Parents say the prices are reasonable and better than not having the program at all.
For 17-month-old Ella Kinder, five hours a week has been life-changing.
That's how long the Cape Girardeau infant, who has Down syndrome, spends in physical, occupational, speech and developmental therapy each week.
But a year ago, Ella's mom, Julia Kinder, was among thousands of Missouri parents unsure whether their disabled children would continue to receive those therapies through the state's First Steps program.
"If we didn't have First Steps, it would be impossible to get those therapists," Kinder said. "Having that has been tremendous. I don't think Ella would be the same baby, it's that big of a deal."
With the exception of physical therapy, all of Ella's therapies are through First Steps, which serves some 8,000 children ages birth to 3 in Missouri. Last year, Gov. Matt Blunt proposed cutting $23 million from First Steps' budget, essentially eliminating the program.
In the end, the state legislature approved just two major changes to the program, one of which includes requiring some families to pay for services.
The fees -- which range from $5 to $100 per month based on family income and will be implemented by April -- are not unreasonable, say local parents.
"I'd much rather have that than have them considering dropping the program," said Kinder.
Nancy Hale, program director for the 20-county area served by First Steps' Southeast Missouri branch, said the sliding fee scale will not apply to families that receive Medicaid.
The scale is broken down into family size, from two to seven or more individuals. For example, a family of four would only be required to pay a fee if the household income is $38,700 or higher. The highest amount that would ever be required to be paid -- $100 per month -- would apply to a family of four with an annual household income of $154,805 or more.
Hale said that amount is reasonable given the average therapy session cost of $64.
"Some of these children have therapy four or eight times per month, so when you think about it, this is phenomenal," said Hale.
Hale said the fees will also give parents a feeling of ownership in the program.
The second part of Senate Bill 500 -- the bill passed last year by the legislature revamping First Steps -- mandates insurance coverage for some First Steps services.
Health insurance companies are now required to cover physical, occupational and speech therapy costs for children, with an insurance cap of $3,000 per child.
Dale Carlson, coordinator of administration for the Division of Special Education at the Missouri Department of Elementary and Secondary Education, said a new system for handling the billing and insurance claims is being implemented.
Carlson said he has not heard any negative comments from First Steps families regarding the new fees.
"I think it's fairly low, though any amount of a bill is always too much," Carlson said. "But $6 is not even enough to buy a pack of cigarettes anymore, and some kids are getting a significant amount of therapy for that."
335-6611, extension 128
|Annual income||Monthly Fee|
|$38,699 or under||$0|
|$38,700 to $45,956||$5|
|$45, 957 to $53,212||$6.66|
|$53,213 to $60,469||$13.32|
|$60,470 to $67,725||$19.98|
|$67,726 to $74,982||$26.64|
|$74,983 to $82,238||$33.30|
|$82,239 to $89,495||$39.96|
|$89,496 to $96,752||$46.62|
|$96,753 to $104,008||$53.28|
|$104, 009 to $111,265||$59.94|
|$118,522 to $125,778||$66.60|
|$125,779 to $133,034||$73.26|
|$133,035 to $140,291||$86.58|
|$140,292 to $147,547||$93.24|
|$147, 548 to $154,804||$99.90|
|$154,805 or over||$100|