At What Cost? 

Congressional inaction causes fiscal crisis at Children's Home Society

It happened by accident. An employee of the Children's Home Society of Idaho routinely accessed the State of Idaho's Medicaid website to verify billing codes -- but she was stunned by what she discovered on Dec. 20.

"She said, 'Oh my gosh, look at this. This reimbursement rate is significantly different,'" said Teresa Alexander, Children's Home chief executive officer.

"That was our first indication. We had no prior notification."

The change, effective at the stroke of midnight on Jan. 1, unleashed a new formula that dramatically reduces Medicaid reimbursement, instantly plunging scores of Medicaid providers into a deep pool of red ink.

Simply put, the Medicaid battle has been lost in the ongoing political wars being waged in the chambers of the U.S. Congress, at odds over the so-called "fiscal cliff." Buried deep in Congress' reams of legislation is something called the Sustainable Growth Rate, which unless legislators override it, triggers drastic Medicaid payment reductions for 2013.

"Let me show you how this pencils out," said Alexander as she walked to a flip chart filled with numbers. "Let's use Code 90806 as an example: 90806 represents a code for psychotherapy services for a client or family member."

In 2012, the Warm Springs Counseling Center would bill $100 for a therapy session with a child, but that amount would be reduced to $60 by Medicaid. After paying the counselor an average amount of $38 for the session, the center would net $22 for operating expenses.

But the 2013 formula would see Medicaid pay only $30 for the same session, meaning that once the center pays the counselor $38, the Children's Home is instantly in red ink, to the tune of $8 per session.

"This is what we don't want to happen: children falling through the cracks, failing in school, diminished self-esteem, children in detention or incarceration. And we certainly don't want random acts of violence like ..." Alexander took a long pause.

She needn't finish the sentence. Alexander and her colleagues know all too well the trauma that the nation's children have endured in the previous weeks in the shadow of a gunman killing 20 elementary school students in Newtown, Conn.

And if anyone thinks that Idaho is immune to such tragedy, Alexander reminded Idaho's congressional delegation in a letter, pleading for action:

"Robert Manwill, the 7-year-old girl who was so badly bullied at school that she was on the verge of committing suicide, the 5-year-old boy who was so severely neglected that he resorted to violent tendencies," wrote Alexander. "These are the faces of the hundreds of low-income children and families served by Children's Home Society of Idaho."

Alexander took another long breath.

"That's why we're here," she said softly. "But we don't have the people on staff to do our political battles for us."

She's hoping that enough Idaho constituents agree that they'll push Republican Reps. Raul Labrador and Mike Simpson and Sens. Mike Crapo and Jim Risch to act sooner than later. Or at least, before it's too late.

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