Services & eligibility primers
The systems built around a child or person with complex needs are a maze. Early intervention, school services, insurance, eligibility, benefits — each one has its own rules, its own forms, its own quiet deadlines, and its own language that nobody ever sits you down and explains. You are expected to navigate all of it while also doing the actual caregiving, and nobody hands you a map at the door.
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These primers are that map. They are short, plain-language orientation to the systems you have to deal with — written so you can read one in a few minutes and walk into your next conversation less lost. They are not advice, and they do not make decisions for you. The specifics of your situation belong to your team, your district, and your plan. What CareHaven does is explain the landscape in everyday words, so when someone says "we'll need a prior authorization for that" or "she'll transition to Part B at three," you already know roughly what they mean and what to ask next.
You can read these any time, and they work offline. Nothing you read is tracked, and nothing here is shared. To find them: menu icon -> Settings -> About & Help -> Caregiver Education.
Turning 3: from Early Intervention to school services
When a child has been getting help through Early Intervention (EI) — the birth-to-three system that supports babies and toddlers with developmental delays or disabilities — that support does not last forever. Early Intervention ends at age three. It is not that your child stops needing help. It is that the system responsible for providing it changes hands.
Around the third birthday, responsibility moves from Early Intervention to the school system. This is sometimes called the move from Part C to Part B of a federal law called the Individuals with Disabilities Education Act (IDEA). In plain terms: a different set of people, usually your local school district, takes over. Instead of an Individualized Family Service Plan (IFSP), your child may now have an Individualized Education Program (IEP) — a written plan, run through the school, that lays out the services and supports they will get. Many children this age start in preschool special education.
A few things tend to surprise families, so it helps to know them ahead of time:
- The planning starts early. Transition planning usually begins several months before the third birthday — often around six months ahead — not on the birthday itself. There is meant to be time to evaluate your child, decide what they qualify for, and have a plan ready.
- A new evaluation may happen. The school district may do its own assessment to decide whether your child is eligible for services and what those services should be. Qualifying for Early Intervention does not automatically mean qualifying for school services — the criteria can be different.
- The goal is no gap. Ideally, services continue without a break when your child turns three. That does not always happen on its own. Knowing the timeline lets you gently keep things moving.
- The setting changes. School services often look different from what you had at home. Therapies may happen at a school, on a schedule, with new faces. That can be an adjustment for everyone.
- If your child qualifies, school services are free to you. When a child is found eligible under IDEA Part B, the special education and related services written into the IEP are provided at no cost to the family. And being in Early Intervention does not automatically mean a child will qualify — some children are found eligible, and some are supported in other ways.
None of this is something you have to manage alone, and the details depend entirely on where you live and your child's specific needs. Two places to know about: your Early Intervention agency, and your state's Parent Training & Information (PTI) center — a federally funded center that helps families understand this process, listed in Resources, though what each one offers varies. This primer is here so the words and the rough shape of the process are familiar before you are in the room. Available
Questions you may want to ask your team
When you sit down with your Early Intervention team or your school district during this transition, it helps to walk in with your questions already written down. Here are plain-language ones you can borrow or adapt:
- When does transition planning start for my child, and what is the timeline between now and the third birthday?
- How will the move from our Early Intervention plan (the IFSP) to a school plan (an IEP) work, and is there anything you'll need from me along the way?
- Who from the school district will be involved, and who should I contact with questions?
- Will my child be evaluated again, and if so, when, and what does that evaluation look at?
- How will my child's Part B eligibility be reviewed, and how will we hear the outcome?
- What does my child need to qualify for school services, and how is that decided?
- If my child isn't found eligible for an IEP, what other kinds of support might be available, and who can help us understand them?
- If my child qualifies, what is an Individualized Education Program (IEP), and how is it written?
- Will there be a transition meeting, and can I be part of it?
- What will the services look like — where will they happen, how often, and who will provide them?
- For my child, around when might transition planning begin, and what steps would we go through together?
