Physical, speech and behavioral therapy for young children with developmental delays could get cut back starting as early as Monday due to a $4 million budget hole in Colorado’s Early Intervention program.
The changes would impact potentially thousands of children, especially those from low-income families who are on Medicaid.
The sudden news delivered in a letter Tuesday sent shockwaves through the community of therapists who provide services to some of the state’s most vulnerable children. Many expressed anger, sadness and frustration. Colorado’s Department of Early Childhood hasn’t officially informed families of the changes, but the news had already trickled out to many families.
The Early Intervention program, which provides early evaluation and therapeutic support, serves more than 11,000 children up to 3 years old. The $87 million program is funded through federal and state dollars and private health insurance, with 70 percent of funding from the state.
The letter stated that “emergency response measures” are necessary to balance the program’s budget because of increased referrals, federal COVID stimulus dollars running out and a decrease in the number of the program’s children who are enrolled in Medicaid.
The department said it is working with local communities to ensure continuity of services, including expanding telehealth options and connecting families with Medicaid-enrolled providers.
“CDEC is working closely with the early intervention agencies to continue to explore all options to minimize the impact of these measures,” the department said in a statement. “We remain committed to exploring innovative solutions and strengthening partnerships to support children’s development.”
It said the department evaluated areas “where the program is more generous than required in state or federal law.” It said the cost containment measures would run through fiscal year 2025-26.
“Our priority is to continue delivering high-quality services while managing the budget to sustain the program long-term.
Therapy will be cut back to four hours a month. Families with children with high needs, for example Down Syndrome, might work with a speech pathologist, physical therapist and occupational therapist each one hour a week. Now they’d have to choose one therapy over the other or see each more sporadically. Under the changes, newly eligible children would also have to wait longer before starting therapy.
Cuts will hurt poor families the most
Providers are especially angry about a change that prevents children who are on Medicaid from receiving certain therapies.
Medicaid covers occupational therapy, speech language pathology and physical therapy. It doesn’t cover developmental intervention, social and emotional services including mental health and behavioral support, ASL interpretation and instruction, audiology support, support for the visually impaired or registered dieticians. Up until now, families have gotten those critical services through state or other funding sources.
Early Intervention officials said those families must be provided a service that is eligible for payment through Medicaid.
“By separating out families enrolled in Medicaid, (the state) has proposed covering this shortfall at the cost of disproportionately Black and Brown families, separated out by lower income and higher medical needs,” said Anna Norlin, a licensed early childhood special educator. “This is discrimination. It is unethical.”
Families are also eligible for Medicaid coverage due to significant medical costs associated with prematurity, a diagnosed disability.
Norlin would like to see alternatives presented to impact families more equitably.
“The families who will no longer be able to access these services not covered by Medicaid are more likely to need them and no less entitled to them than privately insured families.”
The majority of the caseloads of “developmental interventionists,” who work with children with developmental delays in a variety of areas, are Medicaid families. They, along with other therapists and nutritionists who offer many other supports to children who can’t bill services to Medicaid, can no longer work with those families.
Kimberli Kolden, a pediatric speech pathologist, said families would have to go back onto a waitlist for another therapist to pick them up under another category of service provider, like physical therapy, occupational therapy or speech therapy.
“There's already a shortage of providers within the state,” she said. “A lot of these kids are on waiting lists already and they're likely going to be placed back on these waiting lists and go even longer without being provided these early intervention services, which can mean difficulty learning once they reach preschool age and beyond.”
Research shows early intervention is key for better long-term outcomes --- and less need for intervention down the road. Kolden said “medically fragile” children who get support on a weekly basis from multiple providers will take a longer time to meet their goals, “which could ultimately put more strain on the state and special education services in the long term.”
Providers are also concerned about the legal implications of the changes because the Individuals with Disabilities Education Act mandates that children with developmental delays or disabilities receive appropriate services in a timely manner.
Providers said they would like to see accountability for the abrupt changes that will impact so many families. They have questions about how the $4 million shortfall was unforeseen and uncommunicated leaving no time for feedback or collaborative problem solving.
Norlin said the state should first solicit feedback from families and providers.
“Their lives, the lives of their children and the livelihoods of professionals will change dramatically, we are 8 months into this fiscal year and they couldn't even devote a whole week to planning and communicating? Why?”
The combination of state and federal actions has speech pathologist Kolden worried for the future for families with disabilities.
“I'm afraid it's going to get worse before it gets better because of what's happening in Washington D.C. and with the cuts to Medicaid and what's going to happen long term with the Department of Education,” she said, referring to U.S. President Donald Trump’s call to shut down the department that oversees the Individuals with Disabilities Act.
Early Intervention officials have planned information sessions for families on Monday and Tuesday.
