/Hundreds of Mississippi kids without therapies amid state contract delay

Hundreds of Mississippi kids without therapies amid state contract delay

Nonprofit Mississippi News: Hundreds of Mississippi’s most at-risk children missed early intervention treatments this month due to an administrative misunderstanding between the Department of Health and Department of Finance and Administration. These children are currently enrolled in Mississippi’s First Steps program, which is federally mandated and provides a range of therapies for children under 3 who have been diagnosed with developmental delays or disabilities. The new contracts with therapists were supposed to have been in effect on July 1, the first day for the new fiscal year. The Department of Health has not yet processed hundreds of its contracts, and has asked the program’s staff to stop providing services until they do. The Department did not provide any date. However, therapists warn that even minor delays can cause these children to miss out on months of therapy. Karen Sisco, a DeSoto County physical therapist, said that some of her children will miss two sessions and it can feel like they’re starting over. “When working with babies, consistency is essential.” Mississippi Today was told by the Department of Health that DFA has the problem. DFA took over state contract authority from State Personnel Board in January 1. The Department of Health stated in a statement that DFA’s new board did not provide contract guidance until May, which was just over a month before contracts went into effect. “Normally, we would take four months to process a contract. This year, it took about a month,” Liz Sharlot, Communications Director for the Department of Health, said. The MSDH has more than a thousand contracts to process because we provide statewide services for many programs. This is more than many agencies. We are unable to process all the contracts in the time we were given. We have processed many hundred of those contracts and will continue to do so every day.” DFA stated that it anticipated delays and advised agencies to use the current law and the regulations of the old contract review board to process the contracts. “With regard to the Department of Health we are not aware of any impact that the rulemaking process had upon their contracts. Laura Jackson, executive director at DFA, stated that all contracts from MSDH were approved by the Board within a reasonable time and in compliance with our submission guidelines. Mississippi Today was contacted by twelve First Steps therapists for this story. All but one of the First Steps therapists spoke to Mississippi Today Monday, stating that they still needed a contract. Mississippi Today was told by the Department of Health that they will pay for makeup sessions with therapists after contracts are processed. This is crucial because First Steps’ early intervention services are federally mandated. The state of Mississippi will not provide the services that a child is required to receive if it doesn’t comply with federal or state law. The Department of Health has not yet provided a date for resolution and several therapists stated at this point that it would be difficult, if not impossible, to make up the sessions as promised by the department. Melissa Davis, a Starkville-based owner of Kids Therapy Spot, stated that “these kids are getting nothing.” We’re now three weeks into the fiscal year. That’s almost a month. So that leaves us with three weeks of therapy. They think they can cover their tracks by saying that you can make up these missed visits. But we can’t. “We just don’t have enough time in the week.” Although the Department of Health wouldn’t say how many children missed therapy due to delays, several therapists involved in the program believed it was in the hundreds. First Steps serves about 2,000 children in Mississippi under three years old. Children who are affected by delays are more likely be middle-income and to have private insurance. Many private insurers have caps on the type of early intervention therapies and the visits that a child can receive. This is in contrast to Medicaid. First Steps will cover what the insurer won’t. Parents and therapists, regardless of the person or group responsible, said that they were frustrated by another setback in a program with unlimited potential but sometimes is crippled due to a lack of resources. Dr. Susan Buttross, of the University of Mississippi Medical Center’s Center for the Advancement of Youth, said that “early intervention services are crucial to this state.” There are clear data (not only economic data but also medical data) that shows that early intervention can improve children’s academic success, increase their reading skills, and increase their graduation rates. Then you have a completely different workforce. So economically, Mississippi does better.” However, Mississippi is not known for its early intervention. According to a report in the Journal of the American Medical Association, only 17 percent of Mississippi’s children are screened for developmental delays by a professional before they turn three years old. This is the lowest screening rate in the nation. Even when it happens, many therapists said that providing consistent services can be difficult. It is common for contracted therapists to be turnover high which can lead to delays in matching children with therapists. Mississippi Today interviewed nearly 20 First Steps providers listed on the Department of Health’s First Steps provider directory. Five of them stated that they quit the program because of low reimbursements. Sisco, a physical therapist said that Medicaid reimbursed between $106 to $123 per session. First Steps charges $50-60 for the same service. Joyce Bates, who managed the Summit Health & Rehab Outpatient Clinic until she retired, said that it wasn’t financially viable. “The reimbursements are really low, and you also have to travel to the patients’ homes. “I couldn’t ask my staff to travel to these situations for the amount they were being paid.” Other therapists stated that reimbursements were often delayed by up to 90 days. Families are often referred to First Steps only to be told that they cannot find a therapist. Marty Chunn is a learning facilitator and outreach coordinator for the First Steps program. “I cannot go out and sell this programme and say how wonderful they are and get somebody enrolled just (have them) denied service.” “So, yes, there’s frustration around the state because people are saying they’re all about helping children but if we have to find them, we don’t always have the resources.” Sharlot of Department of Health admitted that the “needs far outweigh” the available funding, writing in an email that she acknowledged this. This could be because Mississippi contributes less state money than neighboring states. Like these states, Mississippi funds its program with a mix of federal and state funds. The federal funds for FY 2019 were $4.1 million. That’s just $29 per child under 3 years old in Mississippi. This is exactly the same amount as Alabama, Louisiana, and Tennessee. However, Mississippi contributed $1.3million in state funds for early intervention in fiscal 2019. This is in contrast to other states. According to Individuals with Disabilities Education Act data, 2013 was the most recent year available, Alabama, Tennessee and Louisiana each contributed $11.3million, 10.4million and $7.7million, respectively. Buttross says this is especially harmful for Mississippi because it has greater needs than other states. Mississippi has been a leader in the country’s high poverty rate and preterm birth rates. Officials say that poverty and premature birth are the biggest risk factors for developmental delays. Buttross stated that instead of spending less money to help children in need, more funding is needed. The low number of children receiving early intervention services from the state despite increased need is a sign of the lack of funding. In fact, the number of young children who receive them is lower than anywhere else in the country. Only 1.7 percent Mississippi children below two years old receive early intervention services. Only 1.5 percent of children in Arkansas and 1.6 percent in Oklahoma receive early intervention services. You’re already at disadvantage when you consider the low screening rates in the state. Buttross stated that even the few children who are screened don’t receive services on time. The Center for Advancement of Youth and Mississippi State’s Social Science Research Center were awarded a $10.5million grant last fall to increase screening efforts over the next three-years. Buttross explained that the grant has its own problems. More children will be screened and more resources will be needed. Mississippi does not have these resources right now. Buttross stated that as we increase developmental intervention in the state, we will discover more children who are in need of intervention. “So I have no doubt that we will need more money for the early intervention program.”_x000D