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Moving toward a healthier Missouri: Re-instituting therapy services in Missouri Medicaid

Originally posted by the Clark-Fox Policy Institute, written by Mary Mellem, Gary Parker, and Atia Thurman

In October 2017, the Center for Health Economics & Policy at the Institute for Public Health and the Clark-Fox Policy Institute at the Brown School at Washington University hosted Transforming Healthcare in Missouri: Ideas for Innovation and Investment to generate ideas for improving healthcare in Missouri. One of the key recommendations offered to officials was to reinstitute coverage for therapy services for Missouri Medicaid beneficiaries to improve the health of Missourians and to help combat the opioid epidemic.

In 2005, Missouri drastically cut Medicaid expenditures, including access to physical and occupational therapy. Prior to the cuts, patients were routinely referred for physical or occupational therapy post-joint replacement surgery in order to keep the joint mobile. After 2005, Medicaid patients could no longer receive such therapy. As detailed at the October event by Paul Taylor, CEO of Ozark Community Hospital Health System, when patients do not receive physical therapy after joint replacement surgery, the joint inevitably becomes immobile, which leaves the patient in pain. Without the availability of physical therapy, the primary mechanism for treating this chronic pain has become narcotic medication, which frequently leads to narcotic dependence and is contributing to Missouri’s opioid crisis. Accordingly, Mr. Taylor suggested that reinstituting Medicaid reimbursement for physical and occupational therapy is a practical, effective way to mitigate narcotic dependence amongst patients with chronic pain.

Following the October event, discussions continued between Dr. Timothy McBride, Professor at the Brown School, and the Missouri Medicaid leadership regarding reinstituting coverage of therapy services for Medicaid patients. Then in January of this year Governor Greitens announced the 2019 budget, which included: “The Missouri Department of Social Services’ Medicaid Program is seeking federal approval to add alternative pain management options for individuals with a pain diagnosis. The alternative pain management options include physical therapy, occupational therapy, chiropractic services, massage, and acupuncture. It is estimated that offering alternative treatments will result in cost savings while improving health outcomes.”

Gary Parker, Director of the Clark-Fox Policy Institute, commended state leaders for helping advance better health outcomes for Missourians, particularly Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, who fully participated in the October convening. Parker further added, “Every effort to reduce the opioid epidemic is critical and helps protect families from the terrible impacts of this crisis.

For access to the full list of prioritized challenges and recommendations, click here.

For more information about Missouri’s commitment to combating the opioid crisis, visit this site: