This was a busy year for Early Childhood Intervention (ECI) advocates at the Texas Capitol. Thank you to everyone who contacted their legislators and visited the Capitol to help policymakers understand the importance of helping kids with developmental disabilities and delays learn to walk, communicate with their families, and meet other milestones.
With the legislative session now behind us, this blog reviews the budget and policy decisions that will impact ECI. As you’ll see, overall ECI funding was reduced based on new estimates of lower enrollment, falling short of the Department of Assistive and Rehabilitative Services (DARS) goal for monthly service hours for the increasingly high-needs ECI population.
In recent years, the ECI program has experienced growth in the proportion of enrolled children who have more complex needs, such as a medical diagnosis or a delay in multiple areas. Much of this change stems from budget cuts in 2011, which led DARS to narrow the eligibility criteria for ECI and keep children with less acute needs out of the program. In addition to narrowing eligibility, the ECI system has undergone a series of changes in recent years, including the transfer of responsibility for collecting Medicaid payments from DARS to ECI contractors, changes to Medicaid Targeted Case Management rate payment, and increases in family cost share. These constant changes to the ECI system have proven a challenge for families and for many ECI providers, and highlight the need for the state to invest in ECI to ensure the state maintains a sustainable early intervention system.
As a result of serving more children with complex needs, DARS requested $14 million in additional General Revenue for the 2016/2017 biennium to provide a higher, more appropriate level of services to children enrolled in the program. "General Revenue, or GR, refers to state funds rather than the federal funds that pass through the state government. In the early stages of the budget process, the Legislature opted to partially fund this request with $3.8 million in GR funding and $5.9 million in All Funds (a combination of state and federal funding). This funding was estimated to allow the program to provide an average of 2.75 monthly service hours, rather than the 2.78 that DARS hoped to reach by 2016 and the 2.88 it hoped to reach by 2017.
However, in the end, revised ECI enrollment estimates led the budget committee to reduce the amount of General Revenue for the program by $4.5 million, wiping out the proposed $3.8 million increase in General Revenue and falling far short of the initial $14 million boost requested by the state agency. In light of the lower enrollment expectations, budget writers also reduced their estimates for how much federal funding would be appropriated. The final budget still anticipates the program will be able to provide an average of 2.75 hours per month, and ties receipt of $3.4 million in federal funding to the program meeting this target.
Overall, the budget appropriates $55.6 million GR and $282.8 million All Funds over the 2016/2017 biennium. This represents a roughly $2.5 million decrease in All Funds from expenditures during the 2014/2015 biennium, despite an anticipated increase in the number of children served and hours of service provided. The program is expected to serve a monthly average of 26,753 children in 2016 and 27,170 in 2017.
ECI providers can access other sources of funding to cover program costs and keep our ECI system running. One of the key sources is Medicaid appropriations for pediatric therapies. However, in an effort to contain costs, the Legislature chose to cut rates for certain acute therapies. Children enrolled in ECI often receive specialized acute therapies such as speech therapy, physical therapy, and occupational therapy as part of their service package. These services involve additional requirements such as training, data collection, and specific child outcomes. The Legislature’s decision to cut therapy rates will significantly impact ECI contractors’ ability to collect adequate reimbursement for acute therapies. The budget does allow the agency to request additional federal funding to reimburse allowable contractor costs should appropriations be insufficient. It will be important to ensure that these funds are available and providers receive the support they need should the ECI system face additional challenges moving forward.
Early Childhood Intervention will also be impacted by the Legislature’s decision to consolidate the state’s health and human service agencies. The functions of the Department of Assistive and Rehabilitative Services will be transferred to the Health and Human Services Commission by 2016, and other health and human service agencies will follow. Ongoing stakeholder input will be crucial to ensuring that ECI remains a priority within the new structure, and that the state seizes opportunities to coordinate services and improve access to care.
Early Childhood Intervention continues to provide critical services to thousands of children and families across the state. During the interim, it will be necessary to address potential challenges, including enrollment that is higher than budgeted for, cuts to pediatric therapy rates, and the impact of transferring DARS functions to HHSC. It will also be important to identify ways to strengthen the ECI system, and continue engaging the voices of families whose lives have been changed by ECI.