To participate successfully in early intervention (EI) programs, speech-language pathologists and audiologists must understand the scope of these programs and their funding mechanisms. The more you know about EI programs, the better prepared you will be to navigate the system.
IDEA Part C
The Early Intervention Program for Infants and Toddlers with Disabilities is also known as Part C of the Individuals with Disabilities Education Act (IDEA). Part C provides grants to states to assist and maintain a statewide system of coordinated, comprehensive, and interagency programs of early intervention services for children from birth through age 2. Through evaluation and assessment, services are identified to address the physical, cognitive, communication, social-emotional, and adaptive developmental needs of infants and toddlers with disabilities. Services include assistive technology, audiology, speech-language pathology, occupational and physical therapy, vision and nutrition services, and other services. The purpose of these services is to enhance the development of infants and toddlers with disabilities and to minimize the potential for developmental delay. The services are provided through a coordinated network of providers, driven by the needs of the family and documented through an Individualized Family Service Plan (IFSP).
Not all services available through early intervention are free to families. Depending on whether a state has adopted a system of payment policy, which must be on file with and approved by the secretary of education, families who do not meet the state's definition of inability to pay may be required to pay for some services.
Lead agencies within each state (typically the department of health or department of education) are responsible for coordinating and providing early intervention services and for developing formal interagency agreements that define responsibilities for services. Each state has a state interagency coordinating council (SICC) that advises and assists the lead agency in the performance of responsibilities, particularly the identification of sources of fiscal support for services, assignment of financial responsibility to the appropriate agency, and promotion of interagency agreements. Funds also may be used to provide direct services that otherwise are not available from other public or private sources.
Early intervention programs are run under the auspices of each state, but the agency in charge varies. The National Early Childhood Technical Assistance Center (NECTAC) offers a list of state Part C coordinators on the NECTAC Web site.
Each state develops its own definition of eligibility. In Virginia, for example, children from birth to age 3 are eligible for EI services if they have a 25% or greater delay in cognitive, physical, communication, social, or emotional development; if they show atypical behavioral disorders; or if they have a diagnosed physical or mental condition that may result in a developmental delay. Additionally, funding for Virginia's Part C system comes from federal Part C funds, State General Funds for Part C Early Intervention, local revenue, Medicaid, private insurance, family fees, and private/other funding.
Medicaid funding for EI services is available through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. This program requires states to cover a comprehensive set of benefits and services for all individuals enrolled in Medicaid who are under the age of 21. Under these mandated benefits and services, speech-language pathology and audiology services include:
- Identification of children with speech or language impairments
- Diagnosis and appraisal of specific speech or language impairments
- Referral for medical or other professional attention necessary for rehabilitation of speech or language impairment
- Provision of speech and language services
- Counseling and guidance of parents, children, and teachers
Covered services also can include hearing aids and augmentative and alternative communication devices. To be covered under the EPSDT program, any service or benefit must be medically necessary.
The EPSDT program may be known in each particular state by the name of its children's Medicaid health care program. In Ohio, for example, the EPSDT program is known as "HealthCheck," and in Louisiana as "KIDMED." Medicaid is funded by both the federal and state governments, with the federal government matching the state's costs, generally ranging from 50% to 80%. Each state administers its own program and establishes eligibility requirements.
IDEA and EPSDT funds are both available for EI services, although for different purposes. ESPDT serves low-income children; IDEA serves children regardless of income. Services provided under an IDEA-driven IFSP can be covered by Medicaid if the child qualifies. The IDEA statute at 20 U.S.C.1440 states that IDEA is to be the payer of last resort. (Medicaid also notes that IDEA is to be payer of last resort for EI services.)
Depending on the state, SLPs and audiologists may have the opportunity to access both IDEA and EPSDT funds for EI services. IDEA funding is likely to be affected by the federal stimulus bill (see story).