JEFFERSON CITY, Mo. -- The state has spent more than $900,000 and seven years overhauling the First Steps program for developmentally disabled children, which Gov. Matt Blunt is now proposing to overhaul again.
Some First Step parents and providers are expressing concern about whether Blunt and lawmakers are rushing to put a new First Steps plan in place that could undermine recent changes.
"The improvements that have been made over the past two years are beginning to yield fruit," said Rick Daulton, vice president of the Daulton Group, which oversees the First Steps regional office in northwest Missouri. "There really isn't a need for a big overhaul."
In 1998, the state launched a redesign of the First Steps program, which serves 8,000 developmentally disabled children from birth to age 3. The changes included establishing regional offices across the state and a central finance office to handle all billing and data collection, said Dale Carlson, special education administration coordinator for the Department of Elementary and Secondary Education.
The latest phase of the redesign took effect July 1 in greater St. Louis and northwest Missouri. Since then, the cost per child has dropped 26 percent statewide.
It's unclear whether Blunt's plan would undo the changes.
Blunt spokeswoman Jessica Robinson said the governor is working closely with lawmakers on how First Steps should be structured, adding it "is still a work in progress." She said the governor is particularly concerned about making sure children in rural areas have access to health-care providers.
The governor's budget originally proposed cutting $23 million in state and federal funds from First Steps, essentially eliminating it. After parents expressed outrage, Blunt outlined an alternative that would largely keep the program intact.
The governor's latest proposal would charge a monthly participation fee ranging from $5 to $100 based on a family's ability to pay. Families eligible for Medicaid would not be affected by the fees. Blunt also supports legislation requiring health insurance companies to cover physical, occupational and speech therapy costs, as well as assistive technology for children, with an insurance cap of $3,000 per year for three years. He estimates the changes could save the state $2 million in the 2006 budget year.
Bills based on the governor's plan have been introduced in the both the House and Senate. A Senate committee heard testimony on the legislation last week.
"If legislators weren't forced to create a whole new program in such a short time, they'd be able to carefully explore improvements that could generate real bottom line savings for First Steps," said Malinda Terreri, whose son just completed the First Steps program.
The previous redesign of First Steps came at the recommendation of Department of Elementary and Secondary Education officials who were concerned the program was not meeting federal guidelines and lacked oversight, Carlson said.
A 42-member task force worked with a consultant to draft recommended changes to the system. In July 2002, the state implemented some recommendations, including establishing the regional offices to coordinate care and the central finance office.
Since then, the department has required offices to hire program consultants who determine the care plan for children in the St. Louis area and northwest Missouri -- an attempt to provide greater oversight of the services. Also in those areas, the health care provider who evaluates a child's needs cannot be the same provider who treats the child -- an attempt to avoid any conflict of interest.
The state planned to roll out those requirements for the entire state beginning in July, Carlson said.
But that plan is up in the air as lawmakers and the governor work on the new First Steps program.
Daulton said since the state enforced the changes in northwest Missouri, he has seen the cost per child in that area drop 39 percent as of February. He supports the governor's plan to charge families, but hopes Blunt will keep in place the previous redesign.
"We've got a really unique opportunity to take all those recommendations from the redesign process and make them happen," he said.