New York has been struggling to provide early intervention services to babies with developmental delays for years now. That’s because of a severe shortage of therapists.
But things have gotten a lot worse in the last few months, with many early intervention providers inconsistently paid since New York state released a new computer software to manage early intervention.
The messy rollout of that system is having devastating consequences for providers and families.
Therapists across the state struggling to get paid and do their work
Financially, this fall has been stressful for Lacie Schweigert.
"I had like no money. Like, I didn’t know if I was going to be able to even have a Thanksgiving meal with my children," she said. "I haven’t paid my rent this month, because I only had enough for half of it."
But Schweigert didn’t have a medical crisis or get laid off from work. She’s a special education specialist, and she’s been working.
She provides therapy to babies and toddlers with developmental delays in Schenectady, Saratoga, Albany, and Rensselaer counties.
She just hasn’t been getting paid for it. "I'm not getting paid consistently and I'm not getting fully paid," she said.
Schweigert is one of thousands of early intervention providers across the state, who have been waiting to be paid for their services since Oct. 15.
That’s when New York launched a new software system to manage early intervention in the state. It’s where therapists are now required to manage cases and bill for their services.
But it’s been slow, full of glitches — and in some cases, nonfunctional.
Rebecca Kelly, the early intervention manager for Lewis County, said all the software issues add up to "just lots and lots of extra time. And therapists are having to work late into the evening and weekends and not getting help or relief from it."
Kelly said tasks that used to take 15 minutes now take hours, and it feels nearly impossible to get help.
"I've had my own service coordinators for the county waiting two hours-plus for a phone call (from the help phoneline), and then when someone answers, they're not even able to help you. And then they have to put in a ticket," she explained.
Providers say this crisis was preventable
What’s frustrating for Kelly, and many others who work in early intervention, is that they say this crisis was preventable.
The new software program, called EI HUB, has been in the works for four years. The third-party company that built it, Public Consulting Group, or PCG, was awarded a contract by New York state in 2020.
The rollout of EI HUB was delayed several times because of the COVID-19 pandemic and feedback from providers during platform testing.
And in that testing, as recently as this summer, Kelly said providers told New York state and PCG that EI HUB had way too many issues, didn’t work, and shouldn't be rolled out yet.
"And so things weren't really ready. And that's really unfortunate because we (people working in early intervention) all could sort of see the writing on the wall with how this was going to play out," said Kelly.
State and PCG say they're working to fix EI HUB
Kelly said the non-functionality of EI HUB is a "real concern for our therapists, which then translates to down the road, a domino effect for our children and getting services in a world where we already have a significant number of kids on the waitlist in the North Country."
North Country Public Radio put in requests for comment about the rollout of EI HUB to the offices of PCG, Gov. Kathy Hochul, and the New York State Bureau for Early Intervention, which falls under the state Department of Health.
Only the last responded, via a written statement, after declining a live interview.
It said that the state Department of Health has made “significant enhancements to the early intervention provider management system” since launching, based on provider feedback.
PCG did not respond to a request for comment or answer any written questions, but they did have representatives at a meeting in Albany last week, the quarterly convening of the Early Intervention Coordinating Council (EICC), which is the advisory board to the Bureau for Early Intervention.
Project Manager Lauren Zelinksy said the company has made many improvements to EI HUB since the launch on Oct 15.
"And we're committed to keeping communication as transparent as possible with all stakeholders," she said. "Again, we look at you as partners, we hear your feedback. We want to know where the holdups are, where the issues are so we can work to update the system to meet your needs."
After he was pressed several times, PCG Project Manager Rob Lillipop told the Early Intervention Coordinating Council that PCG expected to resolve the 10 most pressing issues with EI HUB within about a month (by mid-January) but that other fixes could take much longer.
Decades of disinvestment in early intervention
Providers say the longer EI HUB doesn't work, the more therapists the field will lose. And that's a problem, because early intervention has been in crisis in New York for years.
NYS ranks last, 50th in 50 states, for fulfillment of early intervention services.
For years now, there’s been a shortage of available therapists, and long waitlists for nearly every county in the state.
Traci Harris has been working in early intervention for 30 years, and she runs an agency that provides those services in Watertown, Jefferson County.
Harris and other advocates said there’s a reason why the number of early intervention providers has been dwindling in the state: It’s the pay.
"It's a repeated pattern for New York state to treat providers poorly. And then we don't have providers," she said.
While they provide federally mandated services, early intervention providers aren’t salaried. They’re treated as “independent contractors” by New York state. And they're paid according to fixed rates that the state sets.
Those rates haven't changed for 30 years.
In 1994, a therapist would receive about $70 for half an hour of therapy provided to a child. That high pay was meant to cover transportation costs and administrative work, too.
"You know, back in 1994 you were, it was a great salary to provide these services," Harris said.
But fast forward 30 years, and in 2024, providers are still getting about $70 for half an hour of therapy. Harris said it's mind-boggling.
"Nowhere else in the state would workers work where they weren't getting incremental increases with cost of living and expenses," she said.
That's why, slowly but surely, early intervention therapists have been leaving the field for decades now, and seeking private work, or jobs in K-12 schools, where they can expect raises, a pension and health care.
Earlier this year, in negotiations for the 2024-25 state budget, early intervention providers got a win — they lobbied for an 11% increase in rates, and eventually won a 5% raise in the final budget. But that raise has yet to start being paid out.
Stuck between a rock and a hard place
Harris said a long history of disinvestment in the industry is why the launch of a nonfunctional billing and management system feels like such a slap in the face in 2024.
She said it’s one thing to be paid badly, and quite another to not get paid at all or be paid inconsistently while still providing critical services to children.
