PROVIDENCE — Rhode Island’s health and human services agency is asking Governor Dan McKee for a bump in funding for the state’s Early Intervention program next year, as the program struggles to serve infants and toddlers as required by law.
The request is less than what was recommended by the Office of Health Insurance Commissioner last month, and also below what early childhood advocates have asked for in order to shore up the program.
The new budget request from the Executive Office of Health and Human Services Agency proposes increasing Medicaid reimbursement rates for the critical early childhood program by half as much as was recommended by the Office of Health Insurance Commissioner, while leaving flat some rates that OHIC had proposed to cut.
The newly proposed rates vary by service. For example, if OHIC proposed increasing the reimbursement for a speech therapy session by 16 percent, the state agency is proposing instead to increase that payment by 8 percent in the next fiscal year.
The agency recommends phasing-in the rest of OHIC’s proposed rate increases the following year.
The newly proposed rates, if approved, would go into effect Oct. 1, 2024, three months after the start of the fiscal year. The request amounts to a $1.9 million net increase in state and federal funds for the Early Intervention program.
The new budget proposal comes a week after the Boston Globe and Rhode Island PBS reported nearly 900 children under the age of 3 are on the waitlist for the federally mandated program, which helps children with developmental delays catch up to their peers. The crisis in the program has been ongoing for two years.
Levi, the 2 1/2-year-old featured in the report, waited more than nine months before getting into Early Intervention this year. Federal law requires children be evaluated within 45 days of referral.
The U.S. Department of Education has determined Rhode Island has been out of compliance for the past two years.
Nine private agencies provide the services to the infants and toddlers, and are paid through the family’s heath insurance plan, such as Medicaid or private insurance. Private insurers are required to pay at least the Medicaid rate.
The new Medicaid proposal, which is part of the wider budget requests across state government that were due to McKee over the weekend, will help the governor craft his own budget to present to the General Assembly in January.
“The governor and his team know how vital these services are for families across Rhode Island and we will be looking seriously at increasing resources for Early Intervention during this FY25 budget process,” McKee spokesperson Matt Sheaff said Monday, adding that the budget process is just getting started.
Advocates from the Right from the Start Campaign, a coalition of advocates for early childhood education, had sent a letter to EOHHS in September asking the agency for a 30 percent rate increase across the board. The group also asked for an annual cost-of-living increase to the rates.
Leanne Barrett, the senior policy analyst at R.I. Kids Count, said the campaign’s members are appreciative of what she called a “down payment” of $1.9 million in the new EOHHS budget request.
“We do not believe this amount is enough to eliminate the staffing challenges and waiting lists,” Barrett said. “We will continue to work with Governor McKee and the General Assembly to ensure that Rhode Island’s EI system has adequate operating funds to pay competitive wages.”
“We also need to ensure that the state invests resources needed to strengthen the pipeline of qualified educators and clinicians who provide critical services for infants, toddlers, and preschool-age children with developmental delays and disabilities,” Barrett added.
The group had also asked for early interventionists to be able to access free childcare for their own children, in an effort to recruit more staff.
Medicaid reimbursement rates for the program were flat for two decades before getting a 45 percent increase in 2022. While the additional money helped, providers say the one-time increase was not enough to recruit and retain enough staff to clear the backlog of children waiting.
“We’re short staffed,” said John Kelly, the president of Meeting Street, in an interview over the summer. “Everyone’s short staffed. And not everyone wants to hear it, but that comes down to money.”
Meeting Street is the largest provider of Early Intervention services, and currently has more than 400 children on its wait list.
“It’s criminal,” Kelly said. “It’s really awful.”
Roughly 4,000 children are enrolled in the Early iIntervention program in a given year.
Staffing levels at Early Intervention agencies have started to recover since the pandemic, though they have not yet rebounded to 2019 levels, which were already considered a bit too low.
Laura Hart, a spokesperson for the Rhode Island Department of Administration, said the upcoming budget will represent a “constrained approach to budgeting” because of a projected deficit. She noted that one-time COVID relief funds allocated in prior years are still being utilized by state agencies to “improve the lives of Rhode Islanders and address long-standing needs for which funding had not been available.”
State Senator Louis DiPalma, the chair of the Senate Finance Committee, applauded the health and human services agency’s consideration of the OHIC report, but questioned why the rates would not start to increase until October of next year.
“I need to evaluate and understand why they did what they did, and figure out how that impacts the serious issue that you exposed and presented as it relates to the number of children that are not getting the services for which they’re required to have,” DiPalma told the Globe. “I want to understand why we didn’t put the full dollar amount there, especially given the severity of the situation.”
He said said Early Intervention would be a high priority for the Finance Committee as the panel vets the state budget next year.
“If I just look at financial impact, it’s pretty high,” DiPalma said. “If we don’t mitigate the situation of children from birth to 3 years old, the cost is exponential later on.”