How Services Are Funded
How special-education services are funded in NYC.
Three funding paths
Almost every child we support is funded through one of three routes. The route depends on the child’s age and how the service is authorized, not on what a family can afford.
- 01
IEP / IESP mandate → DOE-authorized
- Who it’s for
- School-age children (roughly ages 3–21) who have a related service (SETSS, speech, OT/PT, counseling, and more) written into an IEP or IESP.
- Who authorizes it
- The NYC Department of Education (or the child's school district) authorizes the mandated service. It is a publicly funded entitlement.
No cost to the family. When a service is mandated on the plan and authorized, the district funds it. Families are not billed.
- 02
IFSP → Early Intervention
- Who it’s for
- Infants and toddlers from birth to age 3 with a developmental delay or a diagnosed condition, whose services are written into an Individualized Family Service Plan (IFSP).
- Who authorizes it
- New York State's Early Intervention program, administered under the NYS Department of Health, authorizes the evaluation and the services on the IFSP.
No cost to eligible families. Evaluation, service coordination, and the IFSP services are provided at no charge when authorized through NYS Early Intervention.
- 03
Insurance / Medicaid
- Who it’s for
- Families seeking evaluations or therapeutic services outside a mandate, or where a plan covers the service, including many children with a qualifying diagnosis under Medicaid.
- Who authorizes it
- Your insurance plan or Medicaid, subject to your specific benefits, medical-necessity criteria, and any prior authorization. Knowledge Road verifies this for you before anything begins.
Verifying your benefits is always free. Any covered service is billed to your plan in the normal way, and we tell you what to expect before it starts.
Mandated and authorized services usually cost families nothing
When a related service is written into an IEP, IESP, or IFSP and authorized by the DOE, your district, or NYS Early Intervention, it is publicly funded. The family is not billed. Cost applies only when a service falls outside a mandate and is billed through insurance. In that case, we verify your benefits and explain any amount before anything begins.
Mandated services
No cost to the family, funded by the DOE or your district.
Early Intervention (birth–3)
No cost to eligible families, funded through NYS.
Insurance / Medicaid
Free to verify; covered services billed to your plan. We tell you the cost, if any, up front.
How we help with funding
Funding rules can be hard to follow. Our coordinators handle the steps families most often find confusing, and we take care of the paperwork.
- Read your child's IEP or IESP with you and explain what it entitles them to
- Providers follow the frequency, duration, and goals written into the plan, so knowing what it says tells you what your child should receive.
- Confirm the mandate and authorization so services start on the right footing
- We check that the service is written into the plan and authorized by the DOE or your district, which is when the district funds it and families are not billed.
- Coordinate Early Intervention from evaluation through the transition at age three
- For infants and toddlers, the evaluation and the services on the IFSP are authorized through New York State's Early Intervention program, and we coordinate each step.
- Verify insurance or Medicaid benefits (at no cost) and explain any out-of-pocket amount in plain language
- We contact your insurer directly before any services begin, and there is no charge to check your benefits or to talk through your child's situation.
- Handle prior authorizations, renewals, and appeals for you
- If a claim is denied, we help gather documentation, coordinate letters from your provider, and submit a complete appeal to the insurer.
No cost to ask
There is no charge to talk through your child’s situation or to verify insurance benefits. Start with a question, and we’ll tell you which path fits.
Common questions about funding
How do your services align with IEP and IDEA requirements?
Every service we deliver maps to the student's IEP or IESP mandate. We work within the framework of the Individuals with Disabilities Education Act (IDEA): providers follow the frequency, duration, and goals written into the plan, document each session, and contribute to the progress reporting that schools and committees rely on at review time.
Does SETSS cost families anything?
When SETSS is mandated on a student's plan and authorized by the DOE, there is no cost to the family. It is a publicly funded service. We coordinate directly within that framework so families aren't out of pocket for a service their child is entitled to.
Does counseling cost families anything?
When counseling is mandated on a student's IEP or IESP and authorized by the DOE or school district, the service is funded by the district. Families are not billed. It is a service the student is already entitled to; our job is to make sure it gets filled.
What does Early Intervention cost?
Nothing, for eligible families. When services are authorized through NYS Department of Health Early Intervention, evaluations, service coordination, and the services on the IFSP are provided at no cost to the family.
How do I know if my insurance covers the services my child needs?
Coverage depends on your state, your plan type (including whether it's self-funded), medical-necessity criteria, and whether prior authorization is required. We contact your insurer directly to verify benefits and explain, in plain language, what your specific policy covers before any services begin.
Do you work with Medicaid?
We work with Medicaid in the locations where we are enrolled as providers. Medicaid coverage for therapeutic services varies by state: many states cover services for children with a qualifying diagnosis, often under EPSDT for children under 21. We'll confirm eligibility and any cost-sharing for your plan.
What does the verification itself cost?
Nothing. There is no charge for us to verify your benefits and walk you through your options. When a service is covered, it is billed to your insurance plan in the normal way.
What happens if a claim is denied?
We help families through the appeals process: gathering documentation, coordinating letters from your provider, and submitting a complete appeal to the insurer. A denied claim can still be appealed.
For help with insurance, see our insurance coverage guidance, or contact our team or call (718) 540-8268.
If you cannot tell who is supposed to pay for this
- The school handed me an RSA letter and told me to find a provider myself.
- An RSA means the school system has no staff available for that service right now. It lets you use an independent provider at no cost to you, as long as the provider is state licensed and cleared by NYC Public Schools. Call us with the letter and we will confirm the mandate and authorization with you.
- Early Intervention asked for our insurance card. Are we going to get a bill?
- NYC Health says Early Intervention is provided at no cost to families. If you have health insurance or Medicaid, it is used to help pay for services, at no direct cost to you. We coordinate Early Intervention from evaluation through the transition at age three, and can walk you through the steps.
- The school said no to a service. Can insurance pay for it instead?
- They are separate systems with separate tests. A school team looks at what your child needs to learn, and a health plan looks at medical necessity, so a denial from one does not decide the other. There is no charge to talk it through, and we will tell you which path fits.
- Your child's date of birth
- The IEP, IESP or IFSP, if there is one
- Any RSA or other authorization letter
- Insurance or Medicaid card, if a service may go that way
- Any evaluation or diagnosis report
You can call without all of these. We will work out the rest with you.
More on getting services started
Education Services
The full catalog of K-12 related services (SETSS, therapies, evaluations, and early intervention) and the coordination team behind them.
Insurance Coverage Guidance
Plain-language help verifying benefits for evaluations and therapeutic services: Medicaid, private, and employer plans. No cost to verify.
Ask which funding path fits your child.
Tell us your child's age and what their plan says. We respond within 24 hours, typically within 4–6 hours, explain the funding route in plain language, and confirm there's no cost when a service is mandated.
