Getting started with ECI: Texas early intervention for babies and toddlers, explained

For what it’s worth, this is my own family’s path through this door: we never used ECI. The wait was long enough that we went straight to a home-health provider through our private insurance instead. None of that makes ECI not worth pursuing. Start it anyway, and start the private search at the same time. But it is exactly why this guide exists.

It covers what ECI is, how to start it yourself today, who qualifies and by what numbers, what the first forty-five days look like, what it costs in the program’s own words, and what your rights are once you are in. It is a plain-language guide to a public program, not medical advice: whether your child needs therapy is a question for your pediatrician and the evaluating team. Current as of September 2026.

What ECI is

ECI — Early Childhood Intervention. Texas’s early-intervention program for children from birth until their third birthday who have a developmental delay, or a condition likely to cause one. Every state has this program under federal law (IDEA Part C); ECI is Texas’s name for it. The state agency, Texas Health and Human Services, runs it through local programs, and there is one for every county in Texas. Services are built around your child’s everyday routines, so they usually happen where your child already is: home, or daycare.

How to start it, today, yourself

Anyone can refer a child to ECI, including you. In the state’s own words, a medical diagnosis or a confirmed developmental delay is not needed to refer. You do not need your pediatrician’s permission or a doctor’s order, though a doctor can refer too, and either path works.

• Find your program. Search by ZIP code on the Texas HHS ECI program locator, or call the HHS Ombudsman at 877-787-8999 and choose the ECI option. Some ZIP codes sit on a county line and show two programs; whichever one you call will route you. Care Connect Kids also lists every ECI program in Texas with the counties it serves, so a family anywhere in the state can create a free account and ask the Concierge which program covers their county.
• What the first call sets in motion. The program assigns you a service coordinator, gives you the state’s ECI Parent Handbook, and explains your rights, how eligibility is decided, and what services look like, all before anything is decided about your child.
• Nothing happens without your written consent. Not the screening, not the evaluation, not any individual service, not a change in how often a service happens, and not contact with your child’s doctor or daycare. You can withdraw consent at any time, and declining one service cannot be used to deny another.

Who qualifies, and by what numbers

There are three ways a child qualifies. Only one of them involves a diagnosis.

• A measured delay. The evaluation, done with a tool the state designates, shows a delay of at least 25 percent in one or more areas: communication, thinking, gross motor, fine motor, social-emotional, or self-help skills. If the only delay is in expressive communication, meaning the words your child produces, the bar is 33 percent. Texas measures delay as a percentage, not in months.
• A qualifying medical diagnosis. A diagnosed condition with a high probability of causing delay. The state keeps a searchable public list. A child with a listed diagnosis is eligible without having to show a delay first.
• A hearing or vision impairment that meets the same definitions the Texas Education Agency uses.

Two details that matter more than they sound. First, if your child’s scores fall just short, the team can still find a delay based on informed clinical opinion, and then re-test within six months. Second, once a child is found eligible at 21 months or older, they stay eligible until the third birthday; younger children are re-checked at least yearly, and the bar for continuing is lower than the bar for starting. A child born early has their age adjusted for prematurity until 18 months.

The first forty-five days

The clock starts the day the program receives your referral. By day 45, your child must have a written plan, called an IFSP, the Individualized Family Service Plan, or the program must have documented why not. Only exceptional family circumstances pause it. In between:

• The evaluation. A team of at least two people from different disciplines, one of them a licensed practitioner, evaluates your child across every developmental area. You are part of it; the evaluation is as much conversation as testing.
• The IFSP meeting. A face-to-face meeting with you where the plan is written: your family’s goals for your child, the services that support them, how often, where, and who provides them.
• Services start as soon as possible after you sign consent for each one.
• Reviews. The plan is reviewed at least every six months and rewritten at least yearly, and you can ask for a review at any time.

