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The Intersection of Early Intervention and Teletherapy Service Delivery in Illinois: A Call for Change

Published in the May 2025 issue of the ISHA Voice.

By Valerie Brosius, member of the Telepractice Committee                              

While the Governor’s state fiscal year (SFY) budget for 2026 provides for a small rate increase for providers at an overall cost of $10 million which would largely be supported by Medicaid funds, it fails to fulfill the investment highlighted in the Governor’s 2023 Smart Start Illinois initiative. Celena Sarillo, Start Early Illinois’ Executive Director finds, “…when we fail to provide sufficient state funding for programs like Early Intervention and home visiting, we fail children during their most crucial developmental periods, and we leave families unsupported in caring for their little ones” (Start Early, February 19, 2025).


Nationwide, there is a shortage of speech language pathologists providing services within early intervention, of which Illinois is no exception. Since the State Fiscal Year (SFY) 2018, caseloads are up by 5%, in light of the provider workforce declining by 6%. This has resulted in record levels of service delays. In response to the shortfall, the Illinois Department of Human Services (IDHS) released a Cost Model that calls for $168 million annually to compensate providers and stabilize the early intervention program, limiting the hemorrhaging of providers and the subsequent increase in the number of children at-risk of disability and developmental delays not having access to services they are legally entitled to.

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The Cost Model for EI and proposed recommendations for payment reform were derived from the Illinois Department of Human Services’ Division of Early Childhood (IDHS-DEC) partnering with Afton Partners. Specifically, in December of 2024, the IDHS-DEC Cost Model-Afton Partners Report entitled “Modeling the Cost of Early Intervention in Illinois: Analysis and Recommendations” was published and identified the systemic challenges and barriers for services which included practitioner shortages, problematic recruitment and retention across all service levels, and poor reimbursement rates, calling specifically for payment reform. “The Cost Model is a flexible tool to inform policy decisions by relying on ongoing engagement with practitioner so that the data reflects costs faced by the EI field” (Afton Partners, 2024, p. 47). Indeed, the current reimbursement rates approximate half of what is required to cover the full cost of EI service delivery, with only 36% of a provider’s time being billable and 20-21% of all appointments being cancelled (Chicago cancellation rate is 23%) and therefore deemed non-billable. Behind the scenes, therapy providers spend 2 hours planning, driving, documenting, billing, and communicating carryover tips and parental training for each hour spent delivering treatment (Afton Partners, 2024). Under the Modeled Cost of Service Delivery, rates statewide would increase between $127-199 for an hour of direct services compared to current rates of $65-101 dollars, an overall average increase of 95% to fully cover provider costs and time, at an estimated price tag of $150 million annually. More specifically, for all audiology services, rates would increase from $53.51 per hour to a true cost of $166.06. Likewise, speech pathologists would see the current rate of $84.64 increase to a true cost of $163.89. This would bring reimbursement rates closer to other states with similar costs of living, finding that “the State should partner across agencies to maximize federal revenues, private insurance coverage, and Medicaid reimbursement for EI, now and as EI transitions to the Illinois Department of Early Childhood (Afton Partners, 2024, p.7) in SFY 2026. While over 48% of children receiving services in Illinois have Medicaid as reported in the May 2024 statistical report, Illinois does not draw as high a percentage of Medicaid funding as other states, including New Mexico and Massachusetts which currently serve the highest percentage of children and families in EI (Afton Partners, 2024).

Unfortunately, provider shortages in IL have not impacted all children and families to the same degree. White and Native Hawaiian or other Pacific Islander infants and toddlers are more likely than those in all other racial and ethnic groups to receive Part C services (Burke, 2024) while “Black and Latino children with developmental delays are 78% less likely to have their need for early intervention services identified” (Burke, 2020, p.8). Evans, Feit, and Trent (2016) followed that “families of color had more challenges and negative experiences when entering early intervention services” (Our Youngest Learners, The Education Trust, May 2021, p.8). These challenges included difficulty learning about existing services and initiating service delivery, having their concerns addressed, and professionals respecting their culture, cultural background and values. Disparities exist outside of Cook and the Collar counties in access to services in both receipt of services and in service delays. While downstate, 29% of children receive EI services, they experience 37% of the delays, whereas in suburban Cook County, 22% of infants and toddlers receive services but only 16% experience delays. In addition, 27% of ZIP codes in rural areas serve lower percentages of children than the state average (Afton Partners, 2024). Service delays also disproportionately affect children of color such that in the Collar counties, while 29% of children receiving services are identified as Hispanic, 35% experience service delays. Similarly, in Suburban Cook County, 16% of Black children receive services with 23% experiencing a delay. Across the rest of the state, 10% of Black children receive services but 18% experience delays. More specifically, service delays have doubled from 2018’s rate of 4.35% to 8.81% as of May SFY 2024 while intake delays (not receiving an initial evaluation and IFSP in 45 days) moved from .01% in 2018 to 7.62% again as of May. Therefore, in the Annual Performance Report SFY 2023, IL did not meet the indicators for the timely provision of services and 45-day timeline for intake. Illinois is thus categorized as a state that “Needs Assistance” by the US Department of Education for failing to meet requirements for more than two consecutive years (US Department of Ed, June 26, 2023). Furthermore, the 2023 Determination Letters in State Implementation of IDEA, the US Department of Education found that the state is not meeting the required standards including the timely provision of services, early childhood outcomes, and planning for children transitioning to Early Childhood Special Education services in the schools.

