TAMPA, Fla. — Thousands of children with autism and other disabilities in Florida are losing medically-prescribed therapy after an audit revealed that unqualified therapists were being paid through Medicaid.
On Dec. 31, Sunshine Health, the company contracted by Florida to run a children’s Medicaid program, will terminate its contract with MTM Health, the company it hired to recruit and manage a network of therapy providers across Florida.
The network included music and art therapists and centers where children can interact with horses and pets. Known collectively as expressive therapies, numerous studies have shown they benefit children with autism, cerebral palsy, Down syndrome and other developmental and emotional issues.
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Sunshine officials said they ended the company’s contract with MTM after learning that some therapists it was paying did not meet Medicaid standards, including holding a Medicaid ID, passing Level 2 background checks and possessing proper field certifications.
The upheaval has thrown Florida’s Medicaid therapy network into chaos, leaving most children without therapy sessions until next year as providers are no longer being paid. MTM also owes tens of thousands of dollars to some practices, multiple providers told the Tampa Bay Times.
The loss of revenue has forced some therapy practices to furlough employees.
“Some therapists have lost their entire workload,” said Elise Scullin, program director at Music Therapy St. Pete, which serves about 100 children on Medicaid. “There is a lot of uncertainty about the future if there is no solution with Sunshine.”
Some practices are still providing therapy pro bono and are encouraging parents to seek alternative funding sources such as state education scholarships.
Florida Music Therapy, which has studios in Melbourne and Fort Myers, served almost 300 children on Medicaid and is owed about $160,000 said CEO Courtney Arndt.
Its 21 employees have taken a pay cut and the practice is using money it saved for a down payment on a new studio to pay salaries and continue therapy sessions for free.
“We are running on fumes and kind messages from parents and a GoFundMe,” Arndt said. “We’re seeing how far can that down payment can stretch.”
Sunshine Health officials said they plan to contract directly with providers and are helping them register as Medicaid providers and to meet other standards.
“If a member’s current provider doesn’t meet Medicaid requirements, our Care Management team is here to support members and their families transition smoothly to a new therapy provider,” the company said in a statement provided to the Times.
But the new contracts will not start until Jan. 1, meaning some children will have missed almost three months of therapy.
Lakeland mom Kristie Owens’ three sons ages 11, 13 and 16 have autism spectrum disorder and were prescribed music therapy sessions for the past two years.
The oldest has severe communication anxiety but has improved through singing exercises with his therapist. Her second son wouldn’t sit still when being read to and was nonverbal. His therapist began singing the words in books to him and he now tells his nurses about his favorite animals.
But their in-home therapy sessions halted about three weeks ago after MTM stopped approving payments. For children with autism who thrive on routine, it’s been a worrying time, Owens said.
“She is a safe person; when one of your safe people stops showing up, it’s a problem,” Owens said. “My one son who is nonverbal keeps asking for his music.”
Music therapists are typically board certified, which involves earning a degree in music therapy from an accredited higher education program and completing a 1,400-hour internship under a qualified therapist.
But music therapists who spoke to the Times said MTM had recruited and submitted Medicaid claims on behalf of practices that hired people with degrees in music as therapists.
State law makes it a felony to practice health without a license, but “music therapist” is not a licensed profession in Florida. It is, though, in 14 other states including California, Georgia, Illinois, North Carolina, North Dakota, Ohio, and Washington.
Other health related professions, including physical and occupational therapist, acupuncturist and midwife, are licensed and regulated by the Florida Department of Health. A 2017 bill to license music therapists failed.
Based in Missouri, MTM Health was contracted by Sunshine Health in 2021. The company took eight days to respond to questions from the Times but declined to answer why it contracted with uncertified therapists.
“MTM is committed to complying with all State and Federal requirements, which includes providers having a Medicaid ID,” said spokesperson Michele Lucas in an email. “MTM is working diligently to ensure that Expressive Therapy providers are paid for services that have been provided.”
The Florida Agency for Health Care Administration is in charge of the state’s Medicaid programs, including Children’s Medical Services, the one run by Sunshine Health.
Officials there declined to answer questions about how many children with disabilities have been affected by the termination of MTM’s contract and whether the agency was aware that uncertified therapists were paid through Medicaid.
Spokesperson Mallory McManus said that expressive therapy is still available for children insured through Sunshine Health but declined to elaborate. It is the responsibility of plan providers like Sunshine Health to ensure that in-network therapy providers are enrolled in Florida Medicaid to be reimbursed for services, she said.
“The Agency is working closely with Sunshine Health Plan to ensure there are no gaps in care and to ensure remediation of any disputes with providers of this service,” McManus said in an email.
Allowing unqualified people to conduct music therapy sessions could be damaging to children, said Jillian Mehler, a Central Florida music therapist.
Therapists conduct a detailed assessment of children’s needs and develop a treatment plan. The therapy is fine-tuned to work on motor skills, communication and other abilities.
Children with autism may have acute sensitivity to noise, she said.
“I am trained to see the cues that a child may exhibit to show distress if music is too loud,” she said. “When you have someone that doesn’t have that training, sure music is fun, but it’s not therapeutic.”
Her practice had to stop therapy sessions for almost 40 children on Medicaid. It provided free “closure” sessions to help children adjust.
Providers of other types of therapy have also stopped receiving payments from MTM.
Tammy Sliger, the owner and director of Kiddy Up Ranch, an equine therapy center in Hudson, said MTM has not paid for sessions dating back to Aug. 30, and she is owed at least $30,000.
The center was serving 60 children through Medicaid.
“Kids do this every single (week) for years — now you’re just going to rip it out from them?” she said. “Kids are distraught.”
Equine therapy is more than just riding a horse. Children are expected to learn how to groom and tack, the term for fitting a saddle and bridle. The sessions are tailored to develop cognitive skills such as memory in addition to helping with motor skills and developing core balance.
The revenue from sessions helps pay for horse feed and veterinary costs, a complication that music therapists don’t face.
“We sit there with a living breathing animal,” Sliger said. “Now you’re messing with our livestock.”
Katie DeNapoli’s daughters, Serenity, 8, and Savannah, 5, are prescribed equine therapy for their autism spectrum disorder.
Serenity, who was nonverbal until she was 5, has improved her communication skills since being around her horse. It took Savannah four months before she was comfortable sitting on a horse. The skills she gained have made her more confident, her mother said.
The presence and interaction with these powerful but gentle animals awakens something in children with autism who struggle to recognize human communication cues, DeNapoli said.
“It’s one of the most beautiful programs because something happens — I don’t know how to explain it,” she said. “You see miracles on the farm everyday.”
DeNapoli didn’t think her daughters would understand the disruption so she told them that the horses needed a rest. The girls have asked over and over again why they can’t be with the horses.
“My children are very routine orientated; they get confused,” she said. “It messes up their emotional regulation; it’s been a constant spiral.”
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