies is to improve patients’ health through case managers whose job is to help sick people and busy foster parents find doctors.

In fact, care coordination is the chief benefit cited by the managed-care industry’s lobbying group.

“Texans who need specialized care and services benefit the most from managed care, because the system ensures each family has a nurse or social worker to coordinate care and help patients navigate the maze of traditional health care services,” Jamie Dudensing, chief executive of the Texas Association of Health Plans, said in a statement.

“More than that, care coordinators work to get patients a range of services that go far beyond traditional Medicaid, including meal coordination, home modifications, housing, and transportation.”

But the companies haven’t hired enough coordinators, and those they have on staff are often referring patients to dead-ends, the state’s own research shows. A report last year by the nonpartisan Legislative Budget Board found that “most members in managed care programs receive minimal or no coordination services from their managed care organization.”

Worse, patients “with the highest needs often experience the largest gaps in access to services that should be coordinated by their managed care organization.”

For example, these coordinators serve under 20 percent of foster kids, according to several state studies, even as the state pays Superior more than $10,000 a year per child. One report blames uncoordinated case management for the fact that many foster children aren’t getting mental-health treatment.

For the quarter-of-a-million elderly and disabled people in Medicaid managed care, coordination is even worse. Year over year, more of those Texans have reported difficulty getting doctor appointments and more basic assistance.

In 2001, Jake Billingsley had a stroke, which blinded him in one eye and impaired his brain function. The 69-year-old’s thoughts can run wild, and he can’t finish basic tasks.

He used to have a personal attendant, a service managed-care companies are cutting systemwide, The News found. But for a year and a half, he’s struggled to get help with preparing meals and cleaning his home outside Llano, where the kitchen and bathroom are filthy, and dirty laundry is piled high.

Right now, he doesn’t have a service coordinator — and says he feels abandoned. “It certainly has pushed me a hell of a lot closer to death,” Billingsley says. “I feel ashamed, living like this.”

Staff writer Jackie Wang contributed to this report.

Report: State cuts led to drop in therapy for young children on Gulf Coast

Report: State cuts led to drop in therapy for young children on Gulf Coast


Jackson Raygor, 4, with his parents Joshua and Kyla on Saturday, Dec. 2, 2017, in Houston.

By Andrea Zelinski, November 29, 2017 Updated: December 3, 2017 10:02pm

AUSTIN — At just over 18 months old, Jackson Raygor struggled to walk more than a few steps at a time. His body would lag back and forth as his undiagnosed cerebral palsy forced the muscles in his legs to work against him.

Step, fall. Two steps, fall. Sometimes five steps, fall again.

It was 2015 and Joshua Raygor said he and his wife Kyla knew something was wrong. After talking to doctors and moving to Houston for work, they enrolled Jackson in Early Childhood Intervention, a state program providing therapy to children under 3 with disabilities or developmental delays.

"When he walked at the time, you could see how much of a struggle it was for him. Now you see him running, you see him walking, you see him playing," said Raygor. "It's a lot more subtle these days due to the work that they've done."

But fewer and fewer children are getting access to the program that helped Jackson. The number of young children enrolled in intervention to cope with conditions that also include autism, speech delays and Down syndrome has dropped 21 percent in the Texas Gulf Coast region as state funding for the program waned.

Hardest hit over the last six years were black children, whose numbers fell by 44 percent regionally and 52 percent in Harris County, according to Texans Care for Children, a nonprofit advocacy and research group studying enrollment in the Early Intervention Program.

"Thanks to ECI, children learn to walk, swallow, communicate with their families, and get ready for school," said Stephanie Rubin, CEO of Texans Care for Children. "It's heartbreaking to know that children are missing these opportunities due to state cuts."

The Texas Legislature approved cuts to the program in 2010. Since then, funding has dropped from $166 million in 2011 to $148 million in fiscal year 2018, leading providers to tighten eligibility criteria.

Lawmakers also cut Medicaid reimbursement rates to community providers offering the services in 2015, though state legislators returned this year and restored about one quarter of cut funding.

Hurricane Harvey made access to therapy worse, with more than a quarter of the state's contractors located in areas hit by the storm, according to the study. Some contractors sustained damage to their facilities, straining their ability to provide services. In other cases, the storm displaced families with children enrolled for therapy, causing them to miss appointments.

Since 2016, six contractors that provide services including speech, physical and occupational therapies to children with disabilities have quit the program, leaving 44 providers across the state. Texas was home to 58 providers before the Legislature cut the program's budget.

Overall, children receiving services statewide fell 10 percent from 2011 to 2016, while the state's population of children under age 3 increased slightly between 2011 and 2015, according to a study of enrollment. In the Gulf Coast region, which included 10 counties in the Greater Houston area and three other lower-population counties, enrollment fell by 21 percent, from 12,062 children to 9,482 children.

Meanwhile, enrollment in several area counties climbed, surpassing the number of children receiving services in 2011 when state funds were originally cut, according to the study. Those counties include Chambers, Colorado, Fort Bend, Galveston, Liberty, Waller, Matagorda and Wharton.

House lawmakers fought during the summer's special legislative session to fully restore cuts to the program, but those efforts failed to gain support in the Senate or from the governor's office because the issue was not among the 20 that Gov. Greg Abbott asked lawmakers to consider.

The Raygors said they can't imagine what their social and athletic son, now 4, would be like without early intervention. Jackson's physical therapist from Easter Seals met with him twice a week, getting him walking and ensuring doctors gave him proper leg braces to retrain his muscles.

