The Colorado Department of Early Childhood plans to cut therapeutic care and other services to babies and toddlers with disabilities as soon as Monday as it grapples with a multimillion-dollar budget shortfall, according to an internal memo reviewed by The Denver Post.
The “emergency cost containment measures,” which were announced to care providers Tuesday, place new limits on how many hours of services like physical or occupational therapy a child can receive through the Early Intervention Colorado program each month, and address reimbursements to providers.
Care providers who spoke to The Post said they were caught off-guard by the cuts, which they said were significant enough to affect the development of Colorado’s most vulnerable children. Questions about the legality of the changes under the Individuals with Disabilities Education Act swirled Wednesday after the agency held a call with providers, they said.
“There’s a lot of uncertainty,” said Katelyn Knox, an occupational therapist based in Larimer County, adding, “It feels like patient abandonment, which is not OK.”
The Department of Early Childhood said in the memo and emails obtained by The Post that the cuts are necessary to balance the fiscal year 2024-25 budget as “referrals to the program continue to increase and stimulus funding that was previously available has fallen off.”
It’s unclear exactly how big of a shortfall the agency expects if the changes aren’t implemented. However, the memo said at least $3.5 million in funding is expected to end June 30. This comes as Colorado lawmakers are grappling with a $1 billion budget gap in the upcoming fiscal year.
Representatives for the Department of Early Childhood did not respond to interview requests from The Post on Wednesday, and a spokesman for Gov. Jared Polis declined to comment.
In an email Wednesday evening, communications director Carolyn Romero said the Department of Early Childhood is working closely with early intervention agencies to minimize the impacts of the cuts, including through expanded use of telehealth options and helping families find Medicaid-enrolled providers.
“Our priority is to continue delivering high-quality services while managing the budget to sustain the program long-term,” she wrote.
The Early Intervention program provides care to babies and children up to age 3 who have developmental delays or disabilities. The cuts are set to take place Monday, according to the memo. Romero said they are temporary and will last through the 2025-26 fiscal year.
“This has involved many extremely difficult decisions and will mean that we will all need to work together to think creatively on how we can best move forward given the current constraints on our budget,” Lenita Hartman, the acting program manager for Early Intervention, wrote in an email to providers and other groups on Tuesday.
As of Wednesday, the Early Intervention program had received 12,200 referrals with 6,635 children found eligible to receive services, the department said. Of those, 5,058 were newly enrolled. The program serves an average of 11,178 children each month.
Early Intervention plans to cap at four the total number of hours worth of services — such as physical or occupational therapy — that a child can receive each month, according to the memo and providers who spoke to The Post. The proposed changes will force families that receive multiple forms of therapy per week or month to prioritize one over another, they said.
“There’s a lot of unanswered questions about how that time can be utilized, but it’s worth stating that there’s no current limit on what a child can access,” said Emma Vornhagen, a pediatric physical therapist in metro Denver. “There’s some super big question marks about how the state wants to proceed with which children can qualify for which services.
Furthermore, providers such as nutritionists or those who offer social emotional services who can’t bill their services to Medicaid will no longer be able work with children who receive the federal assistance to low-income families, providers said. But they can still work with children who aren’t on Medicaid.
Speech-language pathologist Jenny Riat said she felt the proposed changes will target Colorado families on Medicaid, among the most vulnerable families who receive services.
“These families are often systemically disadvantaged already, and the funding would be limited to support them through these proposed changes,” she said. “Kids who need the most help would get resources taken away.”
Riat said there is uncertainty and confusion over what to do next. Riat is trying to keep her providers at Emmé Therapy Services informed, but questions remain and nobody seems to have answers.
“We have a couple providers who are like, ‘My entire caseload would be state-funded,’ ” she said. “We’re trying to understand what it looks like to tell people if they can see the kids on their caseload or not.”
To decide what to cut, Romero said the state department “evaluated areas where the program is more generous than required in state or federal law” to remain within the available funding.
The department appropriated $87.4 million for the Early Intervention program, with about 70% of that funding coming from the state, Romero said. But changes in eligibility have increased Colorado’s share of service costs while Medicaid’s share remained flat, she said.
Knox, the occupational therapist, works with an infant support team that cares for babies that have been discharged from neonatal intensive care units, or NICUs, and are what she calls “medically fragile.” Many of the babies and their families need a wide range of services, from physical therapy to nutrition, she said.
“There’s no way that’s appropriate or adequate and their development will suffer,” Knox said. “To — across the board — blanket cut everyone to the same level (of hours) no matter the need or disability to me is unethical, wrong, maybe illegal.”
Hartman, with the state’s Early Intervention program, sent an email to providers Wednesday morning, saying that the program “is working through options on concerns that are being raised regarding the emergency budget information that was shared (Tuesday).”
“We do not want to share misinformation with families so the communication to them will be delayed,” she wrote in the email obtained by The Post. She said further information would be shared Friday.
But news of the changes already had reached families by Wednesday — including Celia Saravia of Westminster.
Saravia’s daughter, Anastasia, has Down syndrome and receives speech, occupational and physical therapies through the program. Anastasia turns 3 next month, so only qualifies for two more weeks of services, Saravia said.
But the changes mean that instead of getting six sessions — one with each therapist each week — before she is out of the program, Anastasia will only get two, Sarvia said.
“That would have been hard going forward knowing that my child has benefited so much from all three therapies,” she said. “If she was younger and not expiring out of the program, that would have been a huge impact and would have negatively impacted her.”
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