Montana Is Taking Steps on Early Intervention. More Investment Is Still Needed.

Early childhood is a critical period of growth and development. For infants and toddlers with a developmental delay or a disability, early intervention can provide essential support during these early years. In Montana, early intervention services are provided through Montana Milestones. For an in-depth analysis of Montana's early intervention system, see our report, Early Intervention for Montana’s Infants and Toddlers.

Recent changes to early intervention eligibility are a step toward reaching more children, but many children who could benefit still face barriers to accessing services. At the same time, provider rates risk another prolonged period without an increase. After rates were cut in 2017, they remained unchanged for years, even as costs rose. The 2024 rate increase offered important relief. However, without a way to keep rates in step with rising costs, Montana risks repeating this pattern of prolonged rate freezes, making it difficult for providers to effectively reach children and families.

Here are eight things to know about Montana’s early intervention program.

Progress on Access for Infants and Toddlers, With More Work Ahead

1.     Early intervention supports children during a critical period of development.

Montana Milestones provides services to infants and toddlers with developmental delays or disabilities. Children qualify if they have a listed disability on the state’s eligible conditions list or a developmental delay that meets the state’s specified threshold. Early intervention is effective. Almost every child participating in the program improved their social-emotional and language skills, and about one in six young children improved enough to catch up to their peers.

2.     A new referral form can help connect more children and families with services.

Children are often referred to early intervention by health care professionals, child care educators, or other early childhood programs. Recently, the state implemented a new Montana Milestones Referral Form, making it easier for professionals to connect children and families with services. Referral data can also help policymakers identify gaps in referrals and determine where additional outreach is needed.

3.     Updated eligibility criteria allow more children to qualify for early intervention services.

Effective October 1, 2026, Montana Milestones updated the eligibility criteria for children who have a developmental delay. Children now qualify with a delay of at least 40 percent in one or more developmental domains, or at least 20 percent in two or more domains. Previously, the thresholds were 50 percent in one or more domains or 25 percent in two or more domains. The Department of Public Health and Human Services (DPHHS) estimates this change will make 45 additional children eligible.

This is a meaningful improvement, but Montana’s eligibility criteria remain more restrictive than neighboring states. Idaho, Wyoming, North Dakota, and South Dakota include very low birthweight or preterm birth as eligibility criteria. Broader eligibility can help connect children with support earlier, before developmental concerns become more pronounced. 

4.     Montana still has significant gaps in early intervention access.

In state fiscal year 2024, Montana served 744 infants and toddlers, or just 2.2 percent of the state’s infant and toddler population. This puts Montana in the bottom five states for the percent of young children served. Montana is likely missing four out of five infants and toddlers who would benefit in a state with broader reach.  

Keeping Provider Rates in Step with the Cost of Care

5.     Provider rates remain far behind rising costs.

Montana cut early intervention provider rates in 2017, and rates remained stagnant for years before increasing in 2024. While that increase was an important step, it was only 2 percent higher than the 2016 rate. Had the 2016 rate simply kept up with inflation, it would be $730 today, compared with the current rate of $555.83.

6.     One rate increase is not enough to prevent another prolonged period of stagnation.

The 2024 provider rate increase was important, but rates need regular adjustments to keep pace with rising costs. Without a process for routinely reviewing rates or indexing them to inflation, Montana risks repeating the years of stagnation that followed the 2017 cut. Establishing a regular rate review or adjustment mechanism would help prevent reimbursements from falling further behind the cost of providing services.

7.     Stagnant rates put pressure on the workforce and access to services.

When provider rates do not keep up with wages and other costs, agencies that provide services face difficult choices. Family Support Specialists, the individuals working directly with children and families, may take on higher caseloads, serve fewer children, or a combination of both. Hiring and retaining Family Support Specialists is increasingly difficult when provider rates do not reflect the cost to provide services and competitive wages in communities.  

8.     Montana’s youngest children cannot wait for the next funding cycle.

Every biennium that policymakers do not prioritize early intervention funding, entire cohorts of young children miss out on these critical services. Policymakers can build on recent progress by ensuring provider rates reflect the cost of providing services, establishing a process for regular rate adjustments, and continuing to address limited eligibility criteria that prevent more children from accessing support.

Montana has taken steps to improve early intervention access. Sustained state investment is needed to ensure those improvements translate into meaningful, lasting support for children and families across the state.