Free Speech Therapy for Children

Speech therapy for a child can be free through two public programs set up under federal law: early intervention, for children under three, and the local school district, from age three. In every state the early intervention evaluation costs the family nothing, and a parent can request it directly, without a doctor’s referral.

What you’ll learn

• Which public programs offer free speech therapy, and how to start each one
• What is free in every state, and where a fee can come in
• How Medicaid and CHIP cover speech therapy for enrolled children
• Where to turn if your child does not qualify

How Do You Get Free Speech Therapy for a Child?

Free speech therapy for children comes through public programs, and which one to contact depends first on your child’s age. A parent guide from the American Academy of Pediatrics (AAP) and the American Speech-Language-Hearing Association (ASHA) notes that speech and language services may be free through a state’s early intervention program or the school system, offered on a sliding scale, or covered in part or in full by insurance.

• Under three: call your state’s early intervention program, whose evaluation is free.
• Three or older: call a local public elementary school and ask for a preschool special education evaluation.
• Enrolled in Medicaid: ask your child’s doctor for a referral for speech therapy.
• None of these fits: ask private practices about sliding scales and insurance, and university training clinics about fees.

Whether a child’s speech needs a professional look at all is a separate question, covered in knowing when to seek help, and the term itself is explained in what a speech delay is, part of the wider subject of speech and language development.

Free Speech Therapy Before Age Three

Before age three, the public route is early intervention, which serves infants and toddlers from birth, along with their families, under Part C of a federal law called the Individuals with Disabilities Education Act (IDEA). Each state runs its own program under its own name, and the federal Part C regulations list speech-language pathology among early intervention services.

Who qualifies is set by each state’s own definition, so the rules differ from state to state. The federal definition covers a child under three who needs early intervention because of a delay in one or more areas of development, with communication among them, or because of a diagnosed condition likely to lead to a delay.

A parent can make the referral, since federal regulation names parents among the primary referral sources, and the Centers for Disease Control and Prevention (CDC) tells parents of a child under three to call the state or territory’s program directly, adding that a doctor’s referral is not necessary. Under a federal requirement known as Child Find, each state must identify, locate and evaluate every eligible infant and toddler, so answering a parent’s call is part of the program’s job.

A child who qualifies gets an Individualized Family Service Plan (IFSP), the written plan for services, and the family helps decide what goes into it. What to say on the call, and what happens at the evaluation visit, are covered in getting a speech evaluation.

From clinical practice

An early intervention evaluation costs nothing, in every state, and a parent can start one with a single phone call. That is rarely explained, and cost is the question that can keep a family from asking about speech therapy at all.

The evaluation and any decision about services are separate steps. A family hears what the evaluation found, and what a recommended service would cost, before agreeing to anything.

Is Early Intervention Free After the Evaluation?

The early intervention evaluation is free in every state. Under federal regulation 34 CFR 303.521(b), finding children, evaluating them and service coordination, meaning the help of the coordinator assigned to your family, are all carried out at public expense, and no fees may be charged to parents for them.

After the evaluation, states differ. Under federal rules, early intervention services are provided at no cost unless a state has adopted a system of family payments, which can include a sliding fee scale, so some states charge for ongoing services and others charge nothing. A state that charges sets the amount, usually from family income and family size, and a family that meets the state’s definition of inability to pay receives every Part C service at no cost.

Parents can accept or decline each early intervention service at any time, and can drop a service they first accepted without losing the rest. When the coordinator calls, ask:

• Whether your state charges for services after the evaluation, and how the amount is set.
• What counts as inability to pay in your state.
• For a child nearly three, when the transition conference with the school district will be held.

Free Speech Therapy From the School District at Three

From age three, free speech therapy can come through the local school district, under Part B of IDEA, which covers ages 3 through 21. Part B services belong to what the law calls a free appropriate public education, which federal regulation defines as provided at public expense and without charge, preschool included.

Speech or language impairment is one of the Part B disability categories, defined as a communication disorder, such as stuttering, impaired articulation, a language impairment or a voice impairment, that adversely affects a child’s educational performance. Speech-language pathology is also listed among Part B’s related services, and because the district applies its own eligibility criteria, a child who qualified for early intervention is not automatically eligible under Part B.