Now he plays T-ball, enjoys kicking around a soccer ball and running up to other kids asking if they want to play, his father said. Stairs are still a struggle, however, and some playground equipment is difficult for him, Raygor said.

"I hate to think of where my child would be right now had he not gotten the level of services that he had," Raygor said. "Right now, he lives pretty close to a typical 4-year-old life."

Moving, Medicaid, and Motherhood

Moving, Medicaid, and Motherhood

November 22, 2017

My family is moving from Texas to Oregon this month. Many people have asked if we're moving to seek better care for my son, Charlie. The short answer is 'yes'. I've been trying for weeks to write this post. Its not that I don't know what to say. Its that I don't know how to say it or how much of our story to include. But yesterday my son was denied Medicaid by the state of Texas for 2018. And now I'm ready to write. 



You can read all about Charlie's birth story HERE. But all you really need to know for the purposes of this post is that my kid has many special needs - Craniosynostosis, Stroke, Cerebral Palsy and Epilepsy chief among them. This means that we need wheelchairs, gait trainers, AFO leg braces, and monthly prescriptions. There are also costs associated with his incontinence, restrictive diet, and inability to feed himself. Blah, blah, blah... 

After sitting for six years on what Texas calls a Medicaid "interest list", Charlie was finally awarded Medicaid to help us cover the astronomical costs of his medical care. This is a good time to tell you that our family has insurance through my husband's university job. Medicaid was (and is) our secondary insurance. 



I was thrilled when Charlie began to receive Medicaid because I thought it meant we would not have to spend over half of our take-home pay for Charlie's many therapies. We spent our first year on the program figuring out how the system worked. Texas Medicaid was bending under the heavy weight of a 600 million dollar cut from 2015. Health professionals across the board were telling us that services were shrinking and that many of Charlie's needs would not be met. Our second year on the program, Texas state senators voted to cut the budget again - this time by 2.4 billion dollars.



Fearful of what these cuts might mean for my son, I attended a budget hearing at the state capitol in February 2017 to tell them about Charlie and to beg that they stop cutting funding for these much needed programs. After listening to over ten hours of testimony and offering my own, I understood that my senators didn't give a rat's ass about my kid. They also weren't interested in paying for therapies that could greatly improve my son's quality of life. And while they were at it, they would also cut funding for CPS and our foster care system. I can't quite explain the special kind of pain I felt that day. The wealthy state of Texas was saving dollars on the backs of its most vulnerable citizens - medically fragile children and wards of the state. I was disgusted. 

1 in 3 Texas children rely on Medicaid. ONE in THREE. Deep cuts to the state budget for Medicaid caused hospital closings, and the closure of many therapy clinics. With fewer places to choose from, and fewer places even taking Medicaid, thousands of kids were left without much needed therapies. Charlie was one of those kids. We were back to paying out of pocket for his therapy. 



Yesterday, just two days before Thanksgiving, we were notified that Charlie has been denied Medicaid for 2018. The reason? He hasn't had a major medical event this year. And why is that? Its because we finally have the resources to meet most of his needs. Medicaid, for all its faults, is working. Charlie has been stable. Its completely infuriating. 

Once again, I'm in a situation that requires I spend hours and hours on the phone with the state, hours filling out requests for letters of medical necessity from doctors, and slogging through yet another appeals process. This kind of work is a second job - one that doesn't pay. I lose money and time. 

When the state of Texas denies a Medicaid renewal application for a medically fragile child, they are making a bet. The bet is that the family doesn't have the resources to appeal - that they don't have the hours to spend, or the ability to navigate the system, or a vehicle to pick up copies of medical records, or access to a fax machine to send letters from doctors and appeal application materials. They are betting that the families are tired and otherwise engaged with the work of caring for a child with special needs. And guess what? That's a good bet. Most of the families who have medically fragile children on Medicaid cannot jump all of these hoops. The state wins. Parents stop fighting. The state doesn't have to pay. And that was their plan from the beginning because they just cut billions of dollars from the budget. 



So while there are many reasons we're headed to Oregon, one of them is that I'm tired of fighting the state of Texas. Texas lawmakers have made their position clear to me. Don't be female. Don't be disabled. Don't be an immigrant. Don't be a person of color. Don't be gay. Don't be gender-queer. And don't be the mother of any of the above. Just be a good little wage-slave consumer and shut up.

Even with this Medicaid saga, I have to say that we've met great people here in the lone star state. And my husband has loved his university job. But after 7 years of fighting, advocating, begging, and scraping for Charlie, its time to move. We have no family here in Texas, which means that for me, every moment spent outside the walls of my home is a 'pay-to-play' situation.

I'm tired. And I need help. So I'm headed home. Sure - Oregon is just another state system, but at least its one that recognizes my son as a citizen. Oregon is also a Medicaid expansion state. And regardless of the level of support we get from the state, we'll have our family at our side. 

It is the honor of my life to be Charlie's mother. I will never stop fighting for him. But my hope is that this move will allow me to spend more time being his mother and less time being his appeals processor.

House Defies Abbott's Agenda, Votes 138-0 to Restore Funds for Disabled Kids

House Defies Abbott's Agenda, Votes 138-0 to Restore Funds for Disabled Kids


Abbott Photo by World Travel & Tourism Council/Flickr, Straus Photo by David Martin Davies/Flickr, , Patrick Photo by David Martin Davies/Flickr


Defying Governor Greg Abbott's special session agenda, the House voted unanimously Thursday to restore millions in Medicaid funding to disabled children's therapy programs that have been floundering for the past several years because of repeated cuts.