"And I don't want to say no to these services," she said. "I love doing my job. I love making a difference."
She said New York has to treat therapists "with the respect that we deserve as providers."
That’s why Harris has been organizing other providers and has started advocating for their needs.
That’s tricky, because early intervention providers don’t have a union. Because they work as individual contractors, they essentially don't have collective bargaining power.
"But we really need to unite, and we really need to advocate,” Harris said. “And we really need to push the lawmakers and our governor to do something so that this program — which is so critical, I mean again, it's the most vulnerable children that we have across the state — can be successful."
Bigger questions and mounting frustration
Harris and other advocates are frustrated by the response of both the state Bureau of Early Intervention, and the company that built EI HUB, which is a third-party company called Public Consulting Group, or PCG.
Andrew Casini, a Rochester-based occupational therapist, is another provider turned advocate.
He started a Facebook group for providers to troubleshoot their issues with EI HUB when he realized no one was getting through to the help center.
"But it's unreal that professionals need to go to a Facebook group to achieve help to do their jobs," Casini said, "when PCG was awarded $53 million."
Casini is referring to the $53 million contract that PCG was awarded in 2020 by New York state. He said he and other providers want to know why the state hired PCG in the first place.
"They have such a terrible record ... in other states that anybody could google," Casini said.
For example, in 2017, PCG started providing similar early intervention software for the state of New Jersey, with similar rollout problems of providers not getting paid. Issues persisted for years.
The same year, the company was sued for systematically denying overtime pay to Pennsylvania home care workers.
In 2018, Mississippi’s Department of Education abandoned a $5.5 million special education software contract with PCG.
In 2022, PCG settled a lawsuit alleging it had made fraudulent Medicaid claims in New Jersey, and paid $2.5 million back to the federal government.
This is all public record, and Casini said he doesn’t understand why New York chose the company.
"Anyone who's giving a contract to a company, to New York state, to develop the platform that is going to run early intervention across the entire state ... you need to do your vetting," he said. "It's unfathomable that this history of PCG was unknown to the New York State Department of Health. It's unfathomable that it was unknown by the Bureau of Intervention."
Why PCG was chosen, and why NYEIS was replaced
The New York State Department of Health said in its written statement that Public Consulting Group (PCG) was selected after it was the “sole vendor to submit a proposal” to the state’s request for proposals to build a new software platform, and that PCG was evaluated as able to “meet the State’s objectives and requirements” for a new system.
It also said it was critical that the state “move to a new data system,” due to security and safety concerns with the old system, NYEIS, which had been in operation since 2013.
But every provider that North Country Public Radio spoke with said that NYEIS was far more functional than EI HUB, and that they were never told there were safety or security concerns with the platform in the 11 years they've been using it.
The statement cited a report from the State Comptroller’s Office, saying that OCS recommended launching EI-HUB as soon as possible.
But in that same report, the recommendations read that the state should, “work with the EI HUB contractor to expedite release of the new system as soon as practicable. Ensure that municipalities are properly prepared to use EI HUB and that all essential functionality is operation before NYEIS is decommissioned.”
Casini said the way he reads that is the comptroller’s office making clear that EI HUB should have only been released when it was fully operational, which, as reported by providers and county coordinators across the state, it still isn’t.
Patience wearing thin, with no real timeline for a resolution
In the Early Intervention Coordinating Council meeting in mid-December, PCG spokesperson Rob Lillipop asked providers and early intervention county staff for patience.
"I ask providers to stick with us. It's important," he said.
But patience is wearing thin.
Casini said he and other provider advocates met with state and PCG representatives in late October. He said they asked the state to switch back to the still-functioning NYEIS system while PCG worked on EI HUB. That didn’t happen.
A change.org petition decrying the EI HUB rollout and asking for Hochul to intervene has more than 13,000 signatures. There’s been no response.
The Bureau for Early Intervention’s Advisory Board passed a board motion stating its disappointment with the rollout.
Several advocates that North Country Public Radio spoke with said they’ve been asking the U.S. Department of Education for a federal investigation on the relationship between PCG and the New York State Bureau of Early Intervention.
And while providers and county coordinators said EI HUB is working slightly better than it was two months ago, they said it’s a long way from working as well as NYEIS and is devastating their ability to work and provide therapy services to children.
Schweigert, the provider in Albany, said the state is essentially telling therapists that they shouldn’t let delays in the system stop them from providing therapy.
But she said she can’t do that.
"So in theory I can respect that, right? Because we can still go out and see kids. We don't need a piece of paper to say that we can see a child," she said. "However, in practice, when you're not getting paid to see those kids, there’s not money there to put gas in your gas tank to get to see those kids. There's not money to pay your professional and your general liability insurance that the counties require for you to provide services as an independent provider. Or you can't pay your car payment that gets you to those locations. So then what?"
Schweigert said she’s spent countless hours trying to make EI HUB function for her, and waiting for help from PCG. She said it’s demoralizing to beg to be paid for her work.
Shortly after North Country Public Radio spoke with Schweigert, she was told the rest of her unpaid claims since Oct. 15 would be pushed through. She said she was grateful, but it left her wondering: What about next week? And what about therapists with less ability to advocate for themselves?
Harris, the early intervention provider in Watertown, said while EI HUB is making therapists’ lives a nightmare, it’s children who will really pay the price.
"It’s not children with mild delays, it’s children with severe disabilities and diagnoses, and they need their services," Harris said. "These strategies that we give them when they’re really young can help them all the way through (the rest of their lives.)"
When babies and toddlers don’t get that help, Harris said they go into school with much bigger issues that take a lot more work to address.