What the services look like

ECI programs provide service coordination, specialized skills training, speech-language therapy, occupational therapy, physical therapy, nutrition and feeding support, nursing, counseling, and more, depending on what the plan calls for. Two rules shape how it feels:

• The natural environment. Services happen in settings that are normal for a child that age without a disability, which usually means your home or your child’s daycare, with you or the regular caregiver present. The point is to build the work into routines that happen anyway: meals, play, getting dressed.
• Frequency is individualized. The plan sets how often, based on your child and your family. There is no standard weekly amount, and no one should promise you one before the plan is written.

One honest note: each program staffs its own services, and the one you need most can be the one with the line. That is a reason to pursue ECI and private therapy at the same time, not one after the other.

What it costs, in the program’s own words

The state’s sentence is: “ECI asks families who can afford to do so to share in the cost of services. This is called the Family Cost Share.” And its promise is: “No child or family will be turned away because of an inability to pay.” Here is what sits behind those two sentences.

• Always at no cost to you: finding and referring your child, the evaluation and assessment, writing the plan, service coordination, and interpreters or translation, including sign language.
• Services have a monthly maximum charge set by family size and income after allowable deductions, such as childcare and medical costs. It is one maximum per family per month, not per child, and any insurance copays or deductibles you pay for ECI services count toward it.
• The maximum is $0 for families at or below 200 percent of the federal poverty level, for children on Medicaid when you consent to Medicaid being billed, and for children in state conservatorship. Families on CHIP are billed through CHIP like other public coverage; most fall within the $0 income row, so ask your service coordinator where you land.
• Insurance is billed only with your written consent. If you decline, your child still gets services; the family is billed up to its maximum charge instead, and a family with insurance is never charged more than a family without it.

The cost-share agreement has to be signed before services begin, so ask for the current scale at the first meeting. If you think your charge is wrong, there is a set path: the program manager, then a program complaint, then the state Ombudsman.

ECI and private therapy at the same time

Nothing in the rules stops you from doing both, and many families do. ECI is the payer of last resort, which means it bills your insurance or Medicaid before it bills you, so the only real interaction is your insurance plan’s own visit limits. Private therapy is where families go for a specific therapist, a specialty, more intensity, or simply a shorter wait; ECI is where the routine-based, in-home support lives. Our in-home therapy guide covers the private side of the same living room, and the waitlist guide is about the stretch while you wait on either.

Your rights, briefly

• You can decline any service, even one you already accepted, without losing the others.
• You get written notice before the program denies eligibility or changes anything.
• You can see your child’s records, within ten days of asking at the latest.
• You can file a written complaint straight to the state within a year of the problem, without going through the program first, and the state has sixty days to resolve it. Mediation and a hearing exist too. The HHS complaint page has the steps.

Age three, in one paragraph

ECI ends on the third birthday. At least ninety days before it, the program notifies your school district unless you opt out in writing, and it holds a transition conference with you, with the district invited. Your child’s evaluations and plan go to the district only with your consent. The district then runs its own evaluation for school-based services. If a child is referred to ECI fewer than 45 days before turning three, the program sends the referral straight to the district instead. Our age-3 transition guide walks the whole handoff month by month.

Things you will hear that are not quite right

• “ECI is free.” The evaluation, the plan, and service coordination are. Services carry a monthly maximum charge that is $0 for many families and not all.
• “You need a referral from your pediatrician.” You can refer your own child, today.
• “Wait until you have a diagnosis.” A measured delay qualifies on its own, and borderline scores have a path too.
• “ECI is only for babies.” Referrals are accepted until the day before the third birthday, and a child found eligible at 21 months or older stays eligible until three.
• “ECI replaces private therapy.” No rule says so, and many families run both.
• “The school picks up automatically at three.” The district is notified and runs its own evaluation; nothing is automatic, and you can opt out.

Finding pediatric therapy in Central Texas

Care Connect Kids is free for families. Always. Clinics pay for the platform, and speech, occupational, physical, and ABA therapy all live in one place, so the private side of the search runs alongside ECI instead of after it. Every Texas ECI program is listed too, by the counties it serves, so the Concierge can name the one that covers your family wherever in Texas you are.

Not sure whether we reach your family yet? Check your zip code. If you are in Central Texas, the Austin metro page shows where we cover today.