Lately, we’ve been laser focused on potential threats ahead at the federal level. But as state legislative sessions start anew, it’s a good reminder that policymaking swirls ahead in state capitals as well. As our friends at Texans Care for Children described, last year’s Medicaid therapy cuts in Texas are already shutting out some young children with disabilities and developmental delays from needed services. Upcoming policy decisions at the federal and state levels have the potential to make a big difference in the lives of these children, for better or worse.
In Texas, like many other states, Medicaid is one of several funders of Early Childhood Intervention, Texas’ IDEA Part C system. A new brief co-authored with my colleague Karina Wagnerman shows that eligibility and funding cuts since 2011 have meant Texas is not keeping pace with other states in providing early intervention for these children to help them enter school better able to learn. Making matters worse, since new cuts took effect last month, many ECI contractors are reportedly planning to discontinue providing ECI therapies. Some Texas legislators have vowed to reverse these cuts during this year’s state legislative session but they face an uphill battle.
While a reversal would certainly be a big step forward, federal threats to cap or cut Medicaid would take them several steps backward. Last year’s federal budget proposal, shepherded through the U.S. House of Representatives by Budget Committee Chair Tom Price – now President Trump’s HHS nominee – would block grant Medicaid and shift more costs to states such as Texas. So while young children in Texas with disabilities and delays remain in need, Texas stands to lose more federal dollars. Federal cuts would leave Texas lawmakers with even tougher decisions about where else to scale back this already too lean program. When federal funding is cut, inevitably somebody takes the hit and it is often the most vulnerable among us. The Texas ECI experience clearly shows that health care needs don’t go away when coverage is cut.