Children with disabilities are protected by the Individuals with Disabilities Act (IDEA) program and starting at age 3 they are guaranteed access to free and appropriate education through this program.
Access to childcare providers is more limited for disabled children.
Missouri is the only state to fully cover the cost of child care for disabled children from eligible families.
Children with disabilities are covered by the federal Individuals with Disabilities Act (IDEA) program (DESE 2023) (DESE 2023) (Census 2022). IDEA mandates that starting at age 3, children covered by IDEA programs have access to free preschool which is provided through Head Start, the government-subsidized preschool program (Dept of Ed; HSS). IDEA does not mandate free child care for children ages 0-2 (Dept of Ed). Current national data show that about 15% of children younger than 6 have disabilities that may require services, but fewer than 6% of these children receive services through the IDEA program (Urban Institute 2018). To learn more about IDEA, read our science note on Special Education in Missouri.
Low-income families are disproportionately impacted by the lack of services for children with disabilities. They are exposed to conditions that increase the likelihood of a child requiring disability services, and the increased costs of caring for a disabled child contribute to financial difficulty (Urban Institute 2018).
The price of licensed child care is 13% of an average Missouri family’s income (ChildCare Aware 2020). Children with disabilities are more likely to be in a paid childcare setting such as home/ center-based care, other types of early care and education (summer camp, after-school programs, etc.), or combinations of care type compared to children without a disability (OPRE 2020). Additionally, center-based providers were more likely to be currently serving a child with a physical impairment compared to home-based providers (33% vs 21% respectively; OPRE 2020). In MO, center-based care costs $818 per month for infants and toddlers while home-based care costs $489 per month for infants and toddlers (ChildCare Aware 2020).
Currently, there are not enough childcare providers to meet the need in MO with 57 childcare slots for every 100 children under 6 whose parents work (ChildCare Aware 2020). This lack of access is compounded for disabled children. Nationally, most childcare programs were not currently providing child care for children with disabilities at the time of the survey (OPRE 2020).
Lack of care is partly because childcare centers are unable to afford the necessary training and equipment required to safely provide care for a disabled child. Large centers are more likely to have the finances necessary to make this investment (Urban Institute 2018). To be compliant with the Americans with Disabilities Act, all childcare centers must assess each child who applies to enroll in their center to determine if their program can meet the needs of a disabled child without fundamentally altering the program or without introducing a threat to the health and safety of others (ADA).
However, in MO, facilities can contact United4Children to help their program meet the needs of a disabled child. They are a non-profit organization whose inclusion specialists provide on-site observation, technical assistance, short-term consultation, and training for childcare providers to ensure appropriate care for disabled children statewide. They also have a database that lists all licensed childcare facilities in MO. Program details include if the provider cares for disabled children and if so the nature of the disability as well as facility type, capacity, hours, if subsidies are accepted, and more (United4Children).
Read our Science Note Child Care Access to learn why there are not enough childcare providers and the impact it has on Missouri families.
Figure 1. States can increase access to childcare subsidies to eligible families by either guaranteeing a subsidy for a disabled child (yellow) or by prioritizing a disabled child on the wait list (blue). In some states, disabled children are given the same priority as other children (gray), and some states do not mention what level of priority a disabled child is given (striped). Data from CCDF Policies Database 2021
The first strategy provides a childcare subsidy for families of disabled children. States manage these subsidies one of three ways: by specifically reserving a number for disabled children, prioritizing disabled children within the applicant pool, or expanding the eligibility for families with disabled children (Figure 1; Supplemental Table 1). When the number of applicants to the program exceeds funding, children are put on a wait list, where states continue to prioritize enrollment of disabled children (DESE 2023).
In MO families with disabled children who earn less than 242% of the federal poverty level (FPL) are eligible for a childcare subsidy which fully covers childcare costs. Also, the children are prioritized on the waiting list (Figure 1). For comparison, the childcare subsidy in MO for the general population covers:
MO is the only state to have waived copayments for families of disabled children (OPRE 2021). The increase in income eligibility was enacted July 2023 from legislation passed in 2023 (MO DESE 2023).
The second strategy is to increase the number of childcare providers who will care for disabled children. States have tried to do this by offering a higher payment rate compared to the general population or by paying for training and resources that a childcare facility needs to care for a disabled child. In MO, providers are paid a 25% enhanced rate for caring for disabled children needs (MO CCDF 2022).
