Medicaid funding shortages limit early intervention services

Tue, 09/26/2006 - 3:20pm
By: The Citizen

Wyatt a 29 month old toddler with significant delays in speech and sensory processing is at risk of losing the early intervention he needs to start school ready to learn. Likewise, Sanaya, a toddler with significant delays in communication and cognition is being denied needed speech therapy.

Georgia’s Interagency Coordinating Council for Early Intervention Programs (SICC) including parents, service providers and other non-Department of Human Resources, Non-Department of Community Health agency members, called for immediate attention to the recent impact of Medicaid changes, funding shortages, and increased Federal requirements on early intervention services in Georgia. The SICC is charged with providing advice and assistance to the Department of Human Resources (the lead agency for early intervention programs).

Babies Can’t Wait (BCW) is the beginning of special education in Georgia. BCW currently provides early intervention supports and services to families of over 5000 infants and toddlers statewide from birth to age three who have significant developmental delays. Federal funds to support this program come from Part C of the Individuals With Disabilities Education Act (IDEA), the same federal legislation that also funds special education in Georgia’s public schools. Although it is an education program, BCW is administered through DHR’s Public Health branch and services are provided through Georgia’s 18 public health districts.

A large body of research in early child development and education indicates that an investment in early intervention results in long-term savings through reduced special education costs as well as other savings realized through productive employment and participation in society. However, the implementation of Medicaid Care Management Organizations (CMOs), past and present funding shortages and federal requirements to increase caseloads statewide have placed the program in serious financial jeopardy. Funds for the program have declined steadily while demands for service have increased.

BCW funding and costs are intricately interwoven with and impacted by Georgia’s Medicaid policies and rate structure due to federal policies requiring that BCW funds for services be used as a payer of last resort and requiring that other available federal funds such as Medicaid cannot be supplanted by BCW funds. If specific CMOs choose not to provide required BCW services such as service coordination, BCW will have to cover the cost which could mean millions of dollars not available in the current budget.
With the implementation of Medicaid CMOs on June 1st in the metro and central CMO regions of the state, the BCW funding base has been further jeopardized by the loss of service coordination revenues and the additional costs associated with providing services which are not being covered by the CMOs. Extensive loss of service is expected with the September 1 statewide roll-out.

Babies and toddlers with developmental delays are paying the price. Many infants and toddlers like Wyatt and Sanaya, who have been receiving therapy services through the BCW program have been denied services through Amerigroup. These are children who had been receiving early intervention through BCW but because they are Medicaid recipients they are caught in a bureaucratic quagmire and risk losing developmental gains made through early intervention. These families don’t have the means to pay for these services and BCW can’t legally supplant Medicaid funded services.

Compounding that dilemma, the council discovered that many significant barriers exist for service providers when accessing Medicaid CMO reimbursements to support BCW services. For example, the time intensive, labor intensive, paper intensive, confusing and often redundant prior approval process to get BCW services authorized and approved for reimbursement. Likewise, frequent resubmissions of copies of the same documentation are required in order to obtain prior approvals. We are losing early intervention service providers at an alarming rate.

In a call to action letter to Governor Perdue, SICC Chair Cynthia Vail noted, “the bottom line is…that we are losing service providers in a field where critical shortages already exist. Public comment to the SICC during its July meeting in Rome echoed a similar concern, “the State’s capacity to provide early intervention services to children and families will be further diminished if the funding system is not addressed. “ The Council proposes several suggestions to help remedy this disaster in the making. Allowing children in Babies Can’t Wait to be “carved out” of Medicaid CMO enrollment (as is the case for CMS enrolled children) represented a possible remedy among many from the Council.

Interested parties can find more information about the State Interagency Coordinating Council, its officers, members and local affiliates by visiting HYPERLINK “”
The State Interagency Coordinating Council (SICC) is required by federal statute to be appointed by the Governor and is an important participant in the development of a well-coordinated service delivery system. The ICC is an independent group which does not “belong to” any particular agency.

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