The Build Back Better Act (BBBA), the budget reconciliation package that passed the House in November 2021 and is currently being considered by the Senate, includes a range of health and other proposals supported by President Biden, including a proposal to allow the federal government to negotiate the price of some prescription drugs covered under Medicare Part B (administered by physicians) and Medicare Part D (retail outpatient drugs). The negotiation proposal in the BBBA would apply to a limited number of drugs or biologics, as well as all insulin products. The negotiated prices for the first set of selected drugs covered under Part D would take effect in 2025. For drugs covered under Part B, the earliest negotiated prices could first take effect is 2027.

Compared to previous legislation passed by the House in 2019, the BBBA scales back the number of drugs that could be eligible for negotiation and also includes specific criteria for excluding drugs from the negotiation process. In additional to negotiating the price of all insulin products starting in 2025, the BBBA allows price negotiation for no more than 10 Part D drugs in 2025, 15 Part D drugs in 2026, 15 Part D and Part B drugs in 2027, and 20 Part D and Part B drugs in 2028 and later years. In contrast, the earlier proposal would have allowed the government to negotiate drug prices for up to 250 single-source Part B and Part D plus all insulin products. Both legislative proposals would negotiate prices only for those drugs lacking generic or biosimilar competitors. The BBBA also exempts drugs from the negotiation process if they are within several years of their FDA approval date – 9 years for small-molecule drugs and 13 years for biologics – an exemption not included in the earlier proposal.

This brief illustrates the potential scope of the drug price negotiation proposal in the BBBA. In the first part of our analysis, we show the 20 drugs covered under Medicare Part B and Part D that, along with all insulin products, would be subject to negotiation under the BBBA if the proposal was fully implemented this year (rather than in 2028). This analysis is designed to highlight the types of Medicare-covered drugs that could be subject to negotiation. Because the actual implementation date is 2025 (for Part D drugs) and 2027 (for Part B drugs), the list of Part B and Part D drugs that would be subject to negotiation if the BBBA was enacted would likely be different than what our analysis shows, since it would be based on future spending and market dynamics (in particular, the introduction of generic equivalents).

In the second part of our analysis, we show which of the current top-spending drugs covered by Part B and Part D could be subject to price negotiation, and in what years, starting in 2025 (Part D) and 2027 (Part B) when the BBBA proposal would take effect, assuming no generic or biosimilar entry in the intervening years. We also highlight which of the current top-spending drugs would not be subject to negotiation at any point due the BBBA provision that excludes drugs with generic or biosimilar equivalents from the negotiation process.

To derive our list of 20 negotiated drugs, we followed the selection process specified in the BBBA. Drugs were selected for negotiation if they ranked among the top 20 drugs in a combined ordering of Part B and Part D drugs based on Medicare drug spending data for 2019 (the most current publicly available data), ranked by total gross spending for drugs and biological products without generic or biosimilar equivalents, after eliminating products exempt from negotiation based on criteria specified in the BBBA. The gross spending amount used to determine top-spending Part D drugs under the BBBA includes Medicare spending and beneficiary liability but does not exclude the value of rebates. (See Methods for additional details on our analysis.)

Findings

If the drug price negotiation proposal in the BBBA was fully implemented in 2022, the 20 negotiated drugs based on total gross spending would include 18 Part D drugs and 2 Part B drugs, in addition to 42 insulin products. These drugs were used by 8.5 million Medicare beneficiaries in 2019.

• Total gross spending on the 20 Part B and Part D negotiated drugs in our simulation in 2019 ranged from a high of $4.0 billion for Xarelto, a Part D drug used to treat blood clots, down to $0.5 billion for Combivent Respimat, a Part D drug for chronic obstructive pulmonary disease (Table 1). The number of beneficiaries who used these 20 drugs in 2019 ranged from a high of 1.1 million Part D enrollees using Xarelto down to 1,600 Part B enrollees using Soliris, an immunosuppressive drug.
• In total, 3.2 million Medicare beneficiaries enrolled in Part D used one of the 42 insulin products covered under Part D in 2019 that would be subject to price negotiation, including 1.7 million beneficiaries who did not receive low-income subsidies (Table 2). In addition to the potential for cost savings attributable to lower negotiated prices, Part D enrollees who do not receive low-income subsidies may see lower out-of-pocket costs for insulin products based on the BBBA proposal requiring Part D plans to charge no more than a $35 monthly copayment or 25% of the negotiated price for insulin.
• Taken altogether, a total of 8.5 million Medicare beneficiaries in 2019 used one or more of the 20 drugs that would be subjection to negotiation based on their gross spending amount and the 42 insulin products that would also be subject to negotiation, accounting for nearly one in five (18%) of the 47.7 million Medicare Part D enrollees in 2019. This total includes 4.8 million beneficiaries who did not receive low-income subsidies, accounting for 14.4% of the 33.7 million Part D enrollees not receiving low-income subsidies in 2019.

Of the top 20 Part B drugs and top 20 Part D drugs with the highest total Medicare spending in 2019, negotiated prices could be available for nearly half of these drugs starting in 2025 for Part D drugs or 2027 for Part B drugs if no generics or biosimilars come to market and they remain among the top spending drugs.

• Among the top 20 Part D drugs ranked by total gross spending in 2019, 11 drugs would meet the criteria for negotiated prices beginning in 2025 and 1 would meet the criteria in 2028 if no generics or biosimilars come to market and they remain among the top Part D drugs by total spending (Table 3). (Note, however, that the BBBA only allows negotiated prices for up to 10 Part D drugs in 2025.) However, 8 of the top 20 Part D drugs would not qualify for negotiation at any time because they are a reference product for a generic or biosimilar. This includes several drugs with relatively high average out-of-pocket spending by Part D enrollees, such as Revlimid, Imbruvica, and Humira.
• Among the top 20 Part B drugs ranked by total spending in 2019, 7 drugs could be eligible for negotiated prices in 2027 and 6 could be eligible between 2028 and 2031 if no generics or biosimilars come to market, they remain among the top Part B drugs by total spending, and they