Threatened Changes to Medicaid and IDEA Could Impact Developmental Supports for Young Children in California

In addition to looming cuts to Medicaid, the federal government has recently shared plans to relocate the Individuals with Disabilities Education Act (IDEA) program into Health and Human Services as it moves to close the Department of Education. Both changes hold significant implications for California infants, toddlers, and families and combined could mean changes to how children with delays and disabilities are served

Over half of children under age five receive health care from Medi-Cal, California’s Medicaid program. In California, Medi-Cal works in tandem with our IDEA Part C early intervention program to serve children with delays and disabilities before age three. IDEA guarantees a free appropriate public education to eligible children with disabilities and ensures that special education and related services are provided. California’s IDEA early intervention program is called Early Start. Infants and toddlers are eligible if they have a developmental delay of at least 25% in one or more areas of development or are at risk of having delayed development or disability. Services, such as speech or physical therapy, are coordinated by a network of 21 regional centers. As regional centers are payors of last resort, some needed services must be provided by Medi-Cal if they are deemed medically necessary.

Closing the Department of Education and moving IDEA to Health and Human Services (HHS) cannot be accomplished without an act of Congress. However, the Executive Order signed on March 20th instructs the Secretary of Education to “take all necessary steps to facilitate the closure of the Department of Education and return authority over education to the States and local communities.” This sets the stage for substantial reductions in oversight and funding to IDEA services, in addition to workforce reductions already in flight. Furthermore, there is concern among advocates that HHS staff do not have the expertise and capacity to run IDEA.

Pre-dating any threatened changes to Medi-Cal and Early Start, are historic critical funding and access challenges in these programs. The federal government has historically underfunded IDEA, and developmental service provider shortages, compounded by low provider reimbursement rates, have created long wait times for families. Even though an estimated 17% of children have a developmental disability, California only serves 7.8% of its population under age 3 in Early Start over the course of a year.* Furthermore, Early Start has underserved children with Medi-Cal coverage, leading to access disparities for low-income children in our state.

Despite federal uncertainty, California has set in motion multiple strategies to improve access to developmental services, including requiring warm hand offs between Medi-Cal managed care plans and Early Start to improve the coordination. It has also published the Master Plan for Developmental Services. As the state budget realities set in, California may need to make hard choices on what it can afford. For example, during the Great Recession, California made the definition of developmental delay more restrictive and removed the “at risk” category for Early Start. Advocates, like First 5s will need to stay vigilant to ensure young children’s access to critical supports at the most important period of development remain intact.

*Note this statistic is sometimes shared as a snapshot count instead of a cumulative count which alters the presented percent of children served.