Posted on 02/09/2005 8:34:19 PM PST by Huntress
Gov. Matt Blunt says parents of severely challenged infants and toddlers should rely on insurance and Medicaid to pay for the services now provided by Missouri's First Steps program.
State taxes, he says, should be used as a last resort.
But insurance plans generally do not cover therapy for children with birth defects served by First Steps. And when they do, the coverage they offer is limited, according to industry experts and parents. Eliminating the $23.3 million birth-to-3 program would cost the state $10.5 million in federal funding.
A House committee will hold a hearing today on First Steps, and parents say they will flood the halls to demand that legislators restore the funding. In just six days, a Web site — savefirststeps.com — has more than 24,000 signers asking Blunt to reconsider.
The creator of the site, Malinda Terreri of St. Louis, said her autistic son, Nick, had gone from saying four words to complete sentences in the First Steps program. Nick, who will turn 3 on Sunday and enter his school district's special education program, would require much more specialized care and attention from the district if not for First Steps, she said.
“It took my breath away to think about parents who are finding out they are pregnant and won't know for a year or so they need special services and then there is nothing there to help them,” she said. “That their children would be locked in their own world for three years until they can begin to get help (from public school districts) would be a tragedy.”
The program helps about 8,100 infants and toddlers with conditions such as Down syndrome, spina bifida and cerebral palsy.
Losing First Steps, Sharon Maxwell said, would cost her daughter critically needed therapy sessions.
On Tuesday, Maxwell, of Kansas City, cooed encouragement to her 19-month-old daughter, Katelyn, as a therapist coaxed her to clutch a string and pull a blinking toy.
The focus of the hourlong session was to get Katelyn, who has a brain deformity and functions at the 6-month level, to lift her head and reach her tightly curled fists toward objects.
The therapist, Chris Meuli, gets $50 per session through First Steps.
Even though the family has insurance through her husband's job, Maxwell said, it would financially wreck her and her husband, Steve, to pay for Katelyn's therapy.
Katelyn now gets two hours each week of occupational and speech therapy at her home and one hour of physical therapy. She gets an hour of water therapy outside the home. Occupational therapy focuses on fine motor skills.
Her husband's insurance provider excludes speech therapy, Maxwell said, and would cover just 20 occupational therapy sessions a year, compared with the 100 or so Katelyn gets now. The Maxwells would have to pay $20 per visit and 10 percent of the costs. The costs would be the same for physical therapy, but there would be no limits on those visits.
Their income exceeds the guidelines to qualify for Medicaid, Maxwell said.
“There is no way we could ever attempt to continue with any of Katelyn's therapies if we lost this program,” she said.
Through First Steps, the state contracts with 2,600 providers for services, including physical, occupational and speech therapy.
And those therapies traditionally aren't covered by insurance plans, Catherine Edwards, executive director of the Missouri Association of Health Plans, said Tuesday.
“They are very high-cost because of the intensity of the costs required,” she said. “First Steps is a program targeted for those special needs.”
Parents with insurance said they were angry when they heard that Blunt had said last week, “We ought to encourage the use of private insurance rather than a state program.”
“What insurance?” said Beverly Meyers, whose 4-year-old son, George, was in the First Steps program. “Most insurance companies won't pay anything related to autism.”
Kansas has a state law prohibiting insurance companies from excluding autism, said Sandy Praeger, insurance commissioner for Kansas. Praeger, who is also secretary-treasurer of the National Association of Insurance Commissioners, said limits on insurance are the reason the federal government provides states with the money to aid special-needs infants and toddlers.
“They know these are services that are traditionally not covered by insurance and yet are services families need assistance with,” she said. “Unless there is a specific mandate, insurance companies can exclude specific benefits.”
Most Humana Inc. plans cover physical, occupational and speech therapy but limit the number of visits, spokeswoman Mary Sellers said. The limit generally is 60 visits a year, she said.
Humana also offers coverage for “durable medical equipment,” Sellers said, and will help negotiate rates for particular products and services.
“We try and keep it robust when we can but still keep it affordable for the members,” she said.
A First Guard Healthcare official did not return telephone calls this week. Coventry Health Care of Kansas Inc. and Blue Cross and Blue Shield of Kansas City declined to discuss the specifics of their coverage. Cigna HealthCare said it would be unable to immediately answer questions, and United Healthcare officials were unavailable for comment.
The Missouri Department of Elementary and Secondary Education, which oversees the First Steps program, does not charge insurance companies for any First Steps services even if the companies would cover a portion of them.
The agency last year worked to get legislation that would have authorized the charges and required a fee from participating parents. The measure would have saved state taxpayers $3 million to $6 million annually. It failed.
Blunt spokesman Spence Jackson sidestepped a question Tuesday on whether Blunt would support such legislation or a mandate that insurance companies provide coverage to children with birth defects.
“We have had many discussions with individuals who believe that (First Steps) has not been operating efficiently and that there are ways to use the appropriate resources to provide services,” Jackson said.
To reach DeAnn Smith, education reporter, call (816) 234-4412 or send e-mail to dsmith@kcstar.com.
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