The bill, HB25 by Representative Sarah Davis (R-West University Place), would reverse steep cuts to Medicaid reimbursement rates for children's physical, occupational and speech therapy providers by $70 million, money that would come out of the governor's disaster relief fund. This potential relief comes after lawmakers ordered $350 million in cuts to these therapy programs in 2015, and after lawmakers, recognizing the mistake, agreed to restore those cuts by 25 percent during the 2017 regular session. Many providers, some of whom have been forced to shut down because of the cuts, have said this was simply not enough.

"If the governor is going to bring us back here to talk about what bathrooms people can use or what we can do with our trees, then surely the disabled kids should take priority," Davis said.

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That's when Davis stepped up. She had told the Houston Chronicle last week that she didn't care if disabled kids' therapy was not on Abbott's special session agenda, and that she felt it was among the most pressing issues affecting Texas's most vulnerable kids.

"If the governor is going to bring us back here to talk about what bathrooms people can use or what we can do with our trees, then surely the disabled kids should take priority and hopefully we add this to the call,” she said.

But Abbott has remained relatively mum on this issue and whether he would agree to add it, and so as HB25 heads over to the Senate, its members will be faced with a test: Are they, too, willing to defy Abbott's agenda and pass this bill in the name of disabled kids? Or are they going to continue following the governor's instructions, zipping through his list of 20 priorities and sticking to the rules?

In special sessions, the rules are that legislators can't put forth bills that fall outside the governor's agenda. But the rules doesn't necessarily lay out consequences if legislators decide to flout the governor and forge ahead anyway. The official Senate rules state that, if one of those bills not on Abbott's agenda somehow makes it through both chambers and lands Abbott's signature, it still becomes a law.

So that leaves the onus on Abbott — if, and that's a big if, Lieutenant Governor Dan Patrick's Senate is so inclined to leave it with him. Should the Senate follow the House's lead and pass HB25, then is Abbott really willing to veto that bill? Is he really willing to face the wrath of Texas children's advocates and the parents of autistic children, who have been hounding the Legislature for years to fix this children's therapy mess?

We're unsure, because Abbott's press office did not return a request for comment on HB25's passage and whether Abbott will consider adding this to the special session agenda.

The governor's office has already made clear that Abbott would not be adding any additional items to his list until both chambers passed all 20 of his priorities, which, as Davis points out, include bills to regulate both transgender bathroom usage and local tree-removal rules. While the Senate quickly passed 18 items in just two weeks, the House has passed only a few. The lower chamber is taking its sweet time and keeping divisive politics surrounding legislation like the bathroom bill out of the conversation.

Yesterday, Davis and a bipartisan group of House lawmakers again challenged Abbott's agenda, calling on him to add ethics reform to the list, which he had made an emergency item both in 2015 and the 2017 regular session but which failed both times. (The bathroom bill and the tree-removal regulation bill were not emergency items.) The ethics bill would prevent Abbott and lawmakers from raking in campaign donations during the special session, which Abbott is currently doing, and would also stop him from appointing people who donate more than $2,500 to him to top jobs in government agencies — which the governor has done dozens of times.

Yet remarkably, despite his early enthusiasm for ethics reform, Abbott's office called this "showboating." Spokesman John Wittman said the lawmakers' constituents "deserve better," and said legislators just need to focus on those 20 priorities, which also include school-choice vouchers, property tax reform and increased abortion reporting requirements.

Unanimous support to fund essential services for kids with disabilities, however, could hardly be called showboating, and at this point, the pressure is on for senators and for the governor.

“I can tell you one thing that’s crystal clear,” Texas Cares for Children CEO Stephanie Rubin said in a statement. “Legislators, parents, advocates and other Texans are going to keep fighting until these cuts are reversed and kids have the support they need to learn to walk, communicate with their families, prepare for school and meet other goals.”

The Senate has less than two weeks to get HB25 to the floor.


Bryan family thanks therapy program that changed son's life, is losing funding

Bryan family thanks therapy program that changed son's life, is losing funding

By Kathleen Witte | 

Posted: Mon 2:44 PM, Apr 24, 2017  | 

Updated: Mon 5:33 PM, Apr 24, 2017


BRYAN, Tex. (KBTX) - A program that gives children with developmental delays a head start on therapy has seen major funding cuts over the past couple of years.


Because of those cuts to Early Childhood Intervention, or ECI, local provider ECI Easter Seals East Texas says it has been financially forced to back out of the program.

The Contreras family says their son's life was changed through ECI.

"Our worlds were flipped upside down,” began Ana Contreras.

Almost three years ago, Ana’s son Ricardo, or RJ, was born with club foot. As his parents were coping with that, they noticed another issue.

"That was a stressful moment for us,” said Ricardo Sr., RJ’s father. “Just seeing that he wasn't using one arm at all."

Doctors told them RJ had suffered a pediatric stroke, now affecting the left side of his body. Between that and the club foot, RJ would need physical therapy—a lot of it—starting right away.

"The problem we ran into early was our deductible at the time was 3000 dollars,” said Ana Contreras. “How am I going to financially help him get through this?"

“And then ECI came along,” said Ricardo Contreras, Sr.

