BILLINGS — When the 18-month-old boy Beth Hall and her husband were fostering would cry and scream, seemingly without reason, she would feel frustrated and defeated.
The baby boy had been neglected, and his mental development was 87 percent delayed, making him closer to a 3-month-old. Hall was thinking about using engaging toys like stacking blocks when she played with the child, but he wasn’t even at the point where he knew how to make eye contact.
A family support specialist from Early Childhood Intervention, a provider in the state's Montana Milestones program, proved to be Hall’s lifeline. The specialist knew what therapy the baby needed and how to get him appointments fast. She came to Hall’s home twice a month to get down on the floor and interact with the baby and teach Hall tools to keep improving his skills between visits.
“When the family specialist came, I was scared and confused, and when she left I was so confident I could do this,” Hall said in July.
Now the child has caught up, closing the developmental gap, and because of ECI the boy likely won't need special education services in the future.
But ECI and programs like it around the state are in jeopardy of being eliminated under proposed budget cuts by the state Department of Public Health and Human Services. DPHHS administers the federal entitlement program and pays for it through a mix of state funds and federal money from what’s called the Part C program of the U.S. Department of Education.
The possible elimination of the program is the latest in a series of body blows. ECI and other Milestone programs had been targeted for a 25 percent cut this summer that was later reduced to 12.5 percent. Even the smaller cut would have devastated some providers, who for years have been trimming budgets to serve more and more kids but still make ends meet.
There are seven not-for-profit providers of early childhood education services statewide in the Montana Milestones program, working under health department contracts in five state regions and serving hundreds of children a year.
In the 11-county region surrounding Billings, ECI works with children ages 0-3 within the city limits, while Support and Techniques for Empowering People, known as STEP, serves the rest of the region. STEP also provides similar services for ages 3-21 in the region through a program that's also on the chopping block.
At ECI in Billings, families are connected with a support specialist who becomes their guide, mentor, coach and cheerleader.
Support specialists do everything from getting children appointments with therapists to hands-on visits with children where they teach parents skills so they can work with kids between visits. Their caseloads can run from 17 to 22 families at a time, or more, depending on the number of families that need services. The starting wage is $11.50 an hour.
Hall, a mom to five, including three children she fosters, first learned about ECI when an infant she fostered was very sick.
Her family service specialist was vital from the start. Her case worker questioned if she was exaggerating problems the infant had, but the specialist had documentation of health issues.
“It was very critical that we had ECI on board,” Hall said. “He was life-or-death sick. We would not have caught that without ECI. All we had was a piece of paper that said he had been in the hospital at two days old with a seizure.”
Because of ECI, “we were able to get this baby well quickly. He’s now crawling and at age goals. He’s been amazing.”
Hall uses the word “critical” a lot when describing what ECI’s services meant for her family and children. It's kept her able to be a foster parent. It's also probably kept the children she fosters from needing special education down the road, something that costs thousands more than the roughly $500 ECI is paid to serve each child a month.
“Not one state has eliminated Part C early intervention because they all know we pay now or pay later,” David Munson, who runs ECI in Billings, told a legislative committee last week. Munson spent a significant part of his career as the special education director for Billings Public Schools and knows firsthand the economic benefits of helping children early.
The most immediate and concerning threat to Montana Milestones funding comes from Gov. Steve Bullock's request that DPHHS cut an additional 10 percent from its budget.
The state needs to come up with $226 million in additional savings in the face of lower-than-expected revenue collections. Agencies offered up $226 million in reductions, with about $105 million coming from the health department, the largest of all state agencies.
Some people would question why the state just doesn’t reduce the amount of money it puts toward the program instead of cutting the whole thing. That’s because instead of being a federal matching program, Part C is a “maintenance of effort” program, which basically means if the state ever drops the amount of money it chips in, federal funding goes away entirely.
Montana Milestones is a federal entitlement program, which means it has to serve everyone who has a need. But the state can eliminate it as long as it does not accept federal funding. And the state couldn’t go the route of just reducing the amount of money it puts up for the program because any reduction would have resulted in the loss of federal funds anyway.
Marie Matthews, an official with the health department, said the cuts are severe and come on top of earlier reductions by the Legislature and the governor's office triggered by low revenue.
Possible loss of employees, furloughs and other reductions will slow the pace at which the department can help provide services vital to Montanans. "Everything on the (cut) list is a worry," Matthews said. "There's nothing that feels good here."
By next week, the governor’s budget director is expected to make his recommendations on what reductions will be made. Two legislative committees can also weigh in, but Bullock has the final say. Cuts could start this fall.
Montana Milestones is paid for by $2.14 million in federal money and $2.87 million in state money, for about $5 million for the program. For decades providers had seen the rates they were paid either stay the same or increase slightly.
In 2001, early childhood intervention providers were reimbursed $438.10 per child per month; by 2016 that rate increased to $545.21. Those rates were propped up, the health department said, by federal money carried over from year to year. The money built up because while providers in some areas like Billings serve far more than their quota, other parts of the state serve less and funds were left over.
Even after paying providers for children they served over the quota, in 2009, there was $1.13 million in carryover money. By 2012 that had risen to $2.4 million. But last year, the carryover had dropped to $100,439. Now, it's gone.
The early proposal from the state this year showed a 25 percent decrease in the amount spent per child, dropping the rate to $408.64, a level not seen in about two decades. That was quickly scrapped after outcries from providers statewide. The health department responded by cutting its administrative costs and got the rate reduction down to 12.5 percent, which would still be a significant blow to providers.
The new state plan also would not allow for two providers to work in the same region, as STEP and ECI do now.
For now, Munson and Ann Treece, executive director of STEP, are working to figure out if and how they can provide services under the new plan. But it has already caused concern and upheaval both for staff and families.
“The families are certainly going to feel it, whether it’s a reduced number of visits or less contact with their support person,” Treece said.
Even before the possibility of Montana Milestone's elimination was put on the table, the summer-long uncertainty about funding took a toll.
“A lot of staff just aren’t able to hang in there and see what happens and they need more security about their future,” Treece said. “We lost probably half our staff and a much greater percentage of our knowledge with them.”