Missouri Medicaid reimbursement low and slow, creates boundaries for children with disabilities

Published: Jan. 6, 2020 at 4:54 PM CST
Email This Link
Share on Pinterest
Share on LinkedIn

Many Missouri children might not see the benefits of a new law designed to help them. The "Therapy For All" law requires insurers to pay for things such as speech and occupational therapy for children with developmental disabilities.

Nearly half, 45%, of all Missouri children are covered by the state's Medicaid program, according to a Missouri Health Foundation report released in the spring of 2019. MO Healthnet already covers the therapies mentioned in the new law that went into effect on the first of the year. However, a Springfield speech therapist said Medicaid reimbursement rates are so low, many clinics don't accept it as insurance. Those that do, she said, eat the costs.

At her outpatient children's clinic in Springfield, speech therapist Melanie Stinnett is getting used to saying a word she doesn't like.

"It's extremely hard to say no," Stinnett said.

She's forced to tell many parents she can't treat their children because they're on Medicaid.

"Medicaid reimbursement is really poor in Missouri and so most private clinics don't accept that," she said.

At last count, Stinnett said there were about 150 children on her Medicaid wait list.

"We have a certain percentage of our caseload that can be Medicaid and once we go above that, budget-wise, it just doesn't make sense to continue accepting those clients because the reimbursement can't pay the bills," Stinnett said.

Stinnett advocated in Jefferson City, alongside the Missouri Disability Empowerment organization, for a law that now requires commercial insurance companies to cover therapies for children with developmental or physical disabilities.

"When you think about speech therapy, occupational therapy, physical therapy, to say they're life-changing services is really not enough," she said.

Missouri's Medicaid already covers those things, Stinnett said, but the reimbursement rates are about a third of what they should be, which leads many clinics like hers to deny care.

"If we're limiting access because our reimbursement is so poor, it may be important, as a state, for us to look at where we're spending our money," she said.

That's why Stinnett and State Rep. Crystal Quade, of Springfield, are trying to do.

"When it comes down to, where are those dollars going? We don't always get those answers," Quade said.

Quade said her staff is sifting through data while she talks to community members to figure out what is happening to the money already designated for Medicaid's payout for disability services.

"One of the things that we’re really trying to do with providers in the community, as well as parents, is talk about what services these children would benefit the most from. Are those being covered with this money that we have already allocated? Making sure that there’s accountability for those dollars," Quade said.

Quade said she's heard from clinics that Medicaid reimbursement rates are not only low, but they also take a long time to process. Her goal is to fix part of the problem, and give more providers like Stinnett a chance to help kids get the therapies they need.

Stinnett said simply offering coverage through Medicaid is not enough, if reimbursement rates are creating more barriers for children who already have challenges.

"We have to make sure that if we're providing coverage, we're doing it in a full way that really gives access to children," Stinnett said.

Rep. Quade said she hopes her office can reach agreements with the Missouri Medicaid program to adjust funding and reimbursement rates. However, she said she's not opposed to sponsoring new legislation during the session that starts Wednesday, if it's necessary.

A representative with the Missouri Department of Social Services, the agency in charge of MO Healthnet, said in an email, "MO HealthNet provider reimbursement fee schedule rates are set by and subject to appropriation."