The program cut RJ's therapy costs 80 percent, and, the family says, changed the course of his life.

"He was having a lot of trouble standing,” said Ana Contreras of her son’s condition. "[Easter Seal East Texas therapists] would put things on the couch and have him on the floor and really encourage him to try to pull up on his own.”

“And I remember, I can still see the day that he did it,” Ana Contreras said through tears. “In that moment, I knew he was so determined—and he was going to be fine."

It’s a feeling and a service Ana Contreras doesn't want other parents, or other children, to go without.

"There's no other way around it,” she said. “Without this early intervention, who knows how much more it's going to cost down the line?”

Families in this area who qualify for ECI will still be able to get these services even after Easter Seal East Texas doesn't offer them anymore. ECI is currently working to find another provider who will take up the contract for Brazos Valley kids in need.

The Contreras family would like to specifically thank the following at Easter Seals East Texas:

Carol South, physical therapist

Halei Colbert, services Coordinator

Jill Hodges, occupational therapist

Nancy Lugo, Early intervention specialist

Sandy Yasskin, occupational therapist

Teresa Scamardo, physical therapist

Janette Mejia, physical therapist assistant

Severely disabled children struggle under managed care program

By Elena Mejia Lutz, Austin Bureau April 17, 2017 Updated: April 17, 2017 10:16pm

Photo: Alma E. Hernandez / Alma E. Hernandez / For The San Antonio Express News


Chloe, 10, who was born with a rare chromosome disorder, requires 24-hour care.

The state’s new managed care system for young disabled Medicaid recipients is causing unnecessary delays in care for the state’s most medically fragile kids, said parents and advocates for those children.

Tammy Baldera’s 10-year-old daughter Chloe is one of about 6,000 severely disabled children in the state’s Medically Dependent Children’s Program, which provides nursing care at home. On Nov. 1, participants in the program were required to start using a new managed care system known as STAR Kids.

Baldera said the new system requires prior consultations and referrals that are dangerously disrupting her daughter’s medical care.

“I didn’t have to worry about anything,” Baldera said of the previous system. “But now all these kids are in jeopardy. I shouldn’t have to fight for (her care).”

STAR Kids provides services to about 180,000 young disabled Medicaid recipients. Under STAR Kids, parents must choose a managed care organization, known as an MCO, and a primary care physician, who must be consulted for all services and referrals to specialists.

The problem, Baldera said, is that severely disabled kids like Chloe routinely deal with a variety of specialists and regularly need special equipment and supplies, not just occasionally. These kids can’t wait for appointments and approvals for services and items that aren’t one-time buys, advocates say.

“When disruptions to access to care happen or when their medical team is dismantled, it’s a life-or-death situation for them,” said Hannah Mehta, director of Protect TX Fragile Kids, a nonprofit that advocates for fragile children.

Carrie Williams, spokeswoman for the Texas Health and Human Services Commission, said STAR Kids, which was in a bill sponsored by Sen. Jane Nelson, R-Flower Mound, is tailored for clients to receive comprehensive, coordinated and high-quality care and to reduce the administrative complexity of delivering Medicaid benefits.

Mehta said managed care may be effective for the population of disabled children under the STAR Kids umbrella who need primary care, but she said medically fragile kids cannot fit under this model because they need secondary and tertiary care from birth.

“We’re asking Sen. Nelson to recognize its impact and put in place some safeguards and protections in order for the impact to be mitigated,” Mehta said.

There are only two MCOs in Bexar County: Community First and Superior HealthPlan.

Baldera said she is constantly on the phone with her new insurer, Community First, to get authorization for coverage of Chloe’s life-saving medicine and other services.

The family’s pharmacy denied Chloe’s blood pressure medication, which helps her heart pump efficiently and hold off surgery, because Community First would not cover it. It took several calls to finally get it approved, Baldera said, but even then her usual pharmacy couldn’t fill it. She now drives 40 minutes to pick it up at a compounding pharmacy on the other side of town because the health plan only approves certain medications at certain pharmacies.

Also, Baldera said, having to get referrals from Chloe’s primary care physician every time she needs a specialist puts her at unnecessary risk.

“This delays care. She had hip surgery and her bone broke, so we needed an endocrinologist for calcium injections,” Baldera said. “We had to make an appointment with my pediatrician to get a referral for the endocrinologist so we could go. It took nearly a month and a half to get an appointment.”

Six-year-old Colton Wendell has cerebral palsy, epilepsy and lung disease, among other conditions, that make him dependent on a tracheostomy and a ventilator. His mom, Jenifer Wendell, said she now gets five fewer suction catheters from her supply company since they switched to Community First.

The catheters are used to get fluid out of Colton’s lungs. These tubes can’t be reused, Wendell said, because to go down Colton’s throat, she needs to use sterile equipment. Otherwise, he is at risk of catching pneumonia. The number of catheters needed per week varies based on the child’s condition.

“They said (the number of catheters weren’t) medically necessary,” Wendell said. “But tubes can get clogged depending on how sick he is, and that alone is a big risk for hospitalization. It’s not a matter of being fraudulent or trying to take advantage of the system. It’s a matter of kids who are fragile.”

Another problem with STAR Kids is that the physicians whom families have been seeing for years are suddenly not covered by the MCOs.

Williams said STAR Kids includes protections designed “to help maintain existing provider-patient relationships” by allowing continuity of care inside and outside the service area for one year. For a majority of MCOs, continuity of care for physical, occupational or speech therapy and nursing care is honored for six months or until the health plan conducts new assessments.

