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Who Pays

There is a fee for some families based on family size and income. Families do not bear the cost of insurance co-payments and deductibles. The Massachusetts Department of Public Health, Medicaid, Massachusetts health insurance and health maintenance organizations (HMOs) pay for services.

Is there a fee for Early Intervention (EI) services?

Yes. Part C of the Individuals with Disabilities Education Act (the IDEA) is the federal law that provides Early Intervention Services. Part C of the IDEA allows fees to be collected from families.

I thought services had to be provided for free.

Part C of IDEA requires that some Early Intervention (EI) activities are free.

Those activities include:

  • Child find (outreach to find children who might be eligible for EI).

  • Evaluation and assessment (to determine if a child is eligible for EI).

  • Service coordination (activities that find resources for families).

  • Individualized Family Service Plan (IFSP) development and their reviews.

  • Family rights (known as procedural safeguards and due process).

I thought insurance covered the cost for Early Intervention services.

Most health insurance plans cover Early Intervention services.  The Department of Public Health pays any and all costs that are not covered by insurance including co-payments and deductibles. MassHealth covers Early Intervention services in full.

How will I know if I pay a fee?

The EI program will ask you to provide information about your family size and income. This will take place when you enter the program and again on an annual basis.

Based on your family size and income, the EI program matches this information into one of five categories according to the Federal Poverty Income Guidelines (FPIG).

The information is sent to DPH and will always be kept confidential. The information is not available to any other program (public or private) without your written permission.

If your child has an established condition you will be sent a bill from the EI program when you sign your first Individualized Family Service Plan (IFSP) and then annually.

If your child is eligible based on a delay, clinical judgment, or because of risk factors, the EI program will send you a bill for half of the annual fee when you sign your first IFSP. If your child continues to be eligible after 6 months, you will be billed for the remaining half of the annual fee as long as your child is eligible and you are receiving IFSP services.

Category A: Families whose size and income are below 300% of the FPIG will not pay a fee. A child in foster care or who has any form of MassHealth will not pay a fee.

Category B: Families whose size and income are between 301% and 400% of the FPIG will pay a fee of $60. There will be a fee of $60 for the second child receiving EI. A family will not pay more than $120 a year.

Category C: Families whose size and income are between 401% and 550% of the FPIG will pay a fee of $180. There will be a fee of $180 for the second child receiving EI. A family will not pay more than $360 a year.

Category D: Families whose size and income are between 551% and 750% of the FPIG will pay a fee of $350. There will be a fee of $350 for the second child receiving EI. A family will not pay more than $700 a year.

Category E: Families whose size and income are above 750% of the FPIG will pay a fee of $500. There will be a fee of $500 for the second child. A family will not pay more than $1,000 a year.

IMPORTANT: These are annual fees. If your child is eligible for 6 months, you will be billed half the fee for the first 6 months. If your child continues to be eligible, you will be billed for the other half.

What if I choose not to give information about my family’s income?

Early Intervention staff will ask you to complete the form about your family size and income. They will also ask you to include a statement that you do not wish to provide the information at this time. If you choose not to provide income information, you will be assessed an annual fee of $500 based on Category E.

No family will be denied Early Intervention services based on their inability to pay the fee.

IFSP services, including home visits, child groups, center visits, etc. are subject to the fee.

Can I receive a refund if I decide I do not want Early Intervention?

The fee is not refundable. The fee is adjusted if you are scheduled to receive less than one (1) year of service.

What if I move or transfer to another Early Intervention Program?

If you move or decide to change programs, you would still need to provide the information about your family’s size and income to the new program. You should tell the new program that you have already paid the fee.

My child is eligible for less than 6 months. Will the fee be adjusted?

The fee will be adjusted if your child does not have an IFSP written for a full year.

  • If your IFSP is written for up to 3 full months, you will be billed for 25% of the fee.

  • If your IFSP is written for up to 6 full months, you will be billed for 50% of the fee.

  • If your IFSP is written for up to 9 full months, you will be billed for 75% of the fee.

  • If your IFSP is written for 10 months or more, you will be billed for the full amount.

Questions or Concerns?

The Program Director at your Early Intervention program should be able to answer any questions you have about the fee or Early Intervention services.

Documents

This information is provided by the Early Intervention Program within the Department of Public Health.