New Medicaid rate hampers services

The latest round of Medicaid cuts has Idaho agencies providing assistance for people with developmental disabilities struggling to maintain an adequate level of client service. Brandon Beier, administrator for Alternative Nursing Services in Moscow and Lewiston, said the 34.5-percent cut in the Medicaid reimbursement rate received for providing developmental therapies to clients has forced his agency to reduce its staffing and services. Developmental therapy is used to acclimate clients with developmental disabilities to socializing and living with more independence in their communities. Many agencies claim clients tend to do better working individually with a trained developmental technician, but the Medicaid reimbursement rate change Friday from $20.04 to $13.36 per hour has meant switching to group therapy to keep agencies running, said Beier, meaning one therapy technician is now counseling three clients at a time. “We are turning away certain clients who are authorized for individual therapies,” he said. “Unfortunately the cuts are so drastic the businesses are not able to pay the therapy technicians the proper business amount. The cost outweighs what your reimbursement is.” Heidi Penkert, Moscow manager for Opportunities Unlimited, said her agency and others had prepared for Medicaid cuts, but the impact was still larger than expected. “We’ve been gearing up for this for the last couple of months,” she said. “It’s been painful this week. We’re still trying to provide that exact same service, but in a group environment. I’m determined that we are going to still deliver next month’s service.” C & R Inc. in Moscow has cut 20 staff positions this year in an attempt to continue providing developmental services to its 60 clients, said director Valerie Cutshall. “We’ve had to eliminate a lot of positions,” she said. “We’re just doing our best to provide the best service we can. It’s really limited as far as what we can offer.” Cutting staff to make up the loss of reimbursement funding that pays for administering developmental therapy means a reduction in service for other programs, Cutshall said. Through Community Supported Employment, staff would work with developmentally disabled clients as job coaches, so they could work in the community and bring home a decent wage, she said. “Those folks who we serve who have jobs in the community are also losing their jobs,” Cutshall said. “A lot of our folks need job coaching to maintain the skills that they need to keep their jobs.” Penkert said the intensive behavioral intervention program, which deals with at-risk developmentally disabled children, is expected to be gone by this time next year. “We’ve had kids with autism who’ve come in kicking and screaming and yelling, and now they can come in with their backpacks, sit down at a table and do their work,” Penkert said, adding if children are not assisted now, they will have many behavioral issues as adults. “We’re expecting to see an increase with the criminal justice system.” Switching from individual developmental therapy to group therapy means less attention for each client who needs assistance learning how to cook for themselves, remember to take their medications and perform other routine daily tasks, Beier said. If agencies can’t work with clients to provide them with a safe environment, Beier said the cost will go up for the state when developmentally disabled people left to fend for themselves end up hurt or in jail. And if they can’t live on their own, he said many will be forced into group facilities. “This is kind of regressing back into what we had in history by basically institutionalizing people,” Beier said. “It’s kind of like hiding those individuals away. It’s almost like a lock down, it’s like a little prison.” Penkert said the Medicaid changes passed in House Bill 260 were fought in the Legislature with many agency representatives from across the state — including herself — testifying against the cuts. Both the House and Senate approved the Medicaid overhaul in March. “We’re fighting it,” Cutshall said. “We’re fighting everything we can with the state. We’re proving that they need the services.”