Two decades without a state pay raise, Birth to Three program faces worker shortage

Nicole Sergent, a pediatric physical therapist in Martinsburg, W.Va., works with a child as part of the Birth to Three program. (Submitted photo)

When Kay and Jeremy Rutkowski brought a baby girl in state foster care home from the hospital in 2021, they were told she’d never be able to walk.

A social worker referred the parents, who lived in Inwood, West Virginia, to Birth to Three , a free program that offers a range of in-home services to those who have a delay in their development.

There were weekly physical and occupational therapy sessions, and a $17,000 device — shared with the family at no cost — that helped the now two-and-half-year-old, Lizzie, eventually take her first steps.

“We had a living room full of equipment — all kinds of walkers and seats. We wouldn’t have had any of that without Birth to Three,” Kay Rutkowski said. “If it wasn’t for Birth to Three, Lizzie wouldn’t be able to walk or roll over or crawl.”

Birth to Three has seen a 15% increase in the number of children being served over the past eight years, according to a spokesperson for the West Virginia Department of Health.

As the need has climbed, the pay rate for Birth to Three practitioners hasn’t. Birth to Three rates were last increased in 2003.

Because the program relies on federal disability funding, it can’t turn children away. When there isn’t an available therapist, children can be limited to virtual-only therapy, which can be challenging for little ones who need help learning how to eat, speak or crawl.

“For the first time, we’re finally seeing it affect families — not just us,” said Nicole Sergent, a pediatric physical therapist in Martinsburg who works with Birth to Three. “In a lot of regions we don’t have enough providers, or there isn’t a single provider. [Children] are not able to get all the services they need.”

Kids do better the earlier we intervene. If we’re not careful, these kids won’t be employable because we’re not supporting them and their families.

– Cindy Chamberlin, a Birth to Three physical therapist

Amid Gov. Jim Justice’s repeated calls for a flat budget — and his touting of an $826 million budget surplus — lawmakers trimmed the state health budget in what Republican leaders said was an effort to understand where money was being spent.

Practitioners interviewed for this story said the pay rate, which ranges from roughly $17 to $38 per 15 minutes depending on the specialty, has made it difficult to find and retain workers. They pay for their own gas to drive to families’ homes.

“It’s been 21 years without a cost of living increase,” said Wendy Altizer, owner of Milestones Physical Therapy, which has clinics in Putnam County. “ We need to be able to survive and raise our kids just like everyone else in the job market.”

Sergeant added, “If a practitioner makes $100 for a face-to-face [appointment] now, they need to be paid $165 for the cost of living.”

Birth to Three currently has 850 practitioners serving children and families across the state.

Not every state has a no-cost program like it, which can be especially critical as West Virginia has the highest rate of prenatal exposure to drugs . This puts these children at a higher risk for a variety of physical and mental disabilities.

Cindy Chamberlin is a Birth to Three physical therapist in Beckley. She is West Virginia chapter president of To the Moon and Back , a nonprofit that supports families and children with substance use disorders.

“Kids do better the earlier we intervene,” she said. “If we’re not careful, these kids won’t be employable because we’re not supporting them and their families.”

Pay rate increase could require lawmaker mandate

Birth to Three served 8,277 children in 2022, according to the most recent DoH data available.

“[West Virginia] Birth to Three is fortunate to access several fund sources for the provision of early intervention services,” Gailyn Markham, a spokesperson for the West Virginia Department of Health, said in an email. “Through an interagency agreement, West Virginia Birth to Three services provided to Medicaid eligible children are paid by Medicaid which is estimated at 60% of the children served annually.”

The state’s Children’s Health Insurance Program, known as CHIP, paid for services for children covered by the program. Federal disability dollars contributed to the program, as well.

“Additionally, the annual allocation in the FY 2025 State Budget is $9,291,855,” Markham said. DoH leaders unsuccessfully sought millions of dollars more for the program as lawmakers scrutinize their budget, Mountain State Spotlight reported .

Sergent emphasized that the program saves the state money when children start receiving services at an early age and sometimes no longer need long-term specialized help.

“ I know for certain without our service those students would need an [Individual Education Program],” she said.

Markham said DoH is evaluating a potential change to Birth to Three reimbursement rates.

“Any adjustments in reimbursement may require a request to the state legislature for additional dollars or policy changes to support implementation once the cost analysis is complete,” she wrote.

Sen. Patricia Rucker, R-Jefferson, said she couldn’t get other lawmakers to prioritize a rate increase for the program during the regular session, which wrapped in March.

She has a personal connection with Birth to Three: two of her children benefited from the program.

“It made a huge difference for my children. It was 100% positive … That support that Birth to Three provides to children who have all sorts of disabilities and special needs is crucial,” Rucker said. “In my area, especially, we are not able to keep providers because the salary is already very low in the area I live in.”

The Rutkowskis, like Rucker, live in the Eastern Panhandle — one of the state’s only growing areas in terms of population.

“It would be nice if the governor would have used the money from [tax revenues] to increase infrastructure and increase the rate for Birth to Three,” Jeremy Rutkowski said. “In the Eastern Panhandle, we’ve seen neighborhoods pop up everywhere but not infrastructure. Birth to Three is part of that infrastructure.”

“It’s kind of sickening that children who need help are kind of put on a back burner in West Virginia, and everything else is being pushed ahead,” Kay Rutkowski said.

A spokesperson for Justice did not respond to an email for this story.

Rucker didn’t think the governor’s surplus should fund a rate increase, saying a pay raise shouldn’t be tied to one-year funding.

“Honestly, I feel unfortunately that the Department of Health is not going to prioritize these salaries of the folks who are doing the services until we make them,” she said. “They didn’t increase the salaries of [Child Protective Services] workers until we passed a law making them. I’m against micromanaging, but I think that’s the only way it’s going to happen.”

‘No one is stepping up to advocate for us’

The Rutkowskis adopted Lizzie, who they affectionately called “Lizard.”

Their daughter, who has been diagnosed with autism, is still learning how to talk and recently started using a $9,000 communication device provided at no-cost to her through Birth to Three.

“Developmentally she is functioning at 11 months or a year at almost 3 years old. She has a lot more work to do,” Kay Rutkowski explained. “She may be developmentally delayed, but we would not be where we are.”

Altizer, who has worked with Birth to Three for 21 years, said that the biggest goal of the program is to give hope to families like the Rutkowskis.

“We’re quietly doing the work that makes a difference,” she said.

Chamberlin added, “It’s a passion for us to take care of these kiddos, and we’ve kind of forgotten to take care of ourselves and no one is stepping up to advocate for us.”

Editor’s note: This story has been updated to clarify that Cindy Chamberlin is the West Virginia chapter president of To the Moon and Back.

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