Adding to the disparity in terms of services, interpreters, translators, and bilingual providers reported shouldering unpaid work to best support non-English speaking families including service coordination, translating therapy materials, creating and adapting materials, helping families navigate and understand the EI system, and addressing access to resources (Afton Partners, 2024). Recognizing that families prefer receiving treatment for their child/children in the home language, the Cost Model proposes incentivizing multilingual providers by offering higher rates of reimbursement, and bonuses and/or stipends, thereby expanding the bilingual workforce. When services are delivered with the assist of a translator, less time is spent on actual therapy due to the additional communication needs and families may experience even longer delays (Burke, 2024). Equitable access to EI services in underserved, rural areas of the state also merits financial incentives including paying for travel, understanding that longer distances are required to travel when delivering services.

What about modes of service delivery? EI services must be provided in the child’s natural environment and during the pandemic, teletherapy or telehealth, which is referred to as Live Video Visits (LVV) supported safe access to services for children and families in these natural environments. Post pandemic, IL Medicaid continues to cover teletherapy delivered by speech language pathologists and audiologists within EI. The question then arises, can telehealth provide access to services for rural areas which present disproportionately concentrated service delays, reducing delays and increasing access? Unfortunately, while LVV holds the promise to do so, in reality, this is not the case. When looking at rural zip codes, 13% of services are delivered via LVV compared to 17% in urban areas (Afton Partners, 2024). Lack of access to the internet and reliable technology are frequently cited as an explanation as to the disparity. However, children in high poverty zip codes are twice as likely to receive LVV as children residing in low poverty zip codes. Explicitly, 20% of all services are provided virtually in high poverty areas of the state whereas only 11% of all provider visits are delivered via LVV in low poverty areas. Children residing in deep poverty communities, defined as being under 50% of the federal poverty level (FPL) receive 35% of their services via LVV compared to the state average of 17%. These deep poverty communities represent predominantly Black areas of Chicago (Afton Partners, 2024), therefore, parental choice in terms of service delivery, face-to-face in-person or via LVV may not be considered. To expand and explore LVV, the Bureau of Early Intervention is developing a Telehealth/LVV workgroup. All interested providers can apply here to be part of the workgroup. Furthermore, to keep abreast of EI, providers can also attend these virtual meetings:

***Under CMS, teletherapy and telehealth service coverage was set to expire at the close of the month on March 31st for all Medicare recipients. However, on March 14, Congress passed the Continuing Resolution (CR) extending coverage until September for speech language pathologists and audiologists. This is not to be confused with Medicaid coverage. In Illinois, Medicaid coverage for telehealth services continues to be covered.

References

Afton Partners (2024). Modeling the cost of early intervention in Illinois: Analysis and recommendations.

Bipartisan Policy Center (2018, December 13). New report ranks states on efficient use of early childhood funds. Retrieved May 29 from: https://bipartisanpolicy.org/press-release/new-report-ranks-states-on-efficient-use-of-federal-early-childhood-funds/

Burbak, E. W. (2023). Medicaid policies to help young children access infant early childhood mental health services: Results from a 50-state survey. Center for Children and Families: Georgetown University McCourt School of Public Policy. Retrieved May 28 from: https://ccf.georgetown.edu/2023/06/09/medicaid-policies-to-help-young-children-access-infant-early-childhood-mental-health-services-results-from-a-50-state-survey/

Burke, T. (2024, June 4). Early Intervention Recommendations Cross-State Research to Inform Early Intervention Service Coordination and Provider Services in Illinois. Retrieved August 6 from: https://providerconnections.org/wp-content/uploads/2024/04/Illinois-EI-Recommendations-04.20.24.pdf

“2023 Determination Letters in State Implementation of IDEA”. US Department of Education, June 26, 2023. https://sites.ed.gov/idea/idea-files/2023-det-letters-on-state-impl-of-idea/

Gillespie, C. (2021, May). Increasing equity in early intervention. The Education Trust. https://edtrust.org/wp-content/uploads/2014/09/Increasing-Equity-in-Early-Intervention-May-2021.pdf

Hohl, C. and. Glasmeier, A. K. (2022). “The Ultimate Tradeoff: Healthy Children or Draconian Attempts to Rein Inflation”, Massachusetts Institute of Technology, 2022. Accessed January 19, 2025 https://livingwage.mit.edu/articles/101-the-ultimate-tradeoff-healthy-children-or-draconian-attempts-to-rein-inflation

Magnuson, D., Minkovitz, C., Kuhithau, K., Caballero,T., and Mistry, K. (2017). Beliefs Regarding Development and Early Intervention Among Low-Income African American and Hispanic Mothers,” Pediatrics 140 (5): e20172059 (2017), https://doi.org/10.1542/peds.2017-2059;

McGowan, A. (2016). IL Partners for Human Service: “Failing to Keep Pace: An Analysis of the Declining Value of Illinois Human Services Reimbursement Rates”.

McManus, B., Richardson, Z., Schenkman, M., Murphy, N., Everhart, R., Hambidge, S. and Morrato, E. (2020). Child characteristics and early intervention referral and receipt of services: A retrospective cohort study. BMC Pediatrics 20(84). Accessed January 21, 2025: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-1965-x

“More than essential: Reimbursement rates and the true value of human services”. Illinois Partners for Human Services. (April 2021). https://issuu.com/lwrightilphs.dool/more_than_essential 2021_rates_report

Start Early champions for early learning. The Illinois Policy Agenda FY 2024-FY 2027. Retrieved May 30 from: https://www.startearly.org/what-we-do/policy-advocacy/illinois/illinois-policy-agenda/

Zero to Three: Early Connections last a lifetime. State and local policy. (June 15, 2023). Retrieved May 29 from: https://www.zerotothree.org/resource/illinois-general-assembly-approves-budget-increases-for-early-intervention-program/ 

Zero to Three, “State of Babies Yearbook 2023,” June 2023. Retrieved May 30 from: https://stateofbabies.org/wp-content/uploads/2023/06/State- of-Babies-2023-Full-Yearbook-061820.pdf