Early Intervention in California: How to Access Therapies and Services

Early intervention for children under age three is mandated by Part C of the Individuals with Disabilities Education Act (IDEA), the federal law governing special education. Part C of IDEA is a comprehensive nationwide program of early intervention services for infants and toddlers 0-3 years of age with disabilities and their families. In California, this program is called Early Start. According to the Department of Developmental Services (DDS), Early Start is a multi-agency effort by the DDS and the California Department of Education that encourages partnerships between families and professionals, family support, and coordination of services. The statewide system of early intervention services is available throughout California and can be accessed through Regional Centers for developmental disabilities, county offices of education, local school districts, health or social service agencies, and family resource centers.

Early Start services are coordinated and funded by Regional Centers and/or Special Education Local Planning Areas (SELPAs). Each child enrolled in Early Start will have an Individualized Family Service Plan (IFSP) that is created by a multidisciplinary team that includes the parent or legal guardian as a member.

To learn more about who qualifies for Regional Center services and what types of therapy may be provided for your child, read Regional Center Eligibility and Services: Early Intervention (0–36 months). For most children after age three, the school district provides special education services under an Individualized Education Plan. Some children over age three are still eligible for Regional Center services if they have a qualifying disability.

If your child has been diagnosed with or is at risk of developmental delays or disabilities, your doctor may have advised you to apply for Regional Center early intervention services. Children 0-3 years of age across California receive early intervention services from Regional Centers if they have been diagnosed with, or are at risk for, developmental delays or developmental disabilities. (Note that some children may be eligible for continued Regional Center services under the Lanterman Developmental Disabilities Act after they turn 3, if they have been diagnosed with a developmental disability as defined by California law.)

Regional Centers are a statewide network of local agencies that serve children and adults with developmental disabilities as defined by California law, such as autism, intellectual disability, and cerebral palsy. Each Regional Center operates independently, so services offered (as well as eligibility criteria for specific services) may vary slightly, but many children under age 3 can receive occupational, physical, and speech therapy from the Regional Center during this time, along with other early intervention services. Check out our article How to Get Started with Regional Center for more information about how to apply; you do not need a doctor’s referral.

While many early intervention services are free to families, some are not — for example, Regional Centers fund services as a payer of last resort, meaning you have to first go through other funding sources like private health insurance. You can ask your Regional Center about what services are free to you and what can be covered through your insurance carrier. Regional Centers may also have family cost-sharing requirements for certain services and/or an annual family program fee for families above a certain income, although this requirement is waived for children receiving Medi-Cal. For families with household income below 400% of the federal poverty level, Regional Centers can also assist with copayments for services documented in the IFSP.

Fran Goldfarb, Core Function Director of Community Education, Information Dissemination, and Technical Assistance at the USC University Center for Excellence in Developmental Disabilities (UCEDD), advises families with children in the Early Start program to work with their Regional Center service coordinator or whoever is at the center of their Early Start team to help prioritize and create a plan of care. Regional Center is supposed to take a 360-degree look at a child to help the family identify services that are needed. Even if Regional Center is unwilling or unable to fund those services directly, they’re still obligated to help families find access to those services.

In addition to Regional Center, other public benefits such as Medi-Cal, California Children's Services, and In-Home Supportive Services (IHSS) can help cover health care and support for some children under age 3.

Medi-Cal

Medi-Cal is California’s Medicaid program. While it is traditionally income-based, many people with disabilities are eligible for programs that expand access to Medi-Cal to prevent institutionalization by broadening the financial criteria or applying different thresholds. Medi-Cal can help cover medical and therapeutic services, equipment, and supplies for your child, even if you already have primary insurance. However, Medi-Cal, like the Regional Center, is the payor of last resort, meaning that Medi-Cal will only step in after any private health insurance has paid its share of costs.

Children with disabilities who are Regional Center clients under the Lanterman Act (children over age 3 and some children under age 3) may qualify for Medi-Cal’s institutional deeming waiver program, which provides access to Medi-Cal regardless of parental income.

California Children’s Services

Medi-Cal and California Children’s Services (CCS) can work together to help coordinate your child’s care team.

