Aesop coined the phrase “United we stand, divided we fall.” But what do we do when we cannot find partners to stand with?
Nationally, a shortage of speech-language pathologists often prevents children from receiving services they desperately need.
The State of Telepractice
Spurred by ASHA’s 2005 recognition of telepractice, thousands of SLPs have participated in telepractice so far. Telepractice is thriving; more than 10,000 SLPs have applied to PresenceLearning alone and many more are interested in telepractice considering the many other providers like Visual Speech Therapy and Vocovision.
The fast adoption of telepractice was driven by the well known shortage of SLPs, offering clinicians new work/life and professional choices. However, as accumulated research–40 peer reviewed studies at last count–has shown that telepractice is just as, if not more, effective than traditional, onsite therapy, the uses of telepractice have broadened.
Telepractice is now used to bring children together for social pragmatic groups, connect kids with bilingual therapists, strategically alter the frequency and intensity of therapy, improve SLPs’ schedules, bring in specialists, and re-engage students in middle and high school.
The Problem With Medicaid
One obstacle remains in many states that prevents SLPs from working via telepractice: Medicaid reimbursement. This is a critical issue, as schools can receive reimbursement for up to 50 percent of costs from Medicaid and are often unable or unwilling to adopt telepractice services without this reimbursement. ASHA, to its credit, has been a leader in advocating for school-based Medicaid reimbursement.
State policies preventing Medicaid reimbursement are oversights rather than outright bans. Policy has simply not kept pace with advancements in our field. In fact, most state policies don’t even comment on telepractice.
Many states, including California, Colorado, Virginia, Minnesota, Ohio, have updated their regulations, creating a precedent for other states to follow. These states handle Current Procedural Terminology (CPT) coding in the same way as before, but with a modifier indicating tele-delivery.
In the remaining states, the impact is large and negative:
- SLPs wanting to work via telepractice, many of them retirees or recent parents seeking flexible work, effectively cannot do so within their state.
- Hundreds of thousands of students not receiving services because of the SLP shortage will continue without the care of a SLP and fall further behind in critical areas like reading, writing and communicating.
- Schools struggling to fill their share of the 5,000+ unfilled SLP openings will remain at significant legal risk from non-compliance.
Unfortunately, underserved districts and their students in rural areas and the urban core will continue to be hit the hardest until this blind spot in Medicaid policy is remedied.
What Must Happen
Medicaid reimbursement inequality must be resolved in all 50 states. There are important issues of equity for rural and urban core students, as well as the viability of access to telepractice for SLPs and students alike.
How can you help?
The only way to help is, in the words of Aesop and others, stand together for this cause. Here’s how we can stand together:
- Review your state’s current policies for Medicaid reimbursement regarding telepractice.
- Contact your state administrator of Medicaid for education to express your concern on this issue.
- Cite specific examples of how tele-therapy reimbursement would benefit students in your district and similar districts in your state.
With a cohesive message and ample support from fellow educators, gaining Medicaid reimbursement for tele-therapy for school-based speech-language therapy services can be a reality sooner than you think.
Melissa Jakubowitz, MA, CCC-SLP, is the vice president of speech-language pathology clinical services at PresenceLearning. She is a Board Recognized Specialist in Child Language with more than 20 years of clinical and managerial experience. She is the past president of the California Speech-Language-Hearing Association and is active in ASHA, serving as a Legislative Counselor for 12 years.