Advocacy Defeats N.C. Medicaid Cuts Successful grassroots advocacy by speech-language pathologists in North Carolina—including e-mails to legislators, a rally at the State House, and television news appearances—have thwarted the state’s efforts to reduce an estimated $4.6 billion budget shortfall by eliminating speech-language treatment and occupational and physical therapy services from the Medicaid program. A June ... Grassroots 101
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Grassroots 101  |   October 01, 2009
Advocacy Defeats N.C. Medicaid Cuts
Author Notes
  • Carol Polovoy, production editor of The ASHA Leader, can be reached at cpolovoy@asha.org.
    Carol Polovoy, production editor of The ASHA Leader, can be reached at cpolovoy@asha.org.×
Article Information
Practice Management / Regulatory, Legislative & Advocacy / Grassroots 101
Grassroots 101   |   October 01, 2009
Advocacy Defeats N.C. Medicaid Cuts
The ASHA Leader, October 2009, Vol. 14, 1-7. doi:10.1044/leader.GR.14132009.1
The ASHA Leader, October 2009, Vol. 14, 1-7. doi:10.1044/leader.GR.14132009.1
Successful grassroots advocacy by speech-language pathologists in North Carolina—including e-mails to legislators, a rally at the State House, and television news appearances—have thwarted the state’s efforts to reduce an estimated $4.6 billion budget shortfall by eliminating speech-language treatment and occupational and physical therapy services from the Medicaid program.
A June budget proposal for the state’s 2010 fiscal year (which began July 1, 2009) eliminated Medicaid funding for the three services for children and adults. The proposal reduced funding by 80% (leaving only 20% in place to fund Medicaid’s Early Periodic Screening, Diagnosis, and Treatment services) and cut provider rates by more than 5%.
The proposal would have eliminated services to more than 25,000 children across the state, cut approximately $30 million from the state economy in payroll taxes (from 2,600 SLPs, assistants, and related support and management staff), and resulted in a $45 million loss in matching federal funds to purchase health care services.
Immediate Action
Anticipating budget cuts, the North Carolina Speech, Hearing and Language Association (NCSHLA) sprang into action in late May. Jeri Bates, chief operating officer of Speechcenter, Inc., and a member of the NCSHLA Professional Affairs Committee, recruited private-practice SLPs into a four-member “think tank” that included Joy English, Speechcenter owner; Cynthia Roberts-Flynt, owner of Venture Rehab Group; and Tracy Furr, president of Cheshire Center, Inc. “In the normal course of business, we are friendly competitors,” Bates said. “But this effort has shown us how quickly competitors can become colleagues united to protect the profession and our clients.”
The “think tank” worked tirelessly to strategize and delegate tasks. They gathered information and convened via conference calls, e-mail, and text messages throughout the day and night to determine the best course of action, with a focus that often changed every few days. “This effort was truly nonstop, around-the-clock for three straight weeks,” Bates said.
Reaching out to all SLPs was critical, because the proposed cuts would affect SLPs in every setting, not just those in private practice, Bates said. “Universities would be affected because we wouldn’t need to train clinicians if the services weren’t funded; public schools would experience an explosion in the need for school-based intervention; and early intervention SLPs would lose clients who rely on Medicaid funding.”
NCSHLA, led by Executive Director G. Peyton Maynard and the Professional Affairs Committee, posted legislative updates and action alerts on its Web site and sent e-blast messages encouraging members’ grassroots advocacy. The “think tank” took the lead to:
  • Organize practice owners to contact the state’s Health and Human Services Appropriations Subcommittee to educate committee members about their practices, the size of their staffs, potential job losses from the cuts, and the economic impact on North Carolina if the practices closed.

  • Ask all NCSHLA members to call and e-mail the subcommittee and their own representatives with one message: Don’t decimate the program.

  • Ask SLPs to have their patients contact their legislators about the loss of children’s services. One family contacted the media and was featured, along with the treating SLP, on a local television newscast (see sidebar).

  • Hire a public relations firm (paid by the three “think-tank” practices) to write and distribute a press release and place articles in local newspapers and television stations.

  • Urge SLPs to contact the eight members of the House Appropriations Committee when they received the budget proposal to relay a fiscal impact message: How much the clinicians contribute to the state’s economy and state payroll and sales taxes and the effect of eliminating 20,000 jobs (clinicians, assistants, and support staff)—increased unemployment, public assistance, and professionals leaving the state to find jobs.

  • Post updates and photos on Facebook and Twitter.

  • Ask members to share the updates with every SLP they knew, and to urge non-NCSHLA members to join. “The association is the voice of the professions in North Carolina, and is only as strong as its membership,” Bates said. According to Bates, SLPs made more than 100,000 calls and sent more than 150,000 e-mails to legislators, effectively crashing the e-mail and phone systems at the height of the advocacy efforts.

NCSHLA posted legislative updates on its Web site, urging its members to take action. The “think tank” continued to gather data, information, and case law; make resource contacts; clarify positions and intent of federal and state law; and coordinate ASHA grassroots advocacy messages.
In conjunction with Together NC, a coalition of programs affected by the proposed cuts, NCSHLA organized the attendance of SLPs at town hall meetings and a Pack the House Rally in Raleigh on June 15. SLPs, dressed all in black, represented more than half of the rally attendance.
Compromise
The House eventually restored full funding for Medicaid services; the Senate, however, had placed a cap on visits and cut provider rates by 3%. As the two chambers tried unsuccessfully to hammer out differences before the June 30 deadline, the legislature passed a continuing resolution (CR) that temporarily funded programs at 85% of 2009 levels. Several more CRs were needed as the legislature and governor continued to debate ways to balance the budget.
Final legislation was passed and signed by the governor on Aug. 7. The law:
  • Restores Medicaid funding for speech-language services at the FY 2008 level.

  • Reduces Medicaid provider rates by 3%.

  • Requires Medicaid providers to pay a $100 fee at enrollment and at re-enrollment every three years.

The legislative success is due in no small part to NCSHLA members, Bates said, for taking action and making a difference. “What SLPs do to share the gift of communication with their clients every day is humbling. Thank you for stepping beyond your clinical comfort zone to share that passion for what you do with our legislators—it made all the difference for Medicaid clients throughout North Carolina!”
SLP Helps Save Medicaid Services

Worried that pending cuts to the state’s Medicaid budget would put an end to speech-language treatment for their 6-year-old grandson, Annette and Steve Horsley invited local news station WFMY News 2 to tell their story. In the June 9 newscast, the Horsleys describe how Aaron, who has autism, is learning to communicate with the help of an SLP, ASHA member Michaela Greene of the Speechcenter in Winston-Salem. The proposed cuts would have eliminated Medicaid funding—and Aaron’s treatment.

SLP Helps Save Medicaid Services

Worried that pending cuts to the state’s Medicaid budget would put an end to speech-language treatment for their 6-year-old grandson, Annette and Steve Horsley invited local news station WFMY News 2 to tell their story. In the June 9 newscast, the Horsleys describe how Aaron, who has autism, is learning to communicate with the help of an SLP, ASHA member Michaela Greene of the Speechcenter in Winston-Salem. The proposed cuts would have eliminated Medicaid funding—and Aaron’s treatment.

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October 2009
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