But that’s not enough for some of the children.

Lynn Tu, whose daughter Jaelin was diagnosed with chronic lung disease from a spinal cord injury in 2010, moved from San Antonio to Austin prior to the switch. Under Blue Cross and Blue Shield of Texas, which is Tu’s managed care organization in Travis County, her daughter is at risk of losing her entire medical team in San Antonio when the continuity of care period ends.

Tu said the MCO hinders Jaelin’s access to care because it limits her to Travis County providers. Before STAR Kids, severely disabled Medicaid recipients were under preferred provider organization insurance, so parents had the freedom to choose the doctors and hospitals of their preference under a fee-for-service model.

“My physicians who I trust have taken my daughter from only able to move her finger to eating by mouth. And now we’re getting ready to stand and walk. We want to continue that five-year process, but I won’t continue seeing her physicians,” Tu said.

Colton lost his audiologist with the switch to STAR Kids because the doctor did not contract with Community First. Now all expenses will have to be paid out of pocket, Wendell said, because there are no other pediatric audiologists who do hearing aids and molds in San Antonio under the MCOs.

State Sen. Carlos Uresti, D-San Antonio, who sits on the Senate Finance Committee, said the panel has taken steps to increase state oversight of MCOs. The Senate’s version of the state budget includes a requirement that the Health and Human Services Commission conduct internal monitoring and audits of MCOs’ expenditures and pursue strategies to strengthen the agency’s procurement process and administrative efficiency.

The House version of the budget would direct the commission to develop procedures in its contracts with MCOs that address the medically fragile kids’ special needs and to allow the patients to easily move between service areas.

The final budget has yet to be ironed out.

Parents also fear cuts to the 24-hour nursing care that kids receive under the Medicaid waiver that may be coming when continuity of care ends. Briar McCann, a 14-year-old who has scoliosis, dislocated hips, chronic lung disease and cerebral palsy, had his nursing care cut by 28 hours per week because Superior HealthPlan said it wasn’t medically necessary.

His mother, Gabriella McCann, said Briar’s nursing agency, Texas Kids Home Therapy, sent about 700 pages of documentation to Superior HealthPlan to get authorization for nursing care but that the MCO didn’t see the part where her son needs constant suction because of his tracheostomy to keep his airway unclogged.

“We tried calling them and explaining to them that he did get suction, but they were not seeing the paperwork,” McCann said. “They were already discussing in the letter how they’d be reducing little by little until they got to cut 120 hours.”

McCann filed an appeal to the MCO, which was denied. She then appealed to the state commission and sought a hearing while contacting Disability Rights Texas, which provides legal resources for disabled people. At the hearing, the reduction in hours was finally withdrawn.

“Let’s say I don’t have those 28 hours. Let’s say I fall asleep when I’m supposed to be watching him and he gets a mucus plug. I’m not a doctor, I’m not a nurse,” McCann said. “He only has one airway, that’s it. He can die on me, and I’ll feel guilty for the rest of my life.”

'Sesame Street': Julia, a Muppet with autism, makes first appearance on the show

Julia, a Muppet with autism, made her first appearance on "Sesame Street" Monday and the longstanding children's show posted a 10-minute clip to mark the occasion.

Julia is an old buddy of Elmo's and has already been a staple online and in printed books since making her debut in 2015, but today is her first time on the TV show. Advocates say they hope Julia will help young "Sesame Street" fans and their parents learn more about people with autism.

About 1 in 68 children in the U.S. has been identified with autism spectrum disorder, according to the Centers for Disease Control and Prevention (CDC). Autism spectrum disorder can affect children and adults from all different backgrounds, and people with autism "may communicate, interact, behave, and learn in ways that are different from most other people," according to the CDC. In Julia's "Sesame Street" debut, she helps the other Muppets and people understand how even though she communicates differently, she can still be their friend.

Read: 'Sesame Street' to introduce TV fans to Julia, a Muppet with autism

In the clip, the gang is fingerpainting when Big Bird is introduced to Julia. After she doesn't immediately respond to his greeting and questions about what she is painting, host Alan Muraoka explains that it might take Julia a little longer to answer.

Throughout the show, Alan is the viewers' guide to understanding Julia and what makes children like her special.

"It helps to ask again," Alan patiently explains to Big Bird.

Then Julia proudly shows off her painting.

"I love it. It's so fun and silly," Abby Cadabby says. "Julia, you're so creative!"

Big Bird continues to try to interact with Julia, but she doesn't respond. After Big Bird wonders if maybe it's because she doesn't like him, Alan explains that Julia has autism. He also lets young viewers know what that means.

"For Julia, it means she might not answer you right away," the host explains. "And she may not do what you expect, like give you a high five."

Abby adds that Julia does things a little differently, and that's totally OK. "And she's a lot of fun!" Abby adds.

"Julia likes being with her friends and she loves to play too!" Elmo chimes in.

The gang then plays tag and welcomes Julia into the group. Big Bird is filled in on all of the things that make Julia special.

"It doesn't matter how they play, they are just a bunch of friends having fun," the host adds.

"I think I'd like to be a friend of Julia's too!" Big Bird says.

Watch the full clip above.

#TXKidsMatter | #ReverseTheCuts

Andrew wants to run FAST, but he’s has been waiting over a YEAR for physical and occupational therapy.


