By the end of June, federal government insurance for the poor will no longer pay for a major service for disabled infants and toddlers in North Carolina who have fallen behind in walking, talking or speaking.
State officials must figure out a way to replace the service despite the elimination of federal money, because federal education laws require states to help disabled children. So any future program would likely be trimmed to narrow the kinds of help provided and serve fewer families.
Parents and therapists are pushing back in an effort to preserve the service.
The program provides therapists who go to homes and day care centers to show parents or teachers the best way to interact with young children to improve their physical and emotional development. It is aimed at children younger than 3.
The program, along with other early intervention services, is considered essential to help disabled children prepare for school.
"Our service is there to teach the caregiver," said Briana Kelly, a therapist from Pender County. She started an online petition that had 399 signatures as of Wednesday afternoon.
The program is meant to help disabled children catch up in skills with those of most children their age, Kelly said. If the severity of the disabilities won't allow that, the goal is to "get them to the best they can be," she said.
"If they saw those kids and those families, they won't cut the service," Kelly said of state officials.
In recent years, the federal government has told states to stop using Medicaid money to pay for services that are not considered rehabilitative, said Brad Deen, a spokesman for the state Department of Health and Human Services. The services cost Medicaid an average of $1 million a month over the 12-month budget cycle that ended last June, Deen said.
As the state looks to narrow the kinds of service offered, it will consider how to limit use and keep out some children who state officials don't believe need the help, he said.
"Medicaid would like there to be a little more selectiveness," Deen said.
In August, 4,766 children were eligible for the service, and about 65 percent of them were thought to be on Medicaid, according to Deborah Carroll, head of the early intervention office in the DHHS.
As the state struggles financially, the department is trying to figure out what comes next for the services and the children who get them.
How other states cope
In a Dec. 11 memo, Carroll listed some states that had devised ways to have Medicaid pay for community-based infant and toddler services similar to what North Carolina offers, but she said in an interview this week that she did not know whether the DHHS would pursue that course.
Private insurance, state money and federal grants are also used to pay for the service.
Jennifer Pfaltzgraff of Raleigh, whose 6-year-old son, Ethan, received community-based services when he was younger, said the program is essential for all disabled children and their families.
"It's a great tool in that it's not only the professional working with the child, but the family's involved," she said. "It's the best way to pull the services together and make it understandable for the parent."
Potential impact
Private insurance paid for the services for Ethan, who has cerebral palsy. But Pfaltzgraff said Medicaid cuts can hurt middle-class families, too.
Some private providers could go out of business without the Medicaid income, which would mean fewer therapists available to work with children, said Pfaltzgraff, who is president of the ARC of Wake County, an advocacy group.
"Everyone will be affected by it," she said.