If your child has an eligible diagnosis, CCS can be very good at helping you manage care. While CCS can provide physical and occupational therapy as well as durable medical equipment, they are also a specialty care clinic that can provide and coordinate all the care needed for the diagnosis under which the child qualifies. (However, as Goldfarb also points out, CCS will only support that condition; for example, if you have a child who has an intellectual disability as well as a heart condition, CCS will only treat the heart condition and not the intellectual disability.)

IHSS

In-Home Supportive Services (IHSS) is a Medi-Cal program that provides home-based personal care and related services so that people with disabilities can remain safely in their communities instead of institutions. Although IHSS doesn’t provide early intervention therapies, the program can fund caregiver services in your home so that you have additional resources to support your child. You can even be paid by IHSS to provide certain types of care for your child at home.

There is no minimum age requirement to receive IHSS. However, IHSS hours are awarded to children based solely on care needs that exceed those of a typically developing child, so it is unusual for babies and toddlers to qualify for IHSS unless they have extensive medical care needs or extreme supervision needs. Find more information about IHSS for children under age 5 here.

Special Education Local Plan Area (SELPA)

Special Education Local Planning Agencies, or SELPAs, are agencies that work with districts and private schools to provide special education funding. Their funding is based on the number of students district-wide, including all students, both with and without disabilities. In most cases, Regional Centers will be responsible for providing early intervention services. However, for children with certain low-incidence disabilities, the SELPA will provide services instead of or in addition to the Regional Center. A SELPA is a consortium of local school districts, county education offices, and charter schools tasked with certain special education responsibilities for children with disabilities within its geographic region.

California Education Code Section 56026.5 defines low-incidence disabilities as severely disabling conditions with an incidence rate of less than 1% of statewide K-12 enrollment - specifically, “hearing impairments, vision impairments, severe orthopedic impairments, or any combination thereof.”

For children age 0-5 with low-incidence disabilities, the SELPA is responsible for 1) direct services via Early Start for children age 0-3 under IDEA Part C, and 2) preschool and special education services for children age 3-5 under IDEA Part B in coordination with local education agencies.

A child may have an IFSP with both the SELPA and the Regional Center. However, since the Regional Center is the payor of last resort, services provided by the SELPA will be considered generic resources and the regional center will not duplicate services. If your child is enrolled with both the SELPA and the Regional Center, and you feel that a particular service offered by the Regional Center is more appropriate than what is offered by the SELPA, you will need to demonstrate why the SELPA service, as a generic resource, does not meet your child’s needs.

LEAs

LEAs, or Local Education Agencies, may use funds allocated to them by Title 1, Part A, to support early learning programs such as Head Start or state-run preschools. They may also use funding to provide services to children who are eligible under Title 1, such as children who qualify to attend a Head Start program but have needs that are unmet or require additional services.

Head Start

Head Start is an early learning program that is federally funded and free to families with low income or those who meet other eligibility requirements. Families who are experiencing homelessness or have children in the foster care system are also eligible for Head Start services. These programs focus on school readiness and encourage parental involvement. In fact, programs must match 20% of their federal funds through alternative means. They can collect what the program calls “in-kind” dollars by counting volunteer hours, or calculating the value of donated supplies.

Head Start programs receive federal funding but are created by local agencies, such as school districts, county education offices, and non-profits. All Head Start programs have to demonstrate that 10% of children served are children with disabilities, identified by having an IFSP. Early Head Start often achieves this proportion by identifying children who may be eligible and referring them to the Regional Center or SELPA for evaluation. These agencies may also refer families who meet the income qualifications. If they cannot meet the 10% requirement in this way, programs can waive the income requirements for a child with a disability. Learn more about Head Start in our article Inclusive Options for Early Intervention in California.

Your local family resource center

Goldfarb tells us that family resource centers can be wonderful because they’re often staffed by parents of children with disabilities who are very experienced at navigating the Early Start program.

Kathryn Smith, RN, MN, DrPH, associate director for policy at UCEDD and nurse care manager at the Boone Fetter Clinic at Children’s Hospital Los Angeles (CHLA), recommends that parents reach out to Early Start and become involved in all the systems while they’re waiting for an assessment:

You may have specific needs or preferences regarding therapeutic setting, such as in-home or at a therapy center, but the settings that are most readily available will depend on how you’re accessing and funding early intervention services. In short, Public Benefits Specialist Lisa Concoff Kronbeck explains, the starting question is, “Who’s paying for it?”