Meet Miss Deonc — this beautiful girl has been waiting 2 YEARS for #THERAPY that would allow her to do something we all enjoy…


Speech Therapy for Adrian would mean that he could feed himself. He’s been waiting 3 YEARS!


Texas Kids Matter

Texas Kids Matter

Thanks to all who attended "Special Kids @ the Capitol" last week and urged legislators to #ReverseTheCuts. Our work is far from finished. Please continue to help build awareness around the #TXKidsMatter movement by sharing our video stories.

Using Improv To Help Kids With Autism Show And Read Emotion

Using Improv To Help Kids With Autism Show And Read Emotion

February 13, 20176:15 AM ET

Heard on All Things Considered

It can be difficult to socialize and make friends for many children with autism. Often that's because reading body language and others' emotions doesn't always come easily.

Many of us seem to learn these social skills naturally, but maybe there's also a way to teach them.

The Psychology Lab at Indiana State University is trying to tap into that idea with improvisational theater.

Yes, improv.

Rachel Magin, a doctoral student here, designed a special class for 6- to 9-year-olds with high-functioning autism. The class explores the various ways people communicate. For instance, "through our facial expressions, through the way our body language shows it, or just the tone of our voice," Magin says.

And the overall idea is pretty straightforward: If children improvise different situations, think about their emotions and how they show them, then they'll be able to communicate more clearly in life.

Encountering those social cues can feel like a foreign language, says Magin, "and they haven't necessarily learned that language."

Getting in touch with emotions

These kids are pumped.

From the moment Shaw, who's 8 and has autism, walks into class, he's ready.

He's excited to shake his limbs and yell the warm-up.

Shaw also has anxiety and attention deficit disorder, and when he gets excited, he gets really excited.

Shaw, 8, plays an improv game with Erin McTiernan, an Indiana State University doctoral student. Shaw is a participant in an improv class at Indiana State University for children with high functioning autism.

Peter Balonon-Rosen/Indiana Public Broadcasting

Under bright fluorescent lights the kids pick sentences out of an envelope, then at-random, choose a card with an emotion on it.

They then say that sentence, in that emotion.

Think of it as a child-friendly version of the segment "Scene From A Hat" from the TV show, Whose Line Is It Anyway?

And sometimes the kids guess the emotion right away.

But it can get tricky. Especially when the sentences don't express an obvious emotion.

Like: "It's over!" says Jake, who's 9, waiting for the other kids to guess his emotion.

"Umm, sad," someone says.

"No," says Jake.





Rachel Magin knows this is her teachable moment. "What would have helped him to show that he was happy?" she asks the class.

Silas — Shaw's 6-year-old sister who doesn't have autism, but comes with her brother — knows. She jumps in place yelling: "Yay! It's over!"

"OK, so jumping up and down, having the voice get a little higher and a little louder," Magin explains.

The kids nod.

Next, they role-play, acting out moments that might cause anxiety, like the first day of school. That can be especially important for children with autism who can experience anxiety more intensely and more frequently than other children.

Evidence of improvement

Jim Ansaldo, a research scholar at Indiana University, in his office. Ansaldo also runs an improv summer camp for teens with autism. He says improv-specific programs for children with autism are spreading.

Peter Balonon-Rosen/Indiana Public Broadcasting

"What improv really does is create a safe and fun and authentic environment in which to practice, where mistakes really don't matter," says Jim Ansaldo, a research scholar at Indiana University.

Ansaldo runs Camp Yes And, an improv summer camp for teens with autism. He says improv-specific programs for children with autism are rare — he knows of about a half dozen — but their number is growing.

He refers to improv as a technology for human connection and communication.

And Janna Graf, Shaw's mom, says she has seen how it has helped her son.

She says he can ramble, but recently she saw him introduce himself at a church group: "He said, 'My name's Shaw; I'm 8-years-old,' and then he actually took his hands and waved it to the next person," Graf says. "He's learning to wait."

It's this kind of feedback that the researchers are using to see how this improv class transfers to real social skills. And so far, they're encouraged by the early results.

Supporting Bilingual Children With Special Education Needs

An interview with Elizabeth Kay-Raining Bird.

Posted Jan 18, 2017

Interview conducted by François Grosjean

One of the longest-lasting myths concerning bilingualism is that children with developmental disabilities should not become bilingual, or if they already are using a minority language in the home, should stop using it. Thanks to new research in the field, this view is slowly being replaced by one that states that these children can indeed become bilingual, or remain bilingual. A 2016 special issue of the Journal of Communication Disorders presents research that examines bilingual access and participation for children with developmental disabilities, conducted by an international team of researchers. The principal investigator was Elizabeth Kay-Raining Bird of Dalhousie University in Canada. She kindly agreed to answer some of our questions and we wish to thank her wholeheartedly. 

In your review of the field with Fred Genesee and Ludo Verhoeven, you concentrate on three groups of children with developmental disabilities. Which are they?

The three groups we focused upon were children with Specific (or Primary) Language Impairment (SLI), Down syndrome (DS), or Autism Spectrum Disorder (ASD), because these are the ones who have been studied to any real degree with the emphasis having been put on bilingual children with SLI. Almost no research exists on bilingualism in other populations of children with developmental disabilities such as children with cerebral palsy or intellectual disabilities of other etiologies.

Why has there been such opposition to bilingualism for children with developmental disabilities over the years?

