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Addressing the Needs of Young Children in Child Welfare: Part C -- Early Intervention Services
Bulletin for Professionals

Author(s):  Child Welfare Information Gateway

Year Published:  2007

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You are in section: Table of Contents 1. Child Welfare and Early Intervention 2. Promising Strategies 3. Funding Strategies Resources References

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3. Funding Strategies

Early Intervention funds typically cover the costs of administration, evaluation, and service coordination. However, lead agencies in each State determine how services for eligible children will be funded. Because many children involved in substantiated child abuse and neglect cases have historically not been identified for referral to the EIP, State EIPs may have concerns about increased caseloads and gaps in funding as a result of the new requirements.

In many States, child welfare and EIP collaborations have identified and creatively harnessed multiple funding streams to implement the referral provisions. Some States, such as Massachusetts and New Mexico (see box), tap insurance or require sliding scale fees.

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Medicaid

Medicaid's Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) reimbursement can be used to maximize State resources for early intervention services. The EPSDT program is a health care program for Medicaid-eligible children ages birth to 21. It is designed to detect and treat health problems early through regular medical, dental, vision, and developmental screenings. Many abused and neglected children not placed in foster care, and nearly all children in out-of-home placement, will meet income eligibility guidelines for Medicaid.⁴

EPSDT permits States to use Medicaid to finance an array of services that might otherwise be ineligible for Medicaid reimbursement, including early intervention services and developmental screening (see 42 U.S.C. 1396d(a)). These services must be listed in the State plan. At least 27 States have plans covering EI services, including physical therapy and other rehabilitative therapies such as speech and occupational therapies, screenings, and developmental assessments.

States should consult with the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) to determine the extent to which the EIP services below may be billable to Medicaid:

• Assessment of the child and the child's home life
• Physical, occupational, and speech therapy
• Vision and hearing testing, diagnosis, and treatment, such as eyeglasses and hearing aids
• Nutritional assessment and intervention
• Basic living and social skills development
• Parent skills training
• Case management
• Home visiting programs, including visits by public health nurses to provide screening and referral of children to the EIP
• Transportation costs for the child to receive services, as well as the cost of an attendant to accompany the child where the attendant is not a family member

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Other Federal Funds

Some State agencies have utilized other Federal funds and programs to support EIP referral, evaluation, and services for abused and neglected children, as well as child development training for professionals. States have found it helpful to seek additional guidance from the funding source regarding allowable activities.

• Maternal and Child Health Program (MCH) (title V of the Social Security Act). MCH provides a health-services safety net for women and children to ensure basic health care; it can be used for screening, assessments, and follow-up medical care. States also can use these funds for special projects of regional and national significance, including training for professional staff. In Suffolk County, NY, basic health assessments and monitoring provided by public health nurses are funded through MCH dollars in addition to EIP Child Find funds and Medicaid.
• Head Start/Early Head Start. Head Start requires grantees to perform or obtain developmental screenings and arrange or obtain further diagnostic testing, examination, and treatment for children with a suspected disability or developmental delay. It also requires grantees to establish partnerships with Part C and child protective services.
• CAPTA.The Basic State Grant program under CAPTA requires States to develop a process to ensure the referral of eligible children for early intervention services. This grant funding may be used to fulfill this requirement.
• Temporary Assistance for Needy Families (TANF). Many States have used TANF to fund preventive programs that reduce out-of-home placement, including assessment, case management, and family instruction (Dicker, Gordon, & Knitzer, 2001).

Additional funding streams that might be explored include title IV-B child welfare services program and IV-B Subpart 2 funds under the Promoting Safe and Stable Families program, Abandoned Infant Assistance Act funds, and funding streams that support substance abuse treatment and jail diversion programs.

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Conclusion

The new Part C referral provisions support access to early intervention services for abused and neglected children. The strategies discussed in this bulletin may help States consider options for fully implementing the CAPTA and IDEA directives. By providing access to early intervention services, child welfare administrators can better promote the healthy development of vulnerable children and their families.

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⁴ All States cover most foster children for Medicaid. For more information: www.cms.hhs.gov/MedicaidGenInfo. back

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Updated on October 9, 2009