Parents hear two things about Early Steps that seem to clash: it is "free," and it "bills your insurance." Both are true. This article walks through exactly what the Florida Department of Health's Early Steps Policy Handbook (updated 14 October 2026) says about money: what you never pay, when Early Steps can bill private insurance or Medicaid, what consent means, the few costs that can still reach a family, and how this compares with paying for private ABA.
Is Early Steps really free?
For the services themselves, yes. The handbook's system-of-payments rules are direct:
- No sliding fees. Policy 1.5.1: the Early Steps system of payments "does not include any sliding or cost participation fees but includes the use of public and private insurance."
- No out-of-pocket costs for services. Policy 1.5.2 A: parents "are not charged any out-of-pocket costs for any IDEA, Part C services."
- Money never blocks services. Policy 1.5.2 C: inability to pay "will not result in the delay or denial of services."
- Consent is optional for services. Policy 1.5.2 D: all Part C services on the IFSP are available "whether or not consent to use insurance or Medicaid is required or provided."
- No fees for the basics. Policy 1.5.4: no fees for child find, evaluation and assessment, service coordination, IFSP development and review, procedural safeguards, or early intervention services on the IFSP, "including any co-payments or deductibles related to these services."
- No copays or deductibles. Policy 1.5.5: local programs must ensure parents are not responsible for copays or deductibles for Part C services on the IFSP.
There is also no income test. The state's referral page says families do not need to meet an income requirement, and host programs such as USF's Bay Area Early Steps and UF's Northeastern Early Steps say the same.
Then why does Early Steps ask about my insurance?
Early Steps is funded by a mix of federal IDEA Part C money, state money and insurance payments. When a family agrees, the program bills the family's public or private insurance for covered IFSP services. The state's referral page explains that Early Steps pays for services that public or private insurance does not cover, and that private insurance is billed only with parent authorization.
The handbook sets out how this works:
- Written consent first. Policy 1.7.1: the local program must get your written consent before using your private insurance for the first service on the IFSP, and again each time the frequency, length, duration or intensity of services increases. Your insurance "cannot be used under any circumstance unless the family provides consent."
- A written notice. Policy 1.6.1 and 1.7.2: before you consent, the program must give and explain the Written Notice Related to Private Insurance and Medicaid and a copy of the system-of-payment policies, which list the potential costs to you. Spanish and Haitian Creole versions are linked in the handbook.
- In-network providers. Policy 1.6.8: when you consent, Early Steps must use providers on your child's plan for IFSP services, but this cannot delay or deny services.
What about Medicaid?
Medicaid follows similar protections, with a few extra rules:
- Early Steps may not require you to enroll your child in Medicaid to get services (Policy 1.8.1).
- Consent is required before Early Steps uses Medicaid benefits and before it shares your child's information with a Medicaid managed care plan (Policy 1.8.3).
- If your family has both private insurance and Medicaid, state Medicaid rules make private insurance primary, and Early Steps cannot bill Medicaid unless you have already consented to billing private insurance (Policy 1.5.7).
- You can withdraw consent to share your child's information with the Medicaid fiscal agent at any time (Policy 1.8.4).
Consent or decline: what changes for my family?
| Question | If you consent | If you decline |
|---|---|---|
| Does my child get every IFSP service? | Yes | Yes (Policy 1.5.2 D) |
| Do I pay copays or deductibles for IFSP services? | No (Policies 1.5.4 E and 1.5.5) | No |
| Do I pay premiums? | Yes, as you already do (Policy 1.5.6) | Yes, as you already do |
| Can using insurance affect my benefits? | Possibly: the handbook warns of long-term costs such as loss of benefits under annual or lifetime coverage caps (Policy 1.5.6) | Early Steps visits do not count against your plan |
| Which providers can serve my child? | Providers on your plan (Policy 1.6.8) | Providers chosen through Early Steps |
| Is consent needed again later? | Yes, whenever services increase (Policy 1.7.1) | You can be asked again at those points |
The one row that deserves attention is benefit limits. If your plan caps therapy visits per year (for example, a set number of speech or occupational therapy visits), visits billed by Early Steps may count toward that cap. That could matter if you also want private therapy, or ABA, under the same plan. Ask your insurer in writing whether your plan has visit limits for the services on your IFSP before you sign. Early Steps cannot advise you on your plan's terms; your insurer and your employer's benefits office can.
What costs can still reach a family?
Under the handbook, only a short list:
- Premiums for your health plan, which you pay anyway (Policy 1.5.6).
- Possible long-term costs from using insurance, such as loss of benefits under annual or lifetime caps (Policy 1.5.6).
- Services outside the IFSP. Anything you arrange privately, such as private ABA or extra private speech therapy, is billed under your own plan or paid by you, with the usual copays, coinsurance and deductibles.
If you are ever billed for an IFSP service, you can contest it. Policy 1.5.8 lists your options: mediation, a due process hearing or a state complaint, described in the Summary of Family Rights. Start by calling your service coordinator.
How does this compare with paying for private ABA?
Private ABA is a separate service with a separate payer, so the Early Steps rules above do not apply to it. Here is how the money side differs:
| Early Steps (IFSP services) | Private ABA | |
|---|---|---|
| Family fees | None | Depends on your plan: copays, coinsurance and deductibles usually apply |
| Insurance billed? | Only with your written consent | Yes, if you use insurance; the plan must authorize ABA |
| Diagnosis needed? | No (delay route) or an established condition | Insurance usually requires an autism or Down syndrome diagnosis; self-pay does not |
| Who decides the amount of service? | The IFSP team | The BCBA's treatment plan, then the plan's medical-necessity review |
| Ages | Birth to 36 months | No Early Steps age cutoff; Florida's mandate covers people under 18, or 18 and older and still in high school, who were diagnosed at age 8 or younger, in fully insured large-group plans and HMOs |
Florida's autism insurance law, section 627.6686, requires certain fully insured large-group plans and HMOs to cover ABA for autism and Down syndrome, but it does not apply to self-funded employer plans or individual and small-group plans. Read Florida's autism insurance law explained and what ABA costs in Florida.
A checklist before you sign the insurance consent form
- Ask for the Written Notice Related to Private Insurance and Medicaid and the system-of-payment policies, in your preferred language.
- Ask which IFSP services would be billed to your plan and how often.
- Call your insurer: does your plan cap visits for speech, occupational, physical or other therapy? Do Early Steps visits count?
- If you plan to add private ABA or therapy, ask your insurer whether those share the same limits.
- Remember you can decline, and your child still gets every IFSP service.
- Keep copies of anything you sign.
How Hope Center fits in
Hope Center for Behavior Change provides private ABA, not Early Steps services. Many families use both: Early Steps for coaching in daily routines and therapies on the IFSP, and ABA through private insurance or self-pay. We accept Florida Blue, Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East, and we offer self-pay for all services with a sliding scale. If your child has Medicaid, center policy does not allow self-pay at Hope Center; you can add marketplace or employer insurance, which we accept, and the sliding scale can help with your share. Costs depend on your plan, so we start with a free benefits check, and we have no waitlist. See Early Steps and private ABA, the full Early Steps guide, our insurance page, or contact us at 561-337-8865.