A prevalent fear, expressed by families and professionals alike, is that learning one language is already difficult for these children, therefore learning two or more languages would be just too difficult. Exposing a child with developmental disabilities to two languages, the argument goes, might result in no language being learned well. This is a myth and it has been debunked through studies of typically developing children and children from our three groups. Children with developmental disabilities, regardless of diagnosis, can and do become bilingual but, unfortunately, many professionals and families are not aware of these research findings.

Since we know many children with developmental disabilities need or want to be bilingual, and that many are indeed bilingual, the real issue is not whether they should become bilingual, but how to best support them in their life with two or more languages.

Are simultaneous bilinguals with developmental disabilities any different from similarly affected monolingual peers?

All the available evidence says no, there are no differences in the language skills of children with developmental disabilities and their similarly affected monolingual peers, as long as bilinguals are compared to monolinguals in an appropriate way. By appropriate I mean that if a simultaneous bilingual child with a developmental disability has relatively equal abilities in both languages, then research shows their ability in each language does not differ from that of monolingual similarly affected peers.

However, many simultaneous bilingual children do not have equal abilities in both their languages because they hear and use one language more often than the other. In that case, their stronger language should be the language that is compared to that of monolingual children. When that happens, they are no different from their similarly affected peers

How do sequential bilinguals with disorders fare?

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They fare somewhat differently. As you know, these children have one language they are exposed to from birth and a second language they begin to learn somewhat later. Often, their first exposure to a second language occurs when they enter school and they are taught in this second (majority) language. Research shows that children with Specific Language Impairment (SLI) will often take a number of years to “catch up” to monolinguals who are similarly affected in their second language skills. Research on typically developing children has reported similar lags in second language development. This is not surprising—learning a second language takes time.

The story for children with Down Syndrome (DS) or Autism Spectrum Disorder (ASD) is not clear, but currently the evidence shows no detrimental effects of sequential bilingualism if you take into account both languages of the bilingual child when making comparisons.

Why is it so crucial not to abandon a home language in favor of the majority language?

The impact of abandoning a home language has been studied by interviewing parents of children with Autism Spectrum Disorder (ASD). Many families in these studies were advised to speak only the majority language to their children even though the parent was not fluent in it. Parents often talked about feeling less comfortable and less natural interacting with their child, and some reported that they actually avoided talking to him or her because of their discomfort. This has a detrimental effect on the child’s language development and is particularly problematic for children who have difficulty with communication, such as those with ASD.

Even if parents reported feeling comfortable speaking the majority language to their child with ASD, they expressed feelings of sadness and guilt at not passing their language (and culture) on to their children. When the majority language was the only language of input to a child with ASD in the home, other family members continued to use the home language(s), which effectively isolated the child with ASD from various family conversations.

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How important is everyday exposure to both languages, in particular the weaker one, in children with developmental disabilities?

By definition, children with developmental disabilities have difficulty learning, and this includes learning language. To become and stay bilingual, children with developmental disabilities, just like typically developing children, need to be exposed to and use both their languages on a frequent and on-going basis. It has been shown that frequent input in a language is highly and positively related to proficiency in that language. This is particularly true for the weaker language.

Quantity is not all that is needed, however, as we saw in the interviews of parents with ASD; quality is also important. Children with developmental disabilities, because of their language-learning difficulties, need to experience both their languages in functional interactive contexts designed to facilitate their language learning.

Do children with developmental disabilities have equal access to bilingual programs (immersion, dual language) and, if not, what should be done?

No, they do not have equal access to bilingual programs and to services as shown in our survey in six sites and four countries. Our respondents reported that both sequential and simultaneous bilinguals with disabilities were taught only in the majority language and were assessed and treated only in that language more often than they should be. In general, the more severe the disability, the less likely children with developmental disabilities have access to bilingual supports and services.

Our team also interviewed practitioners and administrators to identify barriers that prevent children with developmental disabilities from accessing and/or participating fully in bilingual services and supports. We found both systemic barriers (e.g. limits in funding, service availability varying by geographic location, etc.) and barriers specific to children with developmental disabilities such as a tendency to prioritize special education services over bilingual services, a lack of integration of special education and bilingual services, and so on.

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What are some of the suggestions that come out of your research project?

We feel that a number of changes should be made: All those involved with children with developmental disabilities need to know that these children can and do become bilingual; their families should be encouraged to enroll them in bilingual programs and services available to other children; special education and bilingual education programs and services should be integrated; staff who work with them should be provided with training and supports, and so on.  

What are your hopes for the future?

My hope is that our societies will value and support people from diverse cultural and linguistic backgrounds. After all, we know a lot about how we can help children become bilingual and remain bilingual and we also know a lot about how to appropriately assess and treat bilingual children with developmental disabilities. I hope that in the future we will continue to study these issues and make bilingual programs accessible to, and supportive of, the needs of children of all ability levels.

5-Year-Old’s Shoe Tying Tutorial Goes Insanely Viral Because It Works

5-Year-Old’s Shoe Tying Tutorial Goes Insanely Viral Because It Works

Do you ever see something on TV or online and think, “Why didn’t I think of that?” For those of us who have unsuccessfully tried to get our little ones to tie their own shoes (clears throat), meet Colton. He is five and has a loose tooth and your ovaries may explode after watching this.

In a video submitted to the Love What Matters Facebook page by Ashley Lillard, Colton shows all of us old dogs a new trick, while also giving a play-by-play of what’s happening in his life. As his mom patiently films her shoe tying ninja in their kitchen, Colton informs us he “has a new way to tie shoes.”

