Therapy for Kids Without Insurance: Every Free and Low-Cost Route

In the US, a child under three can get a free developmental evaluation, and a parent can refer their own child — no doctor needed.¹ From age three the public school district must evaluate and provide services free where a child qualifies, and that includes children who don’t attend public school.² Medicaid and CHIP cover far more children than families assume, and if a child is on Medicaid, a rule called EPSDT requires the state to cover medically necessary therapy up to age 21 even where it wouldn’t cover it for an adult.⁴ Some states also cover children with significant disabilities without counting parent income.⁵ Beyond that: university training clinics, sliding-scale providers, hospital charity care, and non-profits. The route depends mostly on the child’s age, and this page is organized that way.

Which route fits my child?

Start with the child’s age. The first call is different for each row.

Situation	First call	Cost	What you say
Under 3, any concern	Your state’s early intervention program	Evaluation free; services at no cost unless the state has a fee schedule	“I’d like to refer my child for an early intervention evaluation.”
3–5, any concern	School district special education office	Free where eligible	A written evaluation request — script below
School age: learning, speech, motor, behavior	The school	Free where eligible	A written evaluation request
Any age, significant disability	State Medicaid office — ask about waivers and the Katie Beckett option	Free or low cost; parent income may not count	“Does this state have a Katie Beckett or TEFRA option, or a children’s disability waiver?”
Any age, low to moderate income	Medicaid or CHIP application, through healthcare.gov or your state site	Free or a low premium	Apply. Don’t screen yourself out.
Any age, any income, private therapy needed	University clinic, sliding-scale provider, hospital	Reduced	The sliding-scale script below

What’s free for every child, regardless of income?

Two federal programs, both under the Individuals with Disabilities Education Act. Neither has an income test and neither requires insurance.

Early intervention under 3: free evaluation, no referral

Part C of IDEA requires every state to run an early intervention system for children under three. The federal regulations name parents among the primary referral sources, so you can refer your own child without going through a doctor.¹ Once a referral is made, the screening, the evaluation, the assessments and the initial planning meeting must all be completed within 45 days.¹

What happens after eligibility depends on the state. The regulations define early intervention services as provided at no cost, except where federal or state law provides for a system of payments by families including a sliding fee schedule.¹ And where a state does charge, there is a floor: if a family meets that state’s definition of inability to pay, the child must be provided all Part C services at no cost, and inability to pay may not delay or deny services.¹

Find yours by searching for your state’s name with “early intervention,” or ask your pediatrician. Program names vary — Early Steps, First Steps, Birth to Three, ECI. Our guide to milestones and therapy walks through what an evaluation involves.

School services from 3: free where a child qualifies

From age three, Part B of IDEA makes the public school district responsible. Under child find, a state must identify, locate and evaluate all children with disabilities who need special education — explicitly including children attending private schools.² Either a parent or the district may request an initial evaluation, and once you consent it must be completed within 60 days, or within the state’s own timeframe where it has set one.²

Put the request in writing and date it. If the district refuses to evaluate, it must give you prior written notice describing what it refused, why, and what it relied on.² A verbal “we’ll keep an eye on it” is not a response to a written request. Our IEP and 504 guide covers the process and what a plan should contain.

Two honest limits. School therapy targets what affects education, so a child who needs feeding therapy, or a motor program unrelated to school, may get less from this route than they need. And school therapists carry large caseloads, so sessions are often shorter and group-based. It is free and it is real, and it is not always enough on its own.

Could my child qualify for Medicaid or CHIP?

More likely than most families assume, for three reasons.

• Children’s limits are higher. CHIP exists precisely for children in families whose income is too high for Medicaid but too low to afford private coverage. Federal rules set eligibility at the higher of 200% of the federal poverty level or 50 percentage points above the state’s Medicaid level — and many states have gone beyond that for most or all age ranges under 19.³
• A child can qualify when the parents don’t. Eligibility is assessed for the child.
• Circumstances change. A previous denial doesn’t carry forward. Job loss, a new baby, a change in household size — reapply.

