The 10 therapists who work at KM Pediatric Therapy see about 200 kids each week, owner Stephanie Molina told Democratic lawmakers Monday, about 70% of whom are covered by Medicaid.
Molina warned Monday that practices like hers that are already being stretched by administrative demands are at risk of being pushed out of business — or at least having to overhaul who they can and cannot treat — by rate cuts the N.C. Department of Health and Human Services enacted in October.
"We have had to absorb everything that managed care has brought to us, and now a 3% cut on top of it all? We are at the breaking point," Molina said during a roundtable event held at the General Assembly.
She continued, "And if you lose providers like myself who are the backbone of the Medicaid program, you are shooting yourself in the foot."
DHHS reduced reimbursement rates for providers on October 1, after the North Carolina House and Senate were unable to reach an agreement to provide additional funding to the state's Medicaid program. Those cuts were between three and 10 percent, depending on the type of service offered.
Legislative Republicans have said the cuts were politically motivated and argued that the Mediciad program has enough funds to keep providing services until at least April 2026. DHHS officials have said they need to begrudgingly slash rates because the state's Medicaid program cannot remain on a path toward running out of money with time remaining in the fiscal year.
Monday morning's press event took place just hours before what was supposed to be the beginning of a special session Gov. Josh Stein called to address Mediciad funding.
Senate leader Phil Berger and Speaker of the House Destin Hall declined to convene that session, saying Stein had called it unconstitutionally and unnecessarily.
The cuts, they told Stein in a letter last week, are a crisis of the administration's own making because DHHS projects there is enough money for Medicaid to be fully funded at September reimbursement rate levels until at least April 2026.
After Monday's roundtable event ended, Molina and several other providers stood in a circle with Sen. Natalie Murdock, D-Durham, who hosted the event. Murdock pointed blame at legislative Republicans, who generally agree on shifting about $190 million in additional funds the state's Medicaid program but have been unable to agree on a legislative package.
"This is something we can do. We need to get it done. We can't — we should not be able to sleep comfortably knowing these are parents and children that are needing this care," Murdock said.
A threat to 'critical therapies'
Molina is a trained speech pathologist who still sees patients. Additionally, her practice has six other speech pathologists and three occupational therapists. The kids her therapists treat have been diagnosed with autism, Down syndrome, cerebral palsy and others.
Sitting Monday at a long wooden table typically reserved for legislative committee meetings, Molina wore a long purple dress with a high collar. That is abnormal, Molina said, noting that her uniform is typically "some worn-out scrubs."
"This is a hard job. We are in the trenches with these families. We get bit, scratched, urinated on because the kids are so impaired. And we are doing this job diligently day in and day out and we are doing it at a breaking point. We are barely making it," Molina said.
On a typical day, Molina said, each therapist sees 10 to 12 kids, starting in homes and daycares in the morning before switching over to in-office therapy in the afternoon. Every therapist in the practice has at least a Master's degree, she added, with many holding a Ph.D.
"These are not elective therapies to enhance skills. These are critical therapies that are teaching life skills that will not develop naturally because the children have underlying medical conditions that they did not ask for," Molina said.
DHHS cut the reimbursement rates for the therapies Molina's team offers by three percent. While at first blush that may not seem like a deep cut, Molina said it is, particularly because the reimbursement rates for that service have not risen for about 20 years even as administrative costs and burdens have soared.
If the cuts remain in effect, Molina warned, her practice will need to start prioritizing new patients who are covered by private insurers instead of Medicaid. That's because a private insurer typically pays $75 an hour, and sometimes $110, while Medicaid pays somewhere around $64 with the rate cut.
"I just can't continue to keep the doors open if I continue with the 70 percent Medicaid that I'm doing. Somehow, I have to try to make that ratio more balanced," Molina said in an interview.
And, she warned, kids who are already in the practice could see their therapy cut from multiple times per week to once per week.
"These are the kids that need us the most, the most vulnerable among us, and that is why we show up every day and we are begging you to stop this. We don't have the ability to continue to make it work while everyone fights this out behind the scenes," Molina said.
Molina also told lawmakers that her team is paid not on salaries but per visit. And with the lower reimbursement rates, she said, some of the therapists she works with are considering their options.
That means people with advanced degrees in speech and occupational therapy could soon be working in real estate or in nail salons or tending bar instead of doing the jobs for which they were trained.
"Full-time therapists doing very specialized care, very necessary care during the day and then on the weekends having to go and bartend in order to pay their bills. ... I don't understand. Just, make it make sense," Molina told lawmakers.