- How do we make sure there is no gap in services when my child turns three?
- What can I do now to help this go smoothly, and what paperwork should I be gathering?
- If the setting or plan changes, how can we hold on to what's been working for my child?
- What happens if I disagree with the evaluation or the plan — what are my options?
You do not have to ask all of these, and you do not have to ask them perfectly. Pick the ones that matter for your situation. If you want help shaping your asks and keeping them straight across meetings, Advocacy & goals is built for exactly that.
General orientation, not legal advice. The specifics of your child, your district, and your plan belong to your team — they are the ones who can answer for your situation.
Insurance basics: prior authorization and appeals
Two parts of dealing with insurance trip families up more than almost anything else: prior authorization, and what to do when something is denied. Neither is as mysterious as it feels once you know the shape of it.
Prior authorization is when your insurer wants to approve a service, medication, therapy, or piece of equipment before they will agree to pay for it. Your doctor or provider usually sends the request, the insurer reviews it, and they say yes or no. It is a common, ordinary step — not a sign that anything is wrong. The frustrating part is the waiting and the not-knowing. A few things that help:
- Ask early. When a doctor recommends something new, it is fair to ask, "Will this need a prior authorization, and who submits it?" Knowing up front saves you a scramble later.
- It can take time. Approvals are not always instant. Asking roughly how long it usually takes helps you plan around it.
- A denial of authorization is not always final. If a prior authorization is turned down, that decision can often be challenged, just like a denied claim.
Appeals are what you do when a claim or a service is denied. This is the part to hold onto: a denial is not the end of the road. Insurers deny things for many reasons — a missing form, a coding error, a service they want more information about — and many denials are overturned when families push back. You usually have the right to appeal, and there is normally a process and a deadline for doing it.
What makes appeals go better is rarely cleverness. It is a paper trail. When you can show what was said, by whom, and when — the denial letter, the dates you called, the name of the person you spoke to, what they told you — you are in a far stronger position. A calm, organized record does more than a heated phone call ever will.
There is often more than one level to an appeal. Many plans have an internal appeal process, and some denials may also qualify for an external (independent) review by someone outside the plan — whether that applies depends on your plan and on your state's or federal rules. Plans also set their own deadlines, and they can be short, so the dates on the letters they send you matter.
A few places to turn: your plan's member-services line and your provider's office handle the details of your specific case; many states have an insurance-assistance program for appeal questions; and for disability-rights questions, your state's Protection & Advocacy (P&A) agency, listed in Resources, can be a starting point. And if you want all of this in one place, CareHaven's Insurance hub can keep track of prior authorizations, claims, and deadlines for you.
This is orientation, not insurance advice. The exact rules, deadlines, and appeal steps come from your specific plan and the letters they send you — read those carefully, and ask your plan to walk you through anything that is unclear. What this primer gives you is the reassurance to know that a denial is a starting point, not a verdict, and the instinct to keep your records as you go. Available
These are primers, not paperwork
A few things to keep in mind. These primers are educational orientation — plain-language explanations of how these systems generally work. They are not legal, medical, or insurance advice, and they are not a diagnosis. The specifics of your child, your district, and your plan belong to your team, and they are the ones who can give you answers for your situation.
CareHaven also does not file anything for you. It will not submit a prior authorization, request an evaluation, or send an appeal. What it does is help you walk in prepared and keep track of what happens. The Communication Log is your paper trail — a place to record every call and email, who you spoke to, and what they said, so that when you need that record for an appeal or a meeting, it is already there. The Resources library is where you keep the documents, links, and references you have gathered. And when a decision feels heavy, Working through a care decision gives you a calm space to think it through.
More primers may join this set over time, covering other systems families have to navigate. Planned
If a word here is new to you, the Glossary explains the terms in the same plain language. You are not behind for not knowing this already. Almost nobody is taught it. The point of these primers is simply that you walk in a little less lost than you did before.