A rural Texas mom relies on Medicaid to help her toddler. What happens if the program is cut?

Shiloh Creswell’s 2-year-old daughter, Astrid, has trouble walking, but has been making steady progress through therapy that they receive in their home through early intervention.

Medicaid helps the family pay for these services in Big Spring, Texas. Early childhood advocates say the services could face cuts if Republicans move forward with a plan to extend President Trump’s tax cuts.

Creswell worries about the choices she would face if that were to happen.

“We would be looking at either me having to try and play a therapist and try to keep the muscle tone up, not having any kind of education in this, and just kind of using Google to keep up what progress we have had,” Creswell said. “Or it would be waiting for up to a year on some of the wait lists, nine months on some other ones.”

Creswell said her oldest daughter, Sophia, also used early intervention starting at 3 months old until she aged out for a range of therapies addressing dietary needs, speech and other delays.

Johanna Lister, a policy expert with the national early childhood nonprofit organization ZERO TO THREE, said when children like Astrid and Sophia start these kinds of therapies early in life, it increases their chance of success.

“The science is very clear and it also reduces stressors for the family as well,” Lister said.

Although Medicaid is best known for providing health insurance to low-income people – about one in five Americans rely on it – the program also plays a critical role helping families of all income levels who have children with disabilities.

What is early intervention? Why is it important?

Johanna Lister: “Early intervention provides critical services for very young children who are not yet in school. They're often identified as challenges through their pediatrician or through childcare, but it's really an opportunity to provide foundational services to address either developmental delays or physical delays to help that child succeed when they're able to get to school. [It’s] really more on the promotion and prevention end of the spectrum for public health.”

What help has your family received through early intervention?

Shiloh Creswell: “So Sophia is now 7. She started early intervention almost at birth. She had head surgery at 6 months because her head was deformed a little bit, and so we started with physical therapy and occupational therapy… finding out later that she had autism, which we immediately started trying to help make sure that she had all the resources she needed to kind of overcome what most autistic children face, which is just those delays. So she is now in first grade, thriving thanks to early intervention. And then we had number two come along, Ms. Astrid, who was having difficulty with walking and the muscle structure was just a little weaker. So we called early intervention and [were] like ‘Hey, we're kind of having some problems. Our pediatrician wanted us to get looked at by a therapist and we were looking at the wait time for therapists and we were almost a year out and can we get in with y'all?’ And so they came and evaluated a week later and we started therapy that week. We're continuing therapy for another year, and hopefully we graduate out of it and no longer need it.”

What would be the financial impact for you if Medicaid wasn't picking up these bills? 

Creswell: “So we are on a sliding scale to kind of help impact where we're not having to pay hundreds of thousands of dollars a year per each therapist. So right now, from where we're at in rural Texas, we would have to drive an hour to two hours away depending on where we could get seen the soonest. So not only are we having to take time off of work, we're having to drive, and gas, and meals and things of those nature, that we don't have to, thanks to early intervention coming to our house, which is thankfully covered by Medicaid.”

Are these services available through private insurance, and if so, why does the government have to pay for them?  

Lister: “Though these services may be available through private providers, as Shiloh said, those wait lists can be months, if not years long. And because early intervention is actually part of a federal law, these young children, their families are entitled to these benefits. And Medicaid plays a very big role in supporting early intervention in almost all states.”

House Republicans say they do not want to cut Medicaid as they work on plans to extend President Trump's tax cuts. But NPR has reported that the Republicans’ budget likely would require cuts to Medicaid or Medicare. What would be the impact?  

Lister: “So if we're talking about any adjustment to the funding that the federal government contributes to Medicaid, it just means states then have to make really hard decisions around eligibility and benefits. And they will be the ones who are essentially taking services away from everyone, but particularly children and families who rely heavily on Medicaid for these services. So I think it's hard to really understand the ways in which Medicaid is a real backbone of the social safety net and what it would actually, the impact would it be when it, if it actually was drastically changed.”

Find more information on Medicaid Early Intervention here. 

This interview has been edited for clarity. 

Ashley Locke produced and edited this interview for broadcast with Michael Scotto. Locke also adapted it for the web.