Therapists treating Nassau preschoolers with disabilities are in 'financial crisis'

The ability to provide legally mandated therapies to young children with developmental delays in Nassau County has hit financial “crisis mode,” providers say, as costs and wait-lists rise and reimbursement rates for half-hour sessions remain unchanged since 1999.

Providers of preschool-related services — including speech, occupational and behavioral therapy designed to prepare children ages 3 to 5 for kindergarten — say Nassau’s rates are among the lowest in the state and are calling on county lawmakers to increase funding through Nassau's health department.

Democratic legislators point to an opportunity to temporarily fund these agencies using federal pandemic assistance. The administration of County Executive Bruce Blakeman, a Republican, says the state needs to shoulder more of the costs.

“It’s almost impossible to hire therapists,” said Susan Lubrano, owner of Therapy Services of Greater New York, a physical and occupational therapy clinic for children with special needs based in Great Neck Plaza. “To watch children not get the services is really sad. And these therapists just can’t afford to stay.”

Lubrano is among dozens of providers lobbying the county legislature to increase the $40 per half-hour rate for such therapies so her practice can continue to work with preschool-age children, in addition to the other populations she serves.

Since the beginning of 2024, Lubrano and dozens of providers have spotlighted the issue through public testimony at county legislature meetings.

Republicans and Democrats in Nassau's 19-member legislature publicly vowed to research the problem. 

Treatment in jeopardy

David Tellerman, director of New York Therapy, which provides speech, occupational and physical therapy, said the practice is working with “razor-thin margins and in many cases we are losing money.” Based in Port Jefferson Station, the agency contracts with Nassau and Suffolk counties and New York City.

He said many providers have stopped treating preschool-age children. “When these children are not receiving these services, it means they are not receiving their legal mandates,” Tellerman told legislators.

“There is truly no lower rate in the entire state,” Tellerman said. “This needs to be changed immediately, and only Nassau County can make this change. Nassau County should be a leader for special education children.”

In New York, early intervention for children from birth to 5 years old is paid for through county health departments, with reimbursements from the state, which administers federal funding through the Individuals with Disabilities Education Act. 

Preschool children who qualify for the services are evaluated by a committee that includes representatives from the child's school district, the county health department and a special-education teacher or related service provider who recommend a customized plan known as an Individualized Education Program, or IEP.

Therapy services, or what is known as “related” services, to address physical, cognitive or behavioral delays for the preschool population are paid through a county health department fund that pays certified providers.

Nassau's 2024 adopted budget for these services is $12.6 million and about 110 service providers are paid from this budget. The state reimburses the county for 59.5% of preschool special education expenditures, which includes costs for the “related” services. 

Suffolk County allocates $12.565 million for these services and has paid providers $45 per half-hour session since 1993, county spokesman Michael Martino said.

Blakeman spokesman Christopher Boyle said: “Nassau County is doing our part. The state needs to do more.”

“According to the New York State Association of Counties, in states where counties are not responsible for K-12 education, New York is an outlier requiring county government to subsidize these early development programs,” Boyle said. 

Nassau County Legis. Siela Bynoe (D-Westbury) said that with more than 200 children on a waitlist for preschool special education, the county should direct some of its expiring $262 million from the federal American Rescue Plan Act to ease the burden, calling it “educational recovery.”

The Republican-controlled legislature voted along party lines to put most of the money in the county's general fund and set aside $10 million for marketing and events celebrating Nassau's 125th anniversary, at Blakeman's request.

“If you look at the areas in which the county is funding — tourism and such — and it’s not going into areas that are underfunded,” Bynoe told Newsday. 

Avi Small, a spokesman for Democratic Gov. Kathy Hochul, in a statement said the governor is proposing “the first across-the-board rate increase in a decade” with a 5% raise in pay rates for in-person early intervention services statewide. 

Advocating for reforms

New York State Association of Counties Executive Director Steve Acquario said for decades the group has advocated for the education programs to be under the jurisdiction of school districts who would contract with the providers.

“It’s bizarre that counties in the state of New York are involved with a school-based program. Counties are not in the education business, and there is no tether to the K-12 system. It’s a system designed for failure and is not in the best interest of the children and their families — those who are most in need,” Acquario said. 

He said the group most recently argued the point two years ago when the state expanded funding for universal prekindergarten for 4-year-olds.

Among the criticisms of universal pre-K and 3K, which serves 3-year-old children, is the lack of seats for children with special needs.

Sanja Cale, SUNY Old Westbury professor of exceptional learning and director of New York State's Regional Center for Autism at Old Westbury, said many preschool-age children with Individual Education Programs likely need more support because services weren't as available or robust when they were infants in the pandemic. 

“It’s a critical time, their brains are developing rapidly, it’s a time for them to receive any special educational services,” Cale said. 

By Candice Ferrette

candice.ferrette@newsday.comcandiceferrette

Candice Ferrette covers Nassau County government and politics on Long Island. She has been a reporter at Newsday since 2011.