The Unkindest Cut
The fight to keep thousands of Medicaid-dependent kids from losing treatment.
When Dena Dupuie enters her kitchen, eight-year-old Brianna is oblivious. She’s sitting in a swivel chair wearing puffy headphones, her nose hovering six inches from a computer monitor, as intent as a house cat ready to pounce on a bird perched on the opposite side of a window.
“Brianna,” Dena says, her voice warm but firm. Brianna is her only child, but Dena does not seem apt to spoil. After a moment, she says, “Ex-cuse me, ma’am!”
Brianna’s face snaps up. She wears glasses and a dignified expression slightly undermined by half-moons of mucus under each nostril. Brianna is getting a cold, but that’s not why she’s at home this morning. Dena homeschools her daughter three days a week because of her severe ADHD. Right now Brianna is supposed to be studying Latin, not gazing at Nickelodeon’s home page.
Finally registering the presence of her mother and a journalist, Brianna closes her browser window with her left hand. Brianna used to be right-handed, but when she was twelve months old a babysitter shook her so violently that she suffered a traumatic brain injury. The panicked sitter then drove in circles for 45 minutes as fluid built up on the infant’s brain, causing a stroke. When Dena and her husband, Scott, became Brianna’s foster parents, two months later, she could no longer walk or talk or even crawl, and she suffered frequent seizures. Despite regular therapy sessions, Brianna wasn’t much better when the Dupuies adopted her a year later. “My friends will tell you they thought we had lost our minds,” Dena says.
No one questions Dena’s sanity now—or her resolve. Dena, on behalf of her daughter, is among the plaintiffs suing the state Health and Human Services Commission to stop cuts to the rates Texas pays therapists for treating kids like Brianna. Plaintiffs said the cuts, which would save Texas $150 million on Medicaid payments while forfeiting $200 million in federal funds, would cause at least 60,000 Medicaid-dependent kids to lose treatment, in violation of state and federal law. Soon after hearing about the cuts, she and Brianna walked the Capitol, trying to talk to lawmakers. They were horrified by the indifference they found. “Brianna got an education that day,” Dena said.
On September 25, the plaintiffs scored a victory when state district judge Tim Sulak granted a temporary injunction on the new rates and set a full hearing for January. Though Sulak didn’t specifically say so, it seems likely that Dena’s testimony influenced his decision. Right after Pam McDonald, the director of rate analysis at HHSC, testified that the agency had determined that, contrary to previous reports, there were “no wait lists” for pediatric therapy, Dena took the stand. Just weeks before, she explained, she had called the HHSC ombudsman for help finding a new therapist, as hers was shutting down because of the budget cuts. The ombudsman called back saying that she had contacted dozens of providers but all of them were turning away Medicaid patients or going out of business, or—and here Dena looked at McDonald and raised her voice—“had wait lists.” McDonald did not meet her gaze.
The issue is hardly an abstract one for the Dupuies. Last year, a paperwork snag kept Brianna from getting therapy for two months. Brianna’s right foot quickly began to drag and her stutter returned. “She was so frustrated. It got to the point that nobody could understand her—even me,” Dena says tearfully.
That was last year. Now Brianna scampers into the living room, kicks off her pink cowboy boots, and starts fiddling with her Latin flash cards. Dena watches her from the kitchen for a moment, then turns back, her tears gone. Squaring her shoulders, she flips open a legal pad covered in notes, names, and lawmakers’ phone numbers. The courts won’t hear from Dena again until January. But in the meantime, a whole lot of other people will.