Special Education and Regional Center Blog
Helping Parents Navigate the Special Education, the Regional Center, and IHSS program.
As you might have heard, generally the regional center is the “payer of last resort.” That means that if there is any other “payer” available parents/clients are required to ask that payer to pay first before the regional center will pay for the service or support. Other payers might include health insurance (both private and Medi-Cal), the school district, or other governmental agencies.
For instance, a parent might ask the regional center to pay for speech therapy. Often the regional center will say no because the child’s health insurance will pay for the speech therapy. The problem is that when using health insurance might have a copay or deductible.
The good news is that regional center will pay copays, coinsurance and/or deductibles. (Welfare and Institutions Code Sec. 4659.1(a))
For minors, the Lanterman Act provides that the regional center must pay for copays, deductibles or coinsurance if:
1. If the services is included in the child’s individual program plan (IPP) or individual family services plan (IFSP) and the service is needed to ensure that your child receives the service. Note, you might need to request an IEE or IFSP meeting if the service (e.g. speech therapy) is not in the IPP or IFSP.
2. The child is covered by health insurance policy under his parent or guardian.
3. The family’s annual gross income is at or below 400 percent of the federal poverty level. You can check whether your family’s annual gross income is at or below 400 percent of the federal poverty level here: https://aspe.hhs.gov/poverty-research. (Look on the index for the family size and multiply the poverty guideline by 4.)
4. There is no other third party responsible for the cost. What if the regional center says no to your request to pay for copay or deductible.
For the regional center to pay for the copay or deductible, you should first review your IPP (or IFSP) to see if the service is included in the IPP (or IFSP). If not, you should make a request to your service coordinator to hold an IPP (or IFSP) meeting to add the service and request that the regional center pay the copay or deductible. If the service is included, either request an IPP (or IFSP) meeting to be held to make the request to have the regional center pay for the copay or deductible, or make a written request to your service coordinator to pay for the copay or deductible.
If you request that the regional center to pay for a copay or deductible (or any other service or support), the regional center has 15 days to decide about whether or not to authorize that service. The regional center then has 5 days to send you a notice of action if they are denying your request. After you have received the notice of action denying the paying of copays you have 30 days to request a Fair Hearing.
Feel free to contact me if you have any questions about regional center paying for copays or any other services.