Early Start is California’s early intervention program for infants and toddlers aged 0 through 2 years old (up to age 3).  Over the years, laws have changed about Early Start services regional centers can purchase and how the regional centers operate.  This publication describes the law about using private insurance for Early Start services, including recent changes.  

One example of a law change happened in July 2023.  The new law says at the time of development, scheduled review, or modification of an Individual Family Service Plan (IFSP), the planning team can decide if a medical service is not available within 60 calendar days through private insurance or Medi-Cal.  If the needed medical service is not available within 60 calendar days, the regional center can pay for it.  This law went into effect on July 10, 2023.1  This is also described below.

Using Private Insurance

Here is the law since 2012 about using private insurance for medical and health care services identified in an eligible infant or toddler’s IFSP.  

Using a private health insurance plan shall not:2

1. Count towards or result in a loss of benefits for the person with a disability or other covered family members due to an annual or lifetime cap;
2. Negatively affect the availability or result in discontinuance of private insurance for the person with a disability or other covered family members; or
3. Be the basis for increasing the private insurance’s premium for the person with a disability or other covered family members.

Federal law generally requires parental consent for a regional center to use private insurance to pay for early intervention services.3 However, parental consent is not required under federal law if the state has enacted a law that protects parents from a bad result they might otherwise get because a regional center uses private insurance benefits.4  Because California enacted a law which protects parents from three potential bad results, parental consent is no longer required.  A regional center can access private insurance benefits to pay for Early Start services.

Planning Teams Must Ensure Clients Get Medical Services Quickly

Here is the law since 2023 about regional centers paying for medical services.  The planning team must determine at the time an IFSP is developed, reviewed, or modified whether an identified medical service is available through the family’s private health insurance plan within 60 calendar days.5  If that medical service cannot be covered by the family’s private health insurance plan within 60 days, the regional center must pay for it.  Regional centers must authorize purchase-of-service funding for the medical service without delay to comply with the requirement that services are provided quickly.6

Parents Are Protected from Potential Consequences

If a parent incurs any premiums, co-payments, or deductibles, those costs must be included in a system of family payments for Early Start services.7  California has not yet adopted any state system of family payments.  This means parents are not responsible for paying any deductibles or co-payments related to the regional center using private insurance to pay for Early Start services.  If the regional center wants to use private health insurance to pay for Early Start services, parents should make sure the regional center will pay or reimburse any deductibles or co-payments for those Early Start services.  Agreements about this should be in writing, including in the IFSP.

If California does adopt a system which requires parents to pay insurance co-payments or deductibles, the state must also include a provision for determining when a parent cannot pay.8  Early Start services cannot be delayed or denied because of a parent’s unwillingness to consent to using private insurance when they meet the state’s standard of inability to pay.9

Giving Health Care Cards to Regional Centers

Since 2009, California has required parents to provide the regional center copies of any health benefit cards which the child is eligible for, including private health insurance plans.10  This enables regional centers to know which infants and toddlers have benefits that may be used to pay for Early Start services.  Regional centers may regularly ask parents to consent to using their health insurance to pay for services.

Regional Center Must Give Written Notice of Action

If the regional center wants to change something about your child’s Early Start services, they must give written notice a reasonable amount of time before the change happens.  The notice must state: 

• the action the regional center is proposing or refusing;
• the reasons for taking the action; and
• how to file a complaint or ask for a due process mediation or hearing.

The notice must also be clear to most people and in the parent’s language of choice.  The regional center must have it translated and make sure the parent understands it.

Mediation, Hearings, and Complaints

For more information about Early Start appeals and complaints, please see our Early Start Eligibility publication.

• 1. Welfare and Institutions Code Sec. 4646.4(a)(2)(A).
• 2. Government Code Sec. 95004(c).
• 3. 34 CFR Sec. 303.520(b)(1)(i).
• 4. 34 CFR Sec. 303.520(b)(2).
• 5. Welfare and Institutions Code Sec. 4646.4(a)(2)(B).
• 6. Welfare and Institutions Code Sec. 4646.4(a)(2)(B); Government Code Sec. 95004(b)(2); 34 CFR Sec. 303.511(d)(1).
• 7. 34 CFR Sec. 303.520(b)(1)(ii).
• 8. 34 CFR Sec. 303.521(a)(3).
• 9. 34 CFR Sec. 303.520(c).
• 10. Government Code Sec. 95020(b) & (f).