Common questions

Consultation sits at the intersection of early childhood, mental health, adult learning, and consultative practice. That creates two problems.

• Funding is domain-specific. Many sources set criteria for what the money can be used for or who it can serve. Government entities often can’t braid sources together.
• Needs compete within systems. Early childhood funding often prioritizes basic needs like child care access. Mental health funding might go to clinical services for youth and adults. That leaves less focus on prevention programs like consultation.

Consultation also isn’t a widely billable service the way clinical treatment that requires a diagnosis is. It has often been funded through short-term grants.

We don’t know of a state that uses a single dedicated funding source. There’s no single dedicated federal funding source for consultation. Several states dedicate state funding as part of a combination of sources. The most common funding streams are:

• Child Care and Development Fund
• Early Intervention (Part C of the Individuals with Disabilities Education Act)
• Head Start and Early Head Start
• Human services and child welfare funding (including Temporary Assistance for Needy Families)
• Maternal, Infant, and Early Childhood Home Visiting
• Philanthropic, foundation, and private grant funding
• State general funds
• Tax levies and ballot initiatives

See all 14 streams in step 3.

States have reported Medicaid efforts in progress for billing and reimbursement for IECMHC (NCCP 2017 Report (opens in a new tab), NCCP 2023 Report). It’s unclear whether they’re reporting on consultation as a consultative model. Research indicates Michigan is the only state that includes consultation as a Medicaid covered service. No state we’ve found has released information on its success or return on investment.

We worked with one state to explore Medicaid and identified four things to analyze before deciding:

1. Capacity of sites. Is the program equipped to bill Medicaid? Setting up a billing structure for consultation teams takes additional time and resources.
2. Qualifying providers. Providers must meet the state’s qualifications to bill Medicaid. Some consultants might not meet them.
3. Child-focused cases. Medicaid billing is generally for an individual member. Most consultation models encourage classroom- or program-level services.
4. Medicaid-eligible children. You need a way to count the children in child-focused cases who are Medicaid eligible. Some of them won’t be eligible because consultation is typically available at no cost to any adult caring for a child from birth to age 6.

While the Centers for Medicare and Medicaid Services issued guidance in August 2022 (opens in a new tab) encouraging states to avoid requiring a behavioral health diagnosis for some service, there is not a definitive and up-to-date list of states that waive a behavioral health diagnosis, as each state has the flexibility to design its own Medicaid program within federal guidelines. This means requirements for behavioral health coverage can vary by state.

Read how Michigan funds consultation as a Medicaid prevention direct service (opens in a new tab). You can also see Medicaid in step 3.

Three things help. The first is collaboration among early childhood, mental health, child welfare, and health care agencies. The second is a strong cost-benefit analysis. The third is a pilot or demonstration project that shows consultation works. See all three in step 5.

Evaluation data, partnerships, messaging, and public policy are also important levers for sustaining consultation.

Sources of funding for IECMHC vary across the nation, depending on political and economic context. States differ in their financing approaches, but no matter how creative or successful they are in their approaches to funding, advocacy is essential for using existing funding streams and for bringing in new funding to support an IECMHC system.

Use the IECMHC Cost Calculator (opens in a new tab) to find out. ZERO TO THREE built it in partnership with Georgetown University to identify and calculate the costs of a consultation program. The IECMHC cost calculator is for IECMHC professionals, program managers, and administrators and those supporting, designing and managing IECMHC programs. This tool helps determine the true costs of services and supports for infants, toddlers, young children and families and provides evidence-based estimations for infant and early childhood mental health consultation. Price your program in step 2.