_{Editor's note: This story has been updated throughout.}

Approximately 230 children in the Brazos Valley area are slated to lose a provider offering speech, physical and occupational therapy at the end of August. The state's Early Childhood Intervention program has already lost a dozen providers in recent years as state lawmakers have cut program funds. 

Easter Seals East Texas officials have put the Texas Health and Human Services Commission on notice they are ending services through the state’s Early Childhood Intervention program for children in Brazos, Burleson, Grimes, Leon, Madison, Robertson, Walker and Washington counties. The organization will remain a provider until Aug. 31.

Steve Helm, chief financial officer for Easter Seals East Texas, wrote in an April 4 letter to the commission obtained by the Tribune that the organization had been proud to serve as a provider for three years but had decided to end services for financial reasons.

Asked to comment for this article, the Health and Human Services Commission confirmed Wednesday that Easter Seals East Texas is ending its participation in the program.

"We're aware of the decision not to renew and will stay in touch with our contractors to continue to assess the situation," said Carrie Williams, a commission spokeswoman. 

The news further fuels parents' fears that more providers could leave or limit services, leaving Texas children without therapy that eligible children are, under federal law, entitled to receive. A $350 million cut to Medicaid children's therapy services in Texas went into effect in December.

Advocates say those cuts are exacerbating historical underfunding of the state’s Early Childhood Intervention program, which serves 50,000 children under 3 years old with developmental issues including autism, speech delays and Down syndrome. Getting squeezed by both of these funding issues caused providers in El Paso, Tyler and Wichita Falls to back out of the program in 2016. Since 2010, the state has gone from 58 providers in the program to 46. 

Texans Care for Children, an advocacy group, said in a Wednesday news release that its recent survey found 54 percent of the program providers have “seriously discussed the possibility of not renewing its [Early Childhood Intervention] contract.”

The news also comes as Texas House and Senate members prepare to spar over their budgets in the coming weeks. Both chambers passed budgets that did not fulfill the Texas Health and Human Services Commission’s request for an additional $19 million to cover enrollment growth for the Early Childhood Intervention program. The Senate's proposed budget does not include efforts to restore the Medicaid cuts or provide increased funding for the program. But advocates are putting their faith in the House. House Speaker Joe Straus has expressed his support for restoring the Medicaid cuts.

Advocates are also watching how two House budget amendments passed last week — both by Rep. Sergio Muñoz Jr., D-Palmview — will fare in upcoming budget talks. One amendment would reverse the Medicaid cuts, while the other would give the health commission its $19 million request.

Stephanie Rubin, CEO of Texans Care for Children, said in a news release that the Easter Seals announcement was "a wake-up call for state legislators."

“If they shortchange these services in the new state budget, children all across the state may miss out on therapies that help them learn to walk, communicate with their families, get ready for school, and meet other goals,” Rubin said.

In the 2010 through 2015 budget years, Texas reduced spending on the Early Childhood Intervention program by 11 percent, according to a Texans Care for Children report from November. The U.S. Department of Education told Texas officials in December that they could lose a dozen providers due to financial strains.  

Tod Marvin, president and CEO of Easter Seals Central Texas, said legislators didn't consider how rural area providers have more travel costs associated with their programs to see children at homes scattered across the region. He also said Senate Finance Committee chairwoman Jane Nelson, R-Flower Mound, and other lawmakers were more concerned about making budget cuts than how kids with disabilities would be affected. 

"Jane Nelson, in hearing after hearing, has personally guaranteed no families will be denied services," Marvin said. "Should we tell families that are not receiving services they need to call Jane Nelson and ask her how she plans to follow through on her personal guarantee?" 

Nelson said in an email Wednesday that legislators "are going to make sure statewide access is preserved" for children needing therapy services. She pointed out that the Senate budget proposal increases the Early Childhood Intervention program funding by $5 million.

In 2015, lawmakers "brought Texas Medicaid therapy rates to levels on par with other states and private insurance, and it expressly directed the agency to proceed in a manner that preserves access throughout the state," Nelson said.

Read more of the Tribune's coverage:

• Tearful and frightened Texas parents pleaded with Senate Finance Committee members on Tuesday to stop any further cuts for state-funded speech, physical and occupational therapy for children.
• As Texas seeks to implement a $350 million cut to the Medicaid budget for children’s therapy services, Texas health officials are scrambling to maintain a robust network of providers.
• In a wide-ranging interview with The Texas Tribune's Evan Smith, House Speaker Joe Straus shed light on his priorities for state lawmakers.
• Cuts in the state's payments to therapy providers who see children with disabilities remain tied up in court, but Texas officials said last week that they have made about $58 million in cuts from other parts of the health care budget.

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