1. MASSACHUSETTS STATE INFORMATION n Lead Agency Department of Public Health n Projected Cumulative Enrollment SFY 2005 - 30,251 n MA EI Budget (includes specialty) SFY 2005 - $89.9M n Average Cum. Cost Per Child SFY 2005 - $2,730 (direct service, not including specialty) n State Contribution SFY 2005 - $31.9M n Contact Ron Benham, Part C Coordinator n Website www.mass.gov

2. IMPETUS  All Massachusetts Health and Human Services Department’s charged with revenue maximization initiatives in FY-04.  State fiscal crisis from FY-02 forward  Continued growth of Massachusetts Early Intervention system

3. APPROACH  Limit impact to families and providers  Respect utilization of private insurance  Respect expense of administration of cost participation system  Include stakeholder input  Meeting with providers  ICC input  Public Hearing

4. Approach, cont.  Provider Assessment strategy  Providers assessed a projected yield  Offsets on payment vouchers October thru June  Utilization of children served/income stratification from two year prior  Assumes underreporting

5. METHODOLOGY n Several proposal were drafted to ascertain potential revenue and impact on families n Draft proposals were reviewed with the Interagency Coordinating Council, providers, families and other stakeholders. n Public Hearing: coupled with Part C application public hearing

6. Methodology, cont. n Depending on family size and income, your Early Intervention program will determine which category applies to your family. n Category A: Families whose income and size is below 200% of the Federal Poverty Income Guidelines will not pay a fee. Any child in foster care or who has any form of MassHealth will not pay a fee. Category B: Families whose income and size falls between 200% and 300% of the Federal Poverty Income Guidelines will pay an annual fee of $25. There will be a fee of $25 for the second child receiving EI. A family will not be charged more than $50 annually.

7. Methodology, cont. n Category C: Families whose size and income is between 301% and 400% of the Federal Poverty Income Guidelines will pay an annual fee of $50. There will be a fee of $50 for the second child receiving EI. A family will not be charged more than $100 annually. n Category D: Families whose size and income is between 401% and 550% of the Federal Poverty Income Guidelines will pay a fee of $150. There will be a fee of $150 for the second child receiving EI. A family will not be charged more than $300 annually. n Category E: Families whose size and income is above 550% of the Federal Poverty Income Guidelines will pay a fee of $250.There will be a fee of $250 for the second child receiving EI. A family will not be charged more than $500 annually

8. LESSONS LEARNED  Most stakeholders are not supportive of system  No cost participation from mid-70’s forward making for challenging implementation  At present no policy for withholding of services if cost participation not paid n Raises approximately $800K to $1M