Speech Pathologist: ‘I will not be able to accept Medicaid patients – Alaskans with no voice, the children who have disabilities

The House Finance Committee recently held a series of community meetings on Alaska’s budget. The effort helped prompt an outpouring of feedback from Alaskans on the proposals contained in Governor Mike Dunleavy’s budget, which would fundamentally change life for many Alaskans. In the coming days, Alaska House Majority will share some of the nearly 1,800 public comments to help give an idea what’s really at stake. The Majority does not necessarily endorse all of the proposed policy proposals suggested by Alaskans in these comments.


Submitted by June, a Speech Language Pathologist in Anchorage

I am a speech language pathologist in a solo private practice. I specialize in providing speech-language therapy to children with multiple needs, many of whom are medically fragile, and require long-term intervention. My master’s degree and 30 years of experience are what I bring to the children and families I work with. I am one of the few providers in Anchorage that offer home visits for those children whose medical conditions make it difficult to go to a clinic. About two thirds of my caseload are children who have Denali Kid Care or Medicaid TEFRA option, which is Medicaid for children with special health needs so that they may remain at home rather than be institutionalized.
As it has been noted, Medicaid reimburses at a higher rate to many other states. However, over the years, the reimbursement rate has steadily gone down. Last year, I endured a 12.4 percent reduction in reimbursement rate. This year there is a further 5 percent reduction proposed. I do not have the option of reducing the number of children I see, reducing the number of minutes per session I provide, or reducing the number of therapy sessions I schedule. Doing any or all of these things is a direct reduction of services that a child with special needs receives. I am the sole provider. I cannot increase my caseload by 12.4 percent to compensate for the reduction in reimbursement. As it is, I have a full caseload of over 35 children per week, with each child receiving 45 minutes to an hour of direct therapy services per session. Medicaid only reimburses for direct contact with patients and does not reimburse for paperwork, preparation, or coordination of services that I provide, and yet requires that each session’s progress notes or evaluation reports be completed within 72 hours of the direct contact. I do not have the option of seeing more children during the week and catching up on paperwork on the weekend, which I had done in past instances of rate reductions before this 72-hour rule was put in place. And yet, I am fully committed to providing the best care that I can.
At some point, however, it will become impossible to still have a livelihood if reimbursement rates keep going down, and then I will not be able to accept Medicaid patients, the most vulnerable, and most needy of our population – Alaskans with no voice, the children who have disabilities.
One (of my patients) recently had neurosurgery to relieve pressure on her brain from a malformation that blocked cerebrospinal fluid from draining from her brain, which had caused loss of function and a lot of pain. I worked with her prior to surgery to reduce loss of skills and post surgery to re-teach lost skills and to teach new skills that she had not been able to learn due to the pain and neurological involvement. One child breathes through a tracheostomy tube and gets his nutrition through a gastronomy tube. I work with him on respiratory support for speech and on chewing and swallowing so he can eat by mouth.
These are the children on Medicaid. Please do not cut the Medicaid budget. It makes no sense.

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