Advocates on both sides of a new rule limiting Medicaid coverage for intensive day-habilitation services for very young children in Arkansas testified all day Wednesday and part of Thursday in a Little Rock federal courtroom.
U.S. District Judge James Moody Jr. told the parties Thursday that he hopes to issue a written ruling by Aug. 1 -- the rule's scheduled effective date -- on a request to block its enforcement.
Facilities in three locations -- El Dorado, McGehee and DeWitt -- and three sets of parents are challenging the change being implemented by the state Department of Human Services' Developmental Disabilities Division.
They believe stricter requirements for obtaining the services will unfairly deprive many children up to 6 years old of the maximum amount of help they are entitled to under federal law to overcome conditions that, while less severe than other delays and disabilities, can have lifelong negative effects.
Others, including the director of the division, Melissa Stone, say the aim of the more stringent requirements is to move children who don't need the most intense services away from "segregated" environments -- where all kids are developmentally delayed or disabled -- into more natural and integrated environments, which help them more in the long-run.
The goal of federally funded programs is always to help people with disabilities function in the "least restrictive environment" available, helping them to integrate into society and move away from institutionalization.
The plaintiffs in a lawsuit filed June 14 question whether the state is kicking needy children out of the best day programs just to save Medicaid funds. But the state says there are other high-quality centers throughout the state that can provide day services for children who don't qualify for the more intensive services offered under the Early Intervention Day Treatment program, and that parents can seek Medicaid coverage for those services, as well.
They cited day programs operated by Head Start, for children ages 3-5; Early Head Start, for children up to age 3; Arkansas Better Choices and other integrated day care settings, such as a church day care.
The rule change denies Medicaid coverage for day-habilitation services provided through the Early Intervention Day Treatment program unless the children's primary-care physicians also prescribe occupational therapy, physical therapy, speech therapy or nursing services.
But the plaintiffs say that when day-habilitation services are prescribed by physicians for the treatment of developmental disabilities or delays in children up to 6 years old, regardless of whether the children are also prescribed one of the specific therapy services, the services must be provided under the early and periodic screening, diagnosis and treatment provisions of the Medicaid Act.
"Many children who qualify for day-habilitation services have not been prescribed occupational therapy, physical therapy, speech therapy or nursing services," the lawsuit states. "The Rule deprives these children of the day-habilitation they need to obtain the maximum reduction of their developmental disabilities and restoration to their best-possible functional level."
The state first applied the new rule last summer for new enrollees but allowed children who had already been receiving the services, despite not being prescribed at least one other therapy, to be grandfathered in. Those children were scheduled to lose access to the day-habiltation services July 1, but Stone testified Wednesday that she extended the deadline to Aug. 1, in response to the lawsuit.
According to testimony Wednesday, the affected children are those with delays in language, cognition, social-emotional development, gross motor development, fine motor development and adaptive behavior.
Moody heard testimony from experts in child development, including Sharon Landesman Ramey, a developmental scientist who is a professor at the Fralin Biomedical Research Institute and the VTC School of Medicine at Virginia Tech, and Alan Mease, a Little Rock pediatrician for more than 40 years who was the medical director of Child and Adolescent Health at the state Department of Health for five years.
Ramey testified that she doesn't believe that children who have been enrolled in the Early Intervention Day Treatment program will see "any meaningful gains" if they switch to one of the other available programs, which aren't generally covered by Medicaid and "aren't the equivalent" of the early intervention program services.
"I would predict that they would regress," she added.
Mease testified that he doesn't believe that all developmentally delayed or disabled children require services in a segregated center-based program like the Early Intervention Day Treatment program. He said services provided in other settings -- including when a specialist visits a day care or a child's homes -- are "theoretically" just as effective.
"There's not a simple answer to translate all the science into a program," he said, emphasizing that the parent's role is "extremely important" in the effectiveness of any treatment, and that each situation is unique.
Asked how he feels about the changes in Arkansas, he said, "This is a big step in the right direction to be where we need to go."
Metro on 07/19/2019