Congress Entitled Every Disabled Toddler to Early Intervention. It Funds 12 Cents of the Dollar.

Every state has opted into Part C of the Individuals with Disabilities Education Act, which conditions federal money on a promise: identify every infant and toddler, birth through age two, with a disability or developmental delay, and provide early intervention — physical, speech, and occupational therapy, family training, service coordination — at no cost to the family.▸ In fall 2023, 441,515 children were being served under that promise, per the federally required Section 618 child count. Washington wrote the mandate. It doesn't pay for most of it.

Every two years, the IDEA Infant & Toddler Coordinators Association surveys states on how they actually pay for Part C — because no federal report tracks it.▸ The 2023 survey, covering the year running July 2021 through June 2022, found 46 of 56 state and territory lead agencies could report at least some funding data, totaling $3,945,518,108 across federal, state, and local sources. Even that figure is an undercount: 24 of the 46 couldn't say how much Medicaid contributed, so the true total is higher.

State general funds ($944.6 million) and dedicated state Part C line items ($790.0 million) together outweigh every federal dollar combined.▸ Medicaid — billed state by state for eligible children's therapy — contributed at least $683.0 million, more than the federal government did. The federal Part C formula grant itself supplied $454.5 million: 12% of everything states reported spending, a fact the survey's authors call out directly, noting the true federal share "would be even lower if all revenue were reported." A program Congress requires states to run is, in practice, an entitlement states and Medicaid pay for.

The Part C appropriation climbed from $470 million in FY2019 to $540 million in FY2023 — then stopped.▸ It has now held at exactly $540.0 million for three straight years, FY2023 through FY2025, per the Congressional Research Service. Meanwhile, federal Part C dollars covered roughly $1,200 per child served in 2023, according to Georgetown University's Center for Children and Families, a figure it reports "has decreased in recent years due to increased enrollment." Medicaid — the second-largest funding source and, per Georgetown, the single biggest threat to the system if federal Medicaid matching rates are cut — is the piece actually absorbing the growth the flat federal grant no longer covers.

Money aside, Part C runs on a specific kind of labor: licensed physical and occupational therapists, speech-language pathologists, and developmental specialists willing to do home visits with infants for public reimbursement rates.▸ In 2023, the Government Accountability Office surveyed all 56 Part C lead agencies — every state, DC, Puerto Rico, and the outlying areas — on what stood between eligible children and services.

Forty-eight of the 56 programs — six in seven of them — named a lack of qualified service providers as a top barrier, and 23 separately cited staffing shortages inside the state agency itself.▸ It shows up on the finance side too: in ITCA's own 2023 survey, "insufficient funding to recruit and retain local level staff" was one of states' three most frequently named fiscal priorities, filed alongside "increase Medicaid revenue" and "address reimbursement rate." States aren't short on paperwork about the problem. They're short on people to hire.

Funding figures are self-reported by state Part C lead agencies to ITCA's biennial survey and are explicitly incomplete — not all states could report every fund source, and Medicaid contributions in particular are under-reported. Figures cover the reporting period July 1, 2021 through June 30, 2022, the most recent full survey available. The federal appropriation series and the GAO staffing survey are separate, more current federal data cited alongside it.