Hundreds of Mississippi’s most vulnerable children have missed early intervention therapies this month because of an administrative hang-up between the Department of Health and the Department of Finance and Administration.

These children are enrolled in Mississippi’s First Steps, a federally mandated program that provides a variety of therapies to children under three who’ve been diagnosed with disabilities and developmental delays. New contracts with therapists should have taken effect July 1, the first day of the new fiscal year. But the Department of Health still hasn’t processed hundreds of its contracts and has asked the program’s therapists to hold off on providing services until they do.

The Department declined to provide a date for when that might be. But therapists said even a few weeks of delays can set these children back months.

“Some of our kids if they miss two sessions, it’s like they come back in and we’re starting all over again,” said Karen Sisco, a physical therapist in DeSoto County. “When you’re working with babies, it’s extremely important to be consistent.”

The Department of Health told Mississippi Today that the problem rests with DFA, which took state contract authority from the State Personnel Board on January 1. In a statement, the Department of Health said that the new board that DFA assembled did not offer contract guidance until May, just over a month before the contracts were supposed to take effect.

“Usually, where we would have four months to process the contract, this year was about a month,” said Liz Sharlot, communications director for the Department of Health. “The MSDH has over one thousand contracts to process as we offer statewide services for several programs. This is more than most agencies. There is no way to process all of those contracts within the time constraints we were given. We have processed several hundred and continue to do so each day.”

But DFA said it had anticipated these delays and early on told agencies to use current law and the old contract review board’s regulations to process the contracts.

“With respect to the Department of Health, we are unaware of any impact the rulemaking process had on their contracts.  All contracts from MSDH were processed without delay and approved by the Board timely and in accordance with our submission guidelines,” said Laura Jackson, executive director of DFA.

One dozen First Steps therapists spoke to Mississippi Today for this story. As of Monday, all but one said they were still waiting on a signed contract.

The Department of Health told Mississippi Today that it will fund makeup sessions with therapists once contracts have been processed. This is a critical point because the early intervention services that First Steps offers are federally mandated. If Mississippi doesn’t provide the services a child has been prescribed, the state will be in violation of federal and state law.

But the Department of Health has yet to provide a resolution date and several therapists said at this point that making up those sessions, as the department has promised, would be difficult if not impossible.

“These kids are getting nothing,” said Melissa Davis, an owner of Kids Therapy Spot in Starkville. “We’re three weeks into this fiscal year, almost a month, so that’s three weeks of therapy to make up. They’re thinking they’re going to cover their tail by saying you can make up these visits, but we can’t. We just don’t have enough hours in the week.”

The Department of Health would not say how many children have missed therapy because of the delays, but several therapists in the program estimated it was likely in the hundreds.

First Steps serves approximately 2,000 Mississippi children under age three. The children affected by the delays are more likely to be middle income and have private insurance. Unlike Medicaid, many private insurers cap the types of early intervention therapies or the number of visits a child receives. When this happens First Steps covers what the insurer won’t.

Regardless of who is to blame, parents and therapists said they are frustrated by yet another setback for a program that has unlimited potential but is sometimes crippled by a lack of resources.

“I can’t overstate how crucial these (early intervention) services are to this state,” said Dr. Susan Buttross of the University of Mississippi Medical Center’s Center for the Advancement of Youth. “There are clear data, and not just medical data but economic data, that show that if you intervene early and discover children’s developmental issues, then you increase their success in school, you increase their reading levels, and you increase their graduation rates. And then you’ve completely changed the workforce, so economically the entire state does better.”

But Mississippi rarely intervenes early. Only 17 percent of Mississippi children receive proper screening for developmental delays before the age of three, the lowest screening rate in the country, according to a report published last week in the Journal of the American Medical Association.

And even when it does, many therapists told Mississippi Today that consistently providing these services is a challenge. Turnover among contracted therapists is high, which can cause delays in children being matched to a therapist. For this story, Mississippi Today spoke to nearly 20 therapists listed on the Department of Health’s directory of First Steps providers. Five of them said they left the program due in part to low reimbursements.

Sisco, a physical therapist, said Medicaid reimburses between $106 and $123 for a session. First Steps pay $50 to $60 for the same service.

“It wasn’t profitable at all,” said Joyce Bates, who ran the Summit Health & Rehab Outpatient Clinic before retiring. “The reimbursements are real low and on top of that you have to travel to patients’ homes. I couldn’t ask my employees to go into some of those situations for what they’re being paid.”

Other therapists said that reimbursements were not only low but frequently delayed, often by as much as 90 days.

The result is that families are often referred into the First Steps program, only to find that they have to wait months for an available therapist.

“I can’t go out and sell this program and say how wonderful it is and get somebody enrolled just to (have them) denied services,” said Marty Chunn, a learning facilitator who does outreach with the First Steps program. “So yes there is frustration going on around the state because people are saying we’re all about helping the kids but if we find them, we don’t always have the resources.”

Sharlot of the Department of Health acknowledged the lack of resources, saying in an email that “the needs far outweigh the funding that is available.”

This may be because Mississippi contributes far less in state dollars than its neighbor states do. Like those states, Mississippi funds its program through a combination of state and federal funds. Federal funds for FY 2019 totaled $4.1 million, or just about $29 for each child under age 3 in the state, exactly the same as Tennessee, Louisiana and Alabama.

Unlike those states, however, Mississippi contributed $1.3 million in state funds to early intervention in fiscal year 2019. Meanwhile, Tennessee, Louisiana and Alabama each contributed $11.3 million, 10.4 million and $7.7 million, respectively, according to Individuals with Disabilities Education Act data from 2013, the latest year available.

This approach is particularly damaging for Mississippi, according to Buttross, because Mississippi has more needs than most states. The state has traditionally led the nation in both high poverty rates and rates of preterm birth. And premature birth and poverty are the two biggest risk factors for developmental delays, officials say.

“So instead of needing fewer funds to help children early, we need more,” Buttross said.

The lack of funding is evident in the low number of children who receive early intervention services in the state, despite the increased need. In fact, fewer young children receive them here than almost anywhere else in the nation. Just 1.7 percent of Mississippi children under two receive early intervention services. Only Arkansas (1.5) and Oklahoma (1.6) treat a smaller percentage of their children.

“When you take into account the low rates of screening statewide, you’re already at a disadvantage. And when even the small number of children who get screened aren’t receiving services on time, that disadvantage becomes even bigger,” Buttross said.

Last fall, the Center for Advancement of Youth along with Mississippi State’s Social Science Research Center received a $10.5 million grant to ramp up screening efforts over the next three years. But that grant comes with its own set of issues, Buttross said. If more children are being screened, more children will need resources. And right now Mississippi doesn’t have them.

“As we hopefully increase the developmental intervention within our state, we’re going to discover more children who need intervention,” Buttross said. “So there is no doubt in my mind that more money will be needed in the early intervention program.”

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.