For a child who has turned three, the CDC advises calling a local public elementary school, which can be one your child does not attend, and asking for an evaluation for preschool special education services. When a parent asks, the school must provide the procedural safeguards notice, a written explanation of the family’s rights under the law.

The school needs a parent’s informed consent before the first evaluation, and consenting to an evaluation is not consenting to services. The evaluation must be finished within 60 days of the school receiving consent, unless the state sets its own timeframe, and a group of qualified professionals and the parent then decide together whether the child is eligible, with copies of the report and the decision free to the parent.

For a child already in early intervention, the move to the school district is planned ahead on a federal timetable. The early intervention program must hold a transition conference with the family and the district, and add a transition plan to the IFSP, at least 90 days before the third birthday, or up to nine months before if everyone agrees.

Does Medicaid or CHIP Cover Speech Therapy?

Medicaid is run by each state under federal rules, and its benefit for enrolled children under 21, called EPSDT, entitles a child to covered services needed to correct or improve a condition. The federal guide to that benefit from the Centers for Medicare and Medicaid Services names speech and language therapy among those services.

Whether therapy is medically necessary for a particular child is decided case by case. Federal Medicaid rules describe speech and language services as given by or under the direction of a speech-language pathologist or audiologist after a referral from a physician or another licensed practitioner, so on this route the referral comes first.

The Children’s Health Insurance Program, or CHIP, covers children in families whose incomes are too high for Medicaid but too low to afford private coverage. CHIP benefits vary by state and by type of program, and a state whose CHIP is a Medicaid expansion program must provide EPSDT, so with any other CHIP plan, ask the plan whether speech therapy is covered.

Medicaid and school services can overlap, and the rules protect families where they do. A school district cannot require a family to enroll in Medicaid or another public benefit for a child to receive a free appropriate public education, and cannot make parents pay a deductible or co-pay when it bills for services.

If a Child Doesn’t Qualify for Free Speech Therapy

Parents have ways to question an eligibility decision. For early intervention, ask the service coordinator how your state’s dispute process works. For school services, a parent who disagrees with the school’s evaluation has the right to an independent educational evaluation at public expense, under conditions set out in federal regulation.

University training clinics are another place to ask. Graduate students in speech-language pathology provide the therapy there, supervised by someone with ASHA certification, and ASHA’s standards require direct supervision for at least 25 percent of each student’s time with each client. ASHA also considers charging for supervised student services acceptable, so ask each clinic about its fees.

Outside the public programs, ask a private practice whether it offers a sliding scale and whether your insurance pays for part or all of the therapy.

Common Questions From Parents

Is Early Intervention Really Free?

Yes for the evaluation and service coordination, in every state. Ongoing therapy depends on the state: some charge a fee, usually based on income and family size, others charge nothing, and a family that meets its state’s definition of being unable to pay receives every service free.

Can the School District Give My 3-Year-Old Speech Therapy?

Yes, if the district finds your child eligible. From age three, schools provide speech-language pathology without charge, but the speech difficulty must affect educational performance and the district applies its own criteria, so early intervention eligibility does not transfer automatically.

Does Medicaid Cover Speech Therapy for Children?

For enrolled children under 21, Medicaid covers speech and language therapy needed to correct or improve a condition. Medical necessity is decided child by child, and coverage usually depends on a referral from a doctor or other licensed practitioner, so your pediatrician is the place to begin.

Does My Child Need a Diagnosis to Get Free Speech Therapy?

Not for early intervention. Any parent can refer a child, and under the federal definition a delay in communication can be enough to qualify, though states write their own rules. For school services, eligibility is decided by qualified professionals together with the parent.

What If My Child Doesn’t Qualify?

Ask about your state’s early intervention dispute process. For school services, if you disagree with the school’s findings, you can request an independent educational evaluation at public expense, subject to conditions. Medicaid or CHIP coverage, insurance, sliding-scale fees and university training clinics remain options worth asking about.

Can I Get Therapy Through School If My Child Goes to a Private Preschool?

You can ask for an evaluation. The CDC suggests contacting a local public elementary school, including one your child is not enrolled in. The district decides eligibility, so also ask how and where services would be provided.

Reviewed by Monica d’Errico-Franklin, M.S., CCC-SLP

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