Friday, January 02, 2009

Funding difficulties persist for NY State Early Intervention Program

Background reading: New York State's Medicaid Problem in the Schools

Governor Patterson's proposed budget cuts to the Early Intervention program have professionals across the state wringing their hands - read about the speech therapy association's concerns here. Although there are no public documents available currently from occupational therapists I have been sent a lot of internal communication from NYSOTA about that group's concerns.

Some of the concern is about the possibility of implementing family cost sharing for EI services. New Jersey advocacy groups are already on the record against these models. Reasonable cost sharing is a functional model - but of course there are always individual exceptions and sad stories to any cost sharing model that will make the front pages of the 'Living' or 'Family' section of local papers and invariably lead to embarrassment of local officials, if not lynching. It is also true that a cost sharing model, unchecked, will drive people out of the program. There needs to be a balance.

There is additional concern about the implementation of eligibility standards for receiving services. The current standards are the statistically confused and meaningless 25% delay in two areas, 33% delay in one area - or use a standardized test - or obtain a 'qualifying diagnosis.' Professionals have been manipulating the system for years using the improper method of calculating age equivalency to determine percent of delay. Ironically, therapy professionals have made a lot of noise about the meaninglessness of this statistical manipulation but now perhaps they don't like the result of their advocacy for better statistics. There are some articles referenced at the end of this post for additional reading - full text versions of the articles aren't linkable.

All this statistical talk about program eligibility and discussion of cost sharing models probably sounds like so much confusion to many consumers and practitioners. The public doesn't understand - and is being fed poor information from the newspapers. In this article from the Albany Times-Union, David Smith writes that the solution involves increased federal allocation of Medicaid dollars. What he doesn't write is that without increased federal allocation the state will simply cut their own Medicaid costs and leave it to the counties to pick up the tab. So either we pay increased taxes for ballooning federal programs or we pay increased property taxes at the county level. For the politicians it is only about shifting the burden to someone else's cost center - not really controlling the actual cost of the program.

So no one likes the situations that need to be faced in order to control costs, no one wants to be responsible for raising taxes, and no one wants to limit services for these children. The Governor proposes a budget that everyone hates and there is no buy-in from the constituencies because they aren't really participating in a real solution.

In order to find a solution, professionals and politicians and parents - what I call The Mighty Triumvirate of 'P' - need to develop a willingness to work together. A final solution will include reasonable cost sharing, reasonable eligibility requirements, and reasonable funding. Any solution that is dictated from a political office without the involvement of all stakeholders is not likely to be viable in the long term.

Historical note: my original entry on this topic was two and a half years ago. It is only getting worse.

Additional References:

Maloney, E. and Larrivee, L. (2007). Limitations of Age-Equivalent Scores in Reporting the Results of Norm-Referenced Tests. Contemporary Issues in Communication Sciences and Disorder, 34, 86-93

Maring, J. R. and L. Elbaum (2007). Concurrent validity of the Early Intervention Developmental Profile and the Peabody Developmental Motor Scale-2. Pediatric Physical Therapy, 19, 116-120.

McCauley, R.J., & Swisher, L. (1984). Use and misuse of norm-referenced tests in clinical assessment: A hypothetical case. Journal of Speech and Hearing Disorders, 49, 338-348


Alece K. said...

Wow, this was a great entry! You obviously put a lot of effort into researching the history and current state of this issue. I completely agree with your assessment of the necessity of The Mighty Triumvirate of P coming together to work toward a reasonable and universally beneficial solution. Easier said than done though, right?

I am 2nd year MOT student at the University of Washington (in Seattle), and am very interested in political advocacy at the state level. Consequently, I love blogs like this one! For my Master's Project I've just launched a blog about OT advocacy in WA State- you might enjoy checking it out:

macyn said...

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.