Sure, we’ve all seen the helpful tips and tricks online and in parenting books. Hell, if you Google “shoe tying” 736,000 results pop up. There are even adorable little songs you can sing to your children while trying to teach them involving bunny ears jumping into holes. But Colton is a man on a mission and he gets the job done in under a minute. Sorry fluffy bunny, but you’ve been replaced.

While filming, his mom deals with the chaos of everyday life including a very friendly dog that is eager to learn about Colton’s shoe tying breakthrough. Once she gets the dog out of the way, you hear another noise, which little Colton explains is just “my dad comin’ in.” Colton’s mom chimes in, “Hopefully he will be quiet for our video,” a thinly-veiled warning sign familiar to fathers everywhere that you best keep your mouth shut, something important is going down.

As Colton shows us how this new trick works, his mom continues to reassure him from afar, never reaching in to help. She gives him time to learn for himself, continuously offers encouragement throughout the video, and never tries to hurry him along. Some of us, especially those with multiple kids who seem to always be in a constant state of motion, could learn a little something from her patience (clears throat again). The video has already been viewed over 800,000 times since yesterday so we’re thinking we are not alone in loving it.

Once the successful shoe tying is complete, Colton, beaming with pride, shares with us that “I learned that from my friend, River.” Some kids would have tried to take all the glory after receiving their parents’ adulation, but little Colton wants to make sure to give credit where credit is due. Colton’s mom thanks him for sharing his impressive trick to which he sweetly replies, “You’re welcome.”

Seriously, are anyone else’s ovaries in need of medical attention?

Texas House Speaker on kids therapy cuts: 'maybe we made a mistake'

Texas House Speaker on kids therapy cuts: 'maybe we made a mistake'

Texas House Speaker Joe Straus said Tuesday he will look to reverse the $350 million in cuts made to therapy for developmentally disabled children when the 2017 legislative session starts in January.

Straus, a Republican from San Antonio, told the Texas Tribune in a sit-down interview the reduction in reimbursement rates to speech, physical and occupational therapists were "well intentioned" but needed to being revisited.

"It did not work, and it will be addressed in the supplemental budget," Straus told Texas Tribune chief executive Evan Smith. "Maybe they were a mistake."

When lawmakers passed the legislation in 2015 it tasked the Department of Health and Human Services Commission with reducing the reimbursement rate to therapists but also not jeopardize developmentally delayed children's access to care.

The cuts take effect December 15 but already the threat of reductions in payments from Medicaid have forced some therapy providers to shut down.

The Texas Tribune reported a therapy center in Tyler serving 300 children closed in October, leaving the nearest location 40 miles away in Longview.

In Dallas County, three non-profit facilities participate in the Early Child Intervention services program administered by the state.

The Warren Center in Richardson serves 760 children, 60-percent of which utilize Medicaid.

Executive director Amy Spawn says the non-profit will absorb the 25-percent reimbursement cut but will not reduce services for its clients ranging in age from birth to three years.

"It puts in a position where we're looking for more grant opportunities to fill the hole left by these cuts," Spawn said.

On Tuesday, 3-year old Montgomery Smith was receiving language development therapy through the use of physical activity with a speech language pathologist.  For mom Bria, the therapy hasn't just helped her son.

“It means a lot to know that a therapist can help my child out because I didn’t know anything about autism until it came into my view," Smith said. "Now there are things I've been taught by a therapist I can use at home to help him."

The reduction in reimbursement is slated to begin December 15.

Copyright 2016 WFAA

Disabled children in Texas are the first to feel the $350 million in state cuts to Medicaid

Disabled children in Texas are the first to feel the $350 million in state cuts to Medicaid

By Walter Einenkel  

Monday Dec 19, 2016 · 11:00 AM CST


$350 million in budget cuts to Texas’ Medicaid have gone into effect. Don’t worry though, it mostly affects disabled children’s therapy. We all know that God doesn’t like therapists of any sort—physical, speech, occupational, or psychological.

They reduce revenue for some Texas therapy providers. Opponents say they'll force providers to close, and could cost roughly 60,000 children access to speech and occupational therapists.   

Health and Human Services Commission spokeswoman Carrie Williams said the cuts were implemented Thursday to "achieve savings," as directed by state lawmakers.   

This plan was put into place over a year ago by Texas’s brightest lawmakers, and went through a lawsuit that the Texas Supreme Court refused to hear.

The Supreme Court’s announcement means that a lower court’s decision, which found the lawsuit lacked standing, will remain in place, clearing the way for state officials to begin cutting payments to in-home therapists by as much as 25 percent. The Supreme Court had temporarily blocked the cuts from taking effect while it considered whether it wanted to hear the case.

Rachel Hammon, executive director of the Texas Association of Home Care and Hospice, a provider lobby group, said she was disappointed with the high court's decision and called on Gov. Greg Abbott to intervene.

Governor Abbott is not a good person and asking him to do anything for anybody not named “dollar bill” isn’t going to happen. But don’t worry, the spokeswoman for the Health and Human Services, Carrie Williams—whose job includes putting a bright spin on fetal burial laws—had this to say:

"The most important job we have is making sure kids have the services they need and that we are responsible with taxpayer dollars," Williams said in an email. "We will monitor the reduction of rates to ensure access to care is not impacted and that Texans around the state receive the much-needed therapies required to improve their lives."

See? Those words say nice things even if our actions don’t match up in any way imaginable.