What is EPSDT, and why does it matter?

If your child is on Medicaid, this is the most important thing on this page.

Early and Periodic Screening, Diagnostic, and Treatment is the federal Medicaid benefit for everyone under 21. States must ensure coverage of all medically necessary services within the mandatory and optional categories in section 1905(a) of the Social Security Act — regardless of whether those services are covered under the state plan for adults — where they are needed to correct or ameliorate a condition.⁴ Physical, occupational and speech therapy are among those categories.

Two practical consequences. First, a state may apply limits, but additional services beyond those limits must be provided where they are medically necessary for the individual child.⁴ So if you are told “Medicaid doesn’t cover that” or “there’s a visit cap,” EPSDT is the answer: caps written for adults do not bind a child’s medically necessary care. Second, a formal diagnosis is not required under federal Medicaid rules for a service to be covered under EPSDT.⁴

Ask the provider to bill under EPSDT. If a managed-care plan denies it, appeal and name EPSDT in the appeal.

Waivers and Katie Beckett: coverage that ignores parent income

Many states have a pathway to Medicaid for children with significant disabilities that doesn’t count the parents’ income. The mechanism is worth understanding, because it explains why it works.

Federal regulation lets a state cover children 18 or younger who would be eligible for Medicaid if they were in a medical institution, and who are receiving at home the kind of medical care that would otherwise be provided in one.⁵ Because eligibility is assessed as though the child were institutionalized, the parents’ income is not part of the calculation. The state must find in each case that the child needs a hospital, skilled nursing or intermediate care level of care, that it is appropriate to provide that care outside an institution, and that doing so costs Medicaid no more.⁵ This is the option commonly called TEFRA or Katie Beckett, after the 1982 law and the child whose case produced it.

Separately, states run home and community-based services waivers under section 1915(c), which cover children and adults with specific disabilities and often include therapy and respite.⁶ These vary enormously by state, the names differ, and waiting lists can be long.

The question to ask your state Medicaid office, or a local disability advocacy organization: “Does this state have a TEFRA or Katie Beckett option, or a children’s disability waiver, and how do we apply?” Apply early.

Where can we get therapy at reduced cost?

• University training clinics. Speech, occupational therapy and physical therapy programs run clinics where student clinicians treat under licensed faculty supervision, at substantially reduced rates. Supervision means more eyes on the plan, not fewer. Search for the nearest university with “speech and hearing clinic” or “occupational therapy clinic.”
• Sliding-scale community providers. Federally qualified health centers and some private practices scale fees to income. Ask directly; it isn’t always advertised.
• Hospital charity care. Non-profit hospitals are required to have a financial assistance policy. Ask the billing department for the application. Many families who would qualify never do, because nobody told them it exists.
• Non-profits. Easterseals, disability and condition-specific foundations, Rotary and Lions clubs, and local children’s charities fund or provide therapy. Dialing 211 connects you to local resources.
• Telehealth. Speech therapy and parent coaching translate well to video, and telehealth self-pay rates are often lower.

How do we make private therapy cost less?

• Ask for the self-pay rate. It is often lower than the rate billed to insurance. Ask before the first visit.
• Payment plans. Most practices will split an evaluation fee.
• Fewer sessions, stronger home program. A therapist who sees your child every other week and trains you well may get further than weekly sessions you can’t sustain.
• A consultation model. An evaluation, a home plan, and a review every few months. Ask whether it suits your child’s goals.
• Group sessions where the goals fit. Our page on group versus individual therapy covers when they do.
• A health savings account if you have one. Therapy is a qualified expense.

What can we do while we wait?

A lot, and it is worth doing — but it supplements an evaluation rather than replacing one. A home program works best when it targets the right thing, and the evaluation is what establishes what that is. Our sensory activities by system, sensory-friendly home guide, and toddler language strategies are the places to start, depending on the concern, and the sensory processing hub has the rest.

What do I actually say? Scripts for each call

Frequently asked questions

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