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Early Intervention Issues in California

Infant Development Association (IDA) is a nonprofit multidisciplinary membership organization that includes parents and professionals from different disciplines such as early intervention specialists, occupational, physical, speech and language therapists, early childhood educators, infant mental health, and social workers, etc. For more than five decades, we have aimed to enhance the statewide early intervention system by offering leadership through training and advocacy.

Issues impacting California Early Start Program: Part C is a federal program under the Individual Disabilities Education Act (IDEA) ensuring that early intervention services to infants and toddlers with disabilities and their families are provided in a coordinated, family-centered system of services available statewide. Early Start serves approximately 56,000 jointly through the Department of Developmental Services and the California Department of Education.

Rate Reform – Extend Hold Harmless through 7/1/26 to allow programs to figure out how to sustain their programs or transition to something else. A “hold-harmless” protection is provided for State Childcare workers – they were paid on enrollment, not on attendance. Early Start vendors need the same protection for ongoing clients.

  • Implementation of statewide Purchase of Service (POS) billing system to allow make up appointments. Early Intervention, vendors only get paid when doing direct service work with clients. If the client cancels, no matter what the reason, the vendor does not get paid. Some Regional Centers allow makeup visits within the same week; some within the same month; some not at all or have such complicated policies for makeup visits that it is virtually impossible to do so. There is no standard set of rules across all the Regional Centers for makeup visits. With center-based group programs, there is no way to make up the billable time for absent clients.
  • Vendors who employ staff (not sole proprietors) must follow California employment law that requires an employee to be paid for work scheduled, even if there are last minute cancellations. The current rate tables overestimate the income generated per employee, as they don’t seem to factor in the additional costs of these payments, even if a vendor is able to eventually reschedule visits. IDA believes that the cancellation percentage used to set the rate tables are to low. IDA also maintains that the follow up survey to vendors to determine their average cancellation percentages (done by DDS in 2025) was overly complicated and most folks filling it out did not understand the survey questions. We need a Statewide cancellation policy that is consistent across all Regional Centers. We must be allowed to either make up that visit time or (best case) be paid on enrollment, not on attendance.
  • Center-based vs. Community-based: There is a huge issue with the rates for “center-based” programs. The rates for the 2:1 and 3:1 programs, Request DDS reexamine the 2:1 and 3:1 Center-based rates.
  • Typically, therapeutic play groups or integrated therapy groups, are dropping by as much as 40%. These groups are a critical part of Early Start services. They offer children a way to “practice” the skills they are learning from 1:1 home visits and it gives them a chance to begin to make friends and function in group settings. This is the way we educate children in this country (in group settings) so it is a critical skill for children to develop. These group programs also provide connective opportunities for parents, for mutual support and sharing of community resources. Programs across California are saying they will close, as they cannot absorb such a huge cut. The definition of “center-based” – does not seem to take into account programs that are integrated with community children. Even if an Early Start program was operating at a community recreation center, they are still classified as a “center-based” program. The rates established for center-based are too low, based on the cost of doing business in California – minimum wage, rent, insurance, (especially fire insurance,) etc. The rate tables do not include staff set-up and clean up time when estimating billable time during a week. This has a huge impact on the productivity factor per staff person. Programs are not earning as much money as the rate tables estimate.
  • Center-based Therapy Services – Speech Therapy, Occupational Therapy and Physical Therapy are often done in a clinic (center-based) setting. There is about a 20% lower rate for clinic programs. Therapists, which are already in short supply for Early Start, are now stating they will no longer be taking Regional Center infants and toddlers.
  • Therapy Services using Assistants – the lower rate doesn’t cover the cost of Supervision and review that Assistants require. And the rates grossly under-estimate the salary/hourly wages of Therapy Assistants across California. Again, this has resulted in fewer Agencies offering therapeutic service utilizing Assistants to Early Start clients – lowering an already low amount of slots and increasing wait-lists, especially for non-English speaking families. We need Legislative Representatives to request DDS reexamine the Therapeutic Assistant rates, and the Therapeutic Center-based rates.
  • QIP – Quality Improvement Plan – For vendors, the QIP has become referred to as the Quality Improvement Punishment. Essentially, a vendor receives 90% of the rate set out in the rate table, and if they accomplish their QIP, they receive the final 10%. The current QIP is for all vendors to complete a DDS capacity survey by Feb 27, 2026. This date was recently extended. Vendors have struggled with survey links that don’t work, information that is wrong and a huge backlog of “help tickets” that have been submitted to DDS. There is a growing frustration and panic around the ability to complete the survey on time. QIP itself (for vendors) has become a “tool” for DDS and Regional Centers to use against vendors, to gain compliance with a variety of requests. The QIP was intended to improve services, not be used as a weapon or punishment. It has been pointed out that the rate tables (setting aside IDA’s feelings that some of information used to construct certain codes is wrong) establish what a vendor needs to earn to provide high quality service. If that is the minimum, how can a vendor provide high quality service with even less reimbursement, should they not earn their QIP? QIP for Regional Centers provides MORE funding if the QIP is accomplished, not a cut. This creates a terrible dynamic between Regional Centers and Vendors and is quite unfair. This further strains this relationships, given the power differential, and is not supportive of the Individual Family Service Plan (IFSP) team approach.
  • Workforce Shortages – Early Start programs are scrambling to hire highly trained individuals to work with fragile clients. The current rates for Early Intervention Specialists do not allow for competitive salaries, benefits, retirement, etc. With the mandated lower caseloads of Regional Center Early Start Service Coordinators and the expansion of TK – experienced Early Intervention Specialists are moving to these higher paying positions that offer State retirement benefits. Without immediate attention to the workforce issues, there will be no one to provide direct services to these children and their families

Benefits of Early Intervention: Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later. Services are essential prerequisites for later success in schools, the workplace and the community. Services to young children who have or are at risk for developmental delays have been shown to positively impact outcomes across developmental domains including health, language and communication, and cognitive development, and social emotional development. Families benefit from early intervention by being able to better meet their children’s special needs from an early age and throughout their lives. 

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