The paperwork usually arrives before the first therapy session does. Consent forms, an insurance authorization, and somewhere in the stack, a page about family fees. A parent who was told early intervention is free reads that page twice and starts doing math at the kitchen table.

Two things are true at the same time. Part C of IDEA guarantees a specific set of services at no cost to you in every state, and it also permits states to charge families on a sliding scale for a different set of services. Sorting which pile each service falls into tells you exactly what you can and cannot be billed for.

What Federal Law Makes Free in Every State

Federal regulation at 34 CFR 303.521(b) bars any state payment system from charging families for these functions:

• Child Find activities, including the outreach that identified your child in the first place
• The evaluation and assessment that determined eligibility
• Service coordination
• Development, review, and evaluation of the IFSP, including any interim IFSP
• Implementation of procedural safeguards, meaning your rights to consent, to records, to mediation, and to a due process hearing

This is not a state courtesy that a tight budget year can take away. It is the federal floor, and it holds in Alabama, in Alaska, and in every state in between. If a fee schedule or an invoice ever lists an evaluation, an IFSP meeting, or your service coordinator's time, something has gone wrong on their end, and you can say so with the citation in hand.

Your service coordinator's time is part of that free tier, which is one reason it makes sense to route your questions about scheduling, providers, and paperwork through that person rather than solving them yourself.

What Your State Is Allowed to Charge For

Direct services are the other pile. Speech therapy, occupational therapy, physical therapy, developmental instruction, and similar ongoing supports can carry a family cost if the state has adopted what the regulation calls a system of payments.

States land in very different places on this. Some deliver every service at no cost to families and cover the gap with state appropriations and third-party billing. Others set a monthly family fee that rises with income and household size, with an exemption below a set percentage of the federal poverty level. Whatever your state does, the policy has to be written and made available to you. The ECTA Center publishes state-by-state summaries of these payment systems, and your service coordinator can produce the local version on request.

Ask for the fee schedule itself, not a summary of it. A schedule shows the income brackets and the dollar amounts next to them. A summary shows whatever the person explaining it happens to remember.

Where Medicaid Fits In

When a child is enrolled in Medicaid, the state generally bills Medicaid first for the services Medicaid covers. Medicaid does not carry the deductibles and copays that a private plan often does, so for most families this billing happens entirely in the background.

Consent still governs the process. Under 34 CFR 303.520, the state needs your written consent before using your child's public benefits when doing so would reduce lifetime coverage, shift a covered cost onto you, raise your premiums, or put your child's eligibility for a home and community-based waiver at risk.

One pathway routinely goes unmentioned: a child can sometimes qualify for Medicaid on a disability basis even when household income is far too high for regular Medicaid. States that adopted the TEFRA or Katie Beckett option disregard parental income for children with significant disabilities who are cared for at home. If nobody has asked you about that pathway, ask them. Eligibility there can also open the door to waiver services with their own waiting lists, which are worth joining early even if you are unsure you will need them.

Private Insurance and the Form You Sign

Before the state bills your private plan, it needs your consent, and it owes you a clear statement of what that billing could cost you: a deductible, a copay, or movement against a lifetime cap. Declining does not reduce your child's services by a single session. The obligation shifts back to the state, which has to provide what the IFSP says regardless. The full walkthrough of that consent decision lives in our guide to insurance coverage and your rights in early intervention.

If You Cannot Afford the Family Fee

One line in the federal regulation does most of the work here. A state's system of payments must specify that a parent's inability to pay will not result in a delay or a denial of services. The services on the IFSP are the services your child gets, and the fee conversation runs on a separate track from the delivery of therapy.

Three moves make that protection real:

1. Ask in writing for the inability-to-pay provision and whatever form documents it. Every state with a fee system has one, though the name varies from hardship waiver to fee adjustment to sliding scale redetermination.
2. Report income changes when they happen. Fees are set from a snapshot of your finances, and a job loss or a reduction in hours should trigger a new calculation rather than a growing balance.
3. Use the dispute routes if a fee is charged incorrectly or a service stalls over money. A written state complaint, mediation, and a due process hearing are all available, and all three sit inside the procedural safeguards the state cannot bill you for.

Questions to Ask Before You Sign Anything

Bring these to the IFSP meeting or the first call with your service coordinator:

• Which services on this IFSP carry a family fee, and which fall under the no-cost functions in federal law?
• May I see the fee schedule with the income brackets?
• Is my child enrolled in Medicaid, and if not, would a disability-based pathway change that answer?
• If I decline consent for private insurance billing, what changes in the plan?
• What happens to our fee if our income drops mid-year?

The answer to the fourth question should be nothing. If you hear a different answer, that is the moment to ask for the policy in writing.

Reading the Plan Alongside the Bill

The fee page and the service page describe the same child, so read them together. Knowing what the eight required IFSP components contain makes the payment arrangements section legible, because that section is where the state writes down which services it intends to bill for and how.

The money side of early intervention gets settled in offices most families never see. Most of it is written down, and the parts that touch your household budget are the parts you get to ask about before you sign anything. A parent who walks into the meeting with the fee schedule already in hand is doing what any of us would do with a document that has our name on it.