Advocates for early childhood services are calling for an overhaul of how New York state funds early intervention ahead of Governor Kathy Hochul’s State of the State address next week.
Early intervention programs include speech therapy, physical therapy and other support services for children from birth to three years old, but some providers and grassroots groups say the current system for that programming is broken.
Counties administer the early intervention programs and pay providers using rates set by the state. Brigit Hurley, chief program officer at The Children’s Agenda, said right now providers are being severely underpaid and that is contributing to a shortage — and by extension, wait times are so long that some children age out of the program before ever receiving care.
“The brain develops 85% of its capacity within the first three years of life,” Hurley said. “So this is the time kids' brains are developing really rapidly. They can make a lot of progress to catch up developmentally. If they are delayed, it's a lost opportunity.”
The 2024-25 budget passed by legislators and signed by Hochul provided for a 5% increase in reimbursement rates that was supposed to go into effect on Apr. 1, Hurley said. But, she added, the governor and the Division of the Budget are holding off on enacting it until savings can be found in the Early Intervention program.
That would mean cutbacks on other services within Early Intervention, Hurley said, so that the rate increase can go into effect.
“It's ridiculous that we're needing to find cuts in the program to provide a rate increase to providers who are sometimes paid less than they were in the mid '90s when the program started,” she said.
Providers are frustrated that the increase in reimbursement rates hasn't materialized.
“I'd love to see an 11% increase or more or and to see the whole system analyzed," said Beth McLellan, director of educational and clinical services at Rochester Speech and Hearing. "Put something in the budget to look at the system, look at different states, and see how they're doing it, and make it work so that it works for everyone — the families, the staff, the agencies — so that we can, you know, be paid adequately. ...They're just making it more and more difficult in Albany.”
McLellan said she’s seen the difference early intervention services can make and remembers a two-year old in the organization’s care who at the time had what appeared to have undiagnosed cerebral palsy.
“He was basically in a little ball on the floor, could not walk, could not really move, had a very engaging smile, though,” McLellan said. “Watching him grow and change and eventually walk down the hall, that was something I'll never forget.”
But she’s also seen cases where a child missed out on that support, including a family that had resettled from another country.
“They moved from another country to come here, where they thought they would get the services that their child needed, and they ended up on the capacity list,” she said.
As providers face challenges like inadequate pay, many families are left out of receiving services, said Kim Dooher, vice president of Parents Helping Parents Coalition of Monroe County.
Dooher said if the state takes a close look, it will likely show how unsustainable the current system is.
“It's just a fragile system already,” Dooher said. “The fact that providers are still waiting for a rate increase that they were promised in April is a huge strain.”
Dooher said the current shortcomings of New York state’s Early Intervention program are setting up the educational system, as a whole, for failure.
“A lot of these kids are entering kindergarten having received nothing at all, and the schools don't even really know they're coming,” she said. “It's going to happen more and more often as years pass, that the larger this provider shortage grows, the lack of funding continues, the program is going to basically breed children that are very high-need entering the school-age system.”
In late November, Governor Kathy Hochul vetoed legislation that would have directed the state health commissioner to review the Early Intervention program, including reimbursement rates. Hochul cited cost as the reason for her veto.
Hochul is scheduled to make her State of the State Address in Albany on Jan 14.