Private insurance and/or Medi-Cal

You’ll see the biggest difference when you're dealing with insurance versus Regional Center. “With early intervention,” Concoff Kronbeck explains, “you go through your private insurance first. And with private insurance, the in-network providers will usually be in a clinic-based setting. If it's a PPO that will accept a superbill from an out-of-network provider, you might be able to find a therapist who can come to your home and then issue superbills that you can submit to your insurance. But if it's an HMO, services are generally going to be in a clinic. So if [funding] is coming through private insurance, it's going to depend on what your insurance covers.”

As Concoff Kronbeck explains, “Sometimes with a PPO, they'll let you choose a sole practitioner who can give you a superbill and then you can submit it to the insurance, but HMOs don't work like that.” She shares that with Kaiser, for example, superbills are generally not accepted, and you would need to choose a clinic contracted with Kaiser.

For people who don’t have private primary insurance, Concoff Kronbeck explains, “Medi-Cal is generally not going to provide in-home therapies because almost everyone has a managed care plan, which has a closed network of providers, or the plans contract with outside clinics.”

Regional Center

If your child qualifies for Regional Center services, Concoff Kronbeck says, “If the Regional Center is paying, then 1:1 therapy is usually going to be in-home as the default, unless clinic-based services are recommended. But because Regional Center is the payer of last resort, you would need to go through private insurance first regardless of which setting you’re seeking.”

If you believe your child requires home-based services, you should be prepared to demonstrate to the Regional Center 1) why the in-network therapy is not appropriate and 2) that the insurance will not fund therapies in the home. For the latter, you would need to request home-based therapies from your plan and receive a written denial that you can present to the Regional Center.

Regional Center will always look to the private insurance and other generic resources first, Concoff Kronbeck says, so the private insurance would be responsible “unless you can make a compelling argument for why the generic resource isn't appropriate for the child. And in this case, it's the reasons why your child needs the service to be at home, and the fact that the insurance won’t provide it.” When private insurance benefits are otherwise available, Regional Center funding for in-home services won’t be approved because you just prefer having a service at home; there has to be a reason why the child needs it.

On the other hand, if you feel that services need to be in a clinic and the services are being funded by the Regional Center because your insurance isn’t covering the therapies, you should discuss your concerns with the provider who does the initial therapy assessment (or with the therapist, if you’re already receiving home-based services). If the therapist recommends clinic-based services, they should indicate that in the assessment they submit to the Regional Center. If you feel that a clinic-based environment would be more appropriate but the therapist disagrees, you may wish to have your doctor write a letter of medical necessity. As Concoff Kronbeck says, “The law says that they should receive services in their natural environment as much as possible, and not they must receive services always in their natural setting.”

How Regional Center can supplement private insurance

What if your insurance offers therapy benefits but you can’t access them and still need the Regional Center’s help? Let’s look at some scenarios in which you might need the Regional Center to help fund services even if you have private insurance:

Scenario: Insurance only provides clinic services, and you believe home services are medically necessary.

Get a letter of medical necessity from your doctor.

Scenario: Insurance provides clinic services and you’re fine with clinic services, but there are no in-network providers available, or there is a long wait list.

Sometimes, health plans are more prepared to provide therapy to children and adults who have suffered acute injuries, and they aren’t equipped to provide ongoing services to children with developmental disabilities. If your plan doesn’t have an available provider, or the only provider is far away, you may be able to request that the Regional Center fund the therapies instead.

If your plan has available providers, but they have a long wait list, you can request that the Regional Service provide gap funding so that your child doesn’t miss critical months of early intervention due to provider wait times. You will still need to get onto the wait list with an in-network provider and transition to them when your child comes off of the wait list.

Scenario: Insurance provides services but limits annual visits.

Some plans have an annual cap on the number of therapy visits a patient can utilize. Usually, you will need to exhaust your plan benefits before the Regional Center will take over funding services. However, if your plan has a very low visit cap and your child has difficulty adapting to change or developing rapport with new providers, you may wish to ask the Regional Center to consider covering services immediately as an exception, without having to exhaust insurance visits first.

Scenario: Insurance covers the services, but the copays add up.

Even if your per-visit copayment is not too high, those out-of-pocket expenses add up when your child has multiple therapies per week, sometimes even per day. If your copayments are becoming a financial hardship, Regional Center may be able to assist.