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TEXAS LEGE CAN RIGHT A WRONG AND HELP FUND MEDICALLY FRAGILE CHILDREN WITH
DISABILITIES

Veronica Charles
Opinion contributor



Texas was one of the biggest beneficiaries of the American Rescue Plan Act
(ARPA), receiving roughly $862 million dollars in Medicaid funding from the
federal government in 2022 according to the Kaiser Family Foundation. The funds
were earmarked to be spent as the state saw fit for Home and Community Based
Services (HCBS). Unfortunately, state lawmakers chose not to fund additional
nursing hours to support the thousands of medically fragile children throughout
the state who need a private duty nurse (PDN) to stay alive in the comfort and
dignity of their home.

PDN patients are typically children born with an acute medical condition or
disability that requires around-the-clock medical care – care that can be
provided in a sterile hospital room at an average of $2,902 a day according to
Texas A&M, an institutional care setting at an average of $5,125 a day, or in
their bedroom at home surrounded by family, loved ones and their designated
nurse for an average of $750 a day.



Sadly, many Texas children with complex conditions who would benefit from PDN
either do not receive enough care in the home or are unable to access services
due in large part to the lack of funding. Texas has not increased reimbursement
for these professions in nearly two decades. The Medicaid reimbursement rate for
licensed practical nurses serving as PDNs in Texas is roughly $33 an hour
compared to $48 to $66 in neighboring states, according to the rate schedules
for Texas, Arizona, Nevada and New Mexico. The gaps are similar for registered
nurses. For nurses in other settings, however, reimbursement has increased
nearly 12% since 2019 and wages have exploded for contract nurses – increasing
by more than 106%, according to a May 2022 report, The Financial Effects of
Hospital Workforce Dislocation, published by industry analyst Kaufman Hall.



This disparity has forced many PDN nurses to seek employment in other states
where Medicaid reimbursement ranges anywhere from 15% to 100% more than what
Texas programs provide for caring for the same patients. This is why many health
care providers, families and advocates joined in breathing a sigh of relief
following the $862 million dollar ARPA infusion – a chance to recruit more
nurses, get children out of hospitals, allow parents to return to work, and put
Texas families back together.

So what happened?



These vulnerable patients were generally overlooked. The state had the
opportunity to resubmit an ARPA funding request to the Centers for Medicare and
Medicaid Services (CMS) to direct dollars to PDNs but due to the part-time
nature of the Texas legislature, they would have needed to call a special
session and ultimately decided against it. Thus, medically fragile patients did
not receive the same levels of funding as other health care services –
effectively leaving many children in the hospital for extended periods of time.

While this is a blemish on Texas’ already limited Medicaid program, the story
doesn’t have to end here. We have a second chance to act to ensure medically
fragile kids can access the in-home services they need to thrive.



To improve access to care and invest in our children, Texans can support the
current legislative proposal to increase private duty nursing funding by 40% to
make Texas competitive with other states. Appropriate increases and reasonable
reimbursement rates will help ensure continued delivery of this critical service
and promote better quality of life for Texas patients and their families.

If you live in Texas, you can write your house and senate representatives in
support of this legislative need or support the initiative during the committee
hearing in the State Capitol at 9 a.m. on Tuesday, Feb. 21.

Veronica Charles, MPA, is Senior Director of Federal and Government Affairs for
Maxim Healthcare Services, a home health care, personal care and behavioral care
provider serving families with eight locations across Texas.






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