Rural Kids With Disabilities Hurt Most By Texas Cuts To Medicaid, Providers Say : Shots - Health News State lawmakers cut $350 million in Medicaid funding to early childhood intervention therapists last year to help pay for tax cuts. Now rural toddlers are finding it hard to get vital treatment.

Cuts In Texas Medicaid Hit Rural Kids With Disabilities Especially Hard

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Last year, Texas lawmakers looking to balance out a billion dollars in property tax relief made a decision that's now affecting families of children with special needs. The legislature instead trimmed $350 million in Medicaid reimbursement rates for early childhood intervention providers. These are the people who provide in-home physical, speech and occupational therapy. And for months, they've continued working despite financial losses. But now, as NPR's Wade Goodwyn reports, some are giving up.

HAYLEE CROUSE: (Laughter).

WADE GOODWYN, BYLINE: Two-year-old bright-eyed and blond-haired Haylee Crouse toddles around her grandmother's home outside the town of Whitehouse in east Texas.

HAYLEE: (Laughter).

GOODWYN: At the age of eight days old, tiny Haylee Crouse contracted newborn meningitis which left her mentally and physically disabled. At the age of nine months, she began receiving in-home physical, occupational and speech therapy several days a week. Amanda Crouse is Haylee's mother.

AMANDA CROUSE: They were a lifesaver to her and to our family. They taught her how to roll over. They then taught her how to crawl, pull up on the couch, and then finally she learned how to walk.

HAYLEE: (Laughter).

GOODWYN: But the state's cuts to its Texas Medicaid Acute Care Therapy Programs meant that the one early childhood intervention provider in Tyler, Texas, closed its program. The Andrews Center provided in-home therapy to hundreds of families in five east Texas counties. And so that's it for them and for Haley.

CROUSE: Her therapist actually cried, gave her a hug, said goodbye. We took a picture just to kind of document that moment, and it was an emotional day.

MARY CASTRO: Hi, my name is Mary Castro. And I want to thank you, Madam Chair, and the community members for letting me speak on behalf of my son.

GOODWYN: As news of the cuts became public, parents and grandparents of disabled children flocked to Austin to implore the state senate not to do this. Mary Castro's two-year-old son has Down Syndrome.

CASTRO: Without these therapies, Elijah would not be walking, signing, doing word approximations, dancing to music, interacting with his peers. With that said, he is delayed - now, quite delayed - but we love him, and he loves people.

GOODWYN: Pleading with the powerful on behalf of your defenseless child can be an emotional undertaking.

CASTRO: I'm so sorry.

JANE NELSON: Don't be sorry. Take a drink. There's water right in front of you.

CASTRO: OK. (Unintelligible).

GOODWYN: Republican Sen. Jane Nelson, who chairs the Senate Finance Committee, tried to reassure Castro and the other parents that there would be no effect on their children whatsoever.

NELSON: Every eligible child for these services will continue to receive them. And we're going to monitor it, and we're going to make sure that happens.

GOODWYN: But that's been a promise the state has not been able to keep, and it's the rural parts of Texas where the first collapse of service has begun.

WAYMON STEWART: Sometime you need to come out to these rural areas and look and see how things are done and how they have to be done before you just decide to cut a program.

GOODWYN: Waymon Stewart is the executive director of the nonprofit Andrews Center in Tyler, Texas. Stewart predicts profoundly disabled children will suffer the most. For children connected to machines or prone to seizures, long trips each way in the car several days a week are probably not going to happen. The cuts made in the state capital took a $312,000 bite out of Andrews' budget, forcing Stewart to terminate 20 employees.

STEWART: It really hit us hard. So we were really having to dig into reserves to try to make this program last, and we did for a year. After that, we just decided to give our notice. We couldn't continue to do it unless the rates were changed.

GOODWYN: Two hundred and thirty-five miles away in Wichita Falls, the same thing is about to transpire at the North Texas Rehabilitation Center. Mike Castles is the center's president.

MIKE CASTLES: It's all about money. And it created some internal problems financially, you know, with our other programs, as well, because, there's just so much money to make all these work. And we tried it for a year. It got worse instead of better with even more bad news coming in this fiscal year.

GOODWYN: The state is actively hunting for new therapy providers. The trick is finding new prospects who can make the same financial circumstances that drove the previous providers out of the program nevertheless work for them. Wade Goodwyn, NPR News, Tyler, Texas.

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