Medicaid Drops Therapies | Jackson Free Press | Jackson, MS

Medicaid Drops Therapies

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Terry resident Adele Krichbaum says Mississippi children removed from Medicaid funding for speech-therapy services, such as her son Kiefer, will be less able to grow socially and interact with people and teachers.

Adele Krichbaum's son is 18, but he has a 5-year-old's grasp of conversation. "He can learn things as well as anybody, but you have to be able to talk to him and convey the information you're trying to give him," said Krichbaum, who lives in Terry. "The important thing in dealing with children like my son, who has autism, is that you have only a small window of time to teach them the skills they need to communicate, or else you've set them on a road to being behind for the rest of their lives."

Krichbaum and a group of speech pathologists claim the state is working against this by pulling funding for some kinds of speech problems. Pathologists and advocates for the handicapped are speaking out on the Mississippi Division of Medicaid's recent decision to pull funding for speech therapy for some children. The division has been refusing to reimburse speech-therapy providers for services to some Mississippi children since Jan. 1, and critics called the move "arbitrary."

Speech pathologists spoke out at the Mississippi Division of Medicaid-sponsored public hearing at the Mississippi War Memorial auditorium last month, warning Medicaid representatives that program leaders were saddling children with speech difficulties to a potentially higher school drop-out rate and increased likelihood of criminal behavior.

Speech pathologist Jacqueline Trammel, who has been referring children to Medicaid speech therapy services for 20 years, warned that the future for children with untreated speech disorders would likely come back and haunt the state's prison budget.

"Thirty-five percent of special education children have learning disabilities. Of that 35 percent, 75 to 80 percent have a significant speech and learning handicap. Of those learning-disabled children, 35 percent will drop out of high school. Of those 35 percent who drop out, 50 percent will be arrested," Trammel said.

Mary Troupe, executive director of the Coalition for Citizens with Disabilities, compared Medicaid's decision to a repeat of the 2004 attempt by Gov. Haley Barbour to remove Medicaid coverage to 65,000 low-income retirees and disabled who qualified for Poverty-Level Aged and Disabled benefits.

Medicaid spokesman Francis Rullan said the division is merely enforcing a distinction between educational speech therapy and medical necessity, with medical necessity being required for continued coverage. He said Medicaid is only doing a job that it should have been doing for years.

"Say we have a railroad, and for years people have been getting on it knowing the conductor is only going to check it at the third stop. They know they'll get a ride to the third stop, even though they've only paid for the second stop," Rullan said. "New management comes in and says the federal government is now taking a closer look at how it's spending its American Recovery and Reinvestment Act funds, and they're saying we have to start tracking the tickets from the very beginning."

Troupe says the division offered no real notice of the rule change, putting it on the back page of the secretary of state's Web site. Parents only discovered the state had removed their children after the caregiver reported to them that the state would not reimburse them for their services.

Rullan said parents who find their children removed as a beneficiary can re-apply for coverage multiple times. "How long it takes depends on how backed up we are," Rullan said. "If the therapist can write a good evaluation, that magnifies the medical necessity—not the educational component, but the medical necessity—then they have a very good chance of having the request approved."

The spokesman added that, as of July, only 38 out of 635 applicants who have applied for speech-therapy benefits were denied.

House Public Health Committee Chairman Steve Holland, D-Plantersville, said he held a hearing about the rule change on the last day of the special session to address the issue. Holland pointed out that the federal government appears to be putting no pressure on the state agency to scrutinize children's qualifications. The Centers for Medicare and Medicaid Services did not notify or warn the state that its application standard was too lax, and CMMS has sent out no policy changes.

"This is just their attempt at beating the hell out of the most helpless people who really can't afford the time or money to fight this process. Haley Barbour tried this two years ago, and there was such an outcry over kicking little kids out of the system that they backed off it. Now they're doing it again," Holland told the Jackson Free Press. "All I can say is thank God for term limits."

Rullan admitted that the federal government had not initiated the policy change, though he added that the division of Medicaid has cleared the extra scrutiny with the federal government before enacting the restriction.

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