Seanan Handwork can't sit up, feed himself with a spoon or speak like most 16-month-olds due to a genetic disorder called Noonan Syndrome he was born with.

Noonan Syndrome slows his development in many ways, and he doesn't yet have the strength to sit on his own or the coordination to use a spoon - but he's getting there, thanks to weekly sessions with Athens physical therapist Peggy Curren and other specialty therapists.

The Athens therapist and Seanan's mother, Jessica Handwork of Jefferson, fear massive changes in the state Medicaid program may mean cuts in her son's therapy schedule - and a reduced chance that he one day can live a more normal life despite his developmental barriers.

Curren knew the state Department of Community Health was changing to a new way of running the program as the state looks for a way to curb the mounting bill for Medicaid, which costs the state about $2.2 billion last year. Medicaid costs went up about 14 percent a year between 2000 and 2005, mainly because more people have enrolled as Georgia's population swells.

But Curren's first taste of what that might mean for therapists like her and children like Seanan came in July, when she first saw a letter from the community health department stating that unless she filed paperwork to get special permission, the state was going to cut back on the sessions she and other therapists can give to severely disabled infants and children she works with. If she didn't get that permission, Seanan's therapy sessions could be reduced to a third of what he gets now, with consequences that would slow him down the rest of his life, she said.

The state already has backed off on part of the limits, but therapists like Curren fear that at the least, the changes are going to add to an already large paperwork burden.

What Curren and Handwork are seeing is part of a massive overhaul of the state Medicaid system, and they are not the only ones who feel the transformation is off to a bumpy start.

Among other changes, the state has contracted with three "Care Management Organizations" to run much of the Medicaid program. The CMOs are similar to a kind of insurance company called a health maintenance organization.

Most of those affected are Medicaid's youngest recipients, like Seanan.

About a third of Georgia's 2.4 million children are enrolled in Medicaid programs, according to the Healthcare Georgia Foundation. Children make up more than half of the 1.4 million Medicaid enrollees in Georgia, though they account for only about 23 percent of costs.

Curren, who specializes in working with very young children, still isn't convinced the new regime will mean less therapy for Seanan, because he needs the therapy. But she's skeptical about whether the state or the CMOs always will approve the services her young clients need.

"They say it's not going to be a reduction of services. They can say that, but that's not the result," Curren said. "The result is going to be a reduction in services. And they're going to claim it's not their fault, but the therapists' fault."

The three CMOs took over some "service areas" from the state in June, including the Atlanta area. Other areas, including Athens and several surrounding counties, are scheduled to make the move in September.

If therapy for children with Noonan Syndrome and other disabilities is reduced, it's likely to have the opposite effect state policymakers want, say some children's health advocates.

Reducing children's therapy also will reduce their chances of becoming more independent as they get older, said Lauren Waits, policy director at Voices for Georgia's Children, which describes itself as an independent nonprofit public policy advocacy group.

In general, the younger the patient, the more progress they can make in therapy, Waits said.

"The state needs to look at therapy as an investment in the future of our children," she said.

Doctors also are running into problems with the new system, said pediatrician Martin Michaels of Dalton, president of the Georgia chapter of the American Academy of Pediatrics.

By managing care, the CMOs' goal is to save money by reducing emergency room visits and hospital stays without a negative impact on children's health - good goals, Michaels said.

But so far, few specialists such as pediatric orthopedists seem to be signing up with the CMOs, which could be at least partly because Georgia pays physicians less than most states for the same services. "It's a market scenario," he said.

Another problem is logistics, he said. Physicians and other providers are seeing long delays between the time they submit claims and when they get paid, and some claims aren't being paid at all, with no explanation, he said.

That's causing severe cash-flow problems for some pediatric practices, which depend more on Medicaid than most medical specialties since so many of Georgia's children are on Medicaid, Michaels explained. Some pediatricians are choosing to drop out of Medicaid rather than deal with the system, he said.

Three things need to change, Michaels said: one, the CMOs need to sign up more specialists such as children's orthopedists, dermatologists and neurologists; second, the companies' billing technology needs to quickly be improved; and third, the amount the state Medicaid program pays for medical procedures needs to be increased.

Michaels said he's optimistic the problems will be worked out, however.

Hospitals also are having trouble with payments under the new regime, but Georgia Hospital Association spokesman Kevin Bloye also was cautiously optimistic.

"At this point, the jury is still out as to whether it's going to be successful or not," Bloye said.

"Too many lives, hospitals and health care providers are at stake here," he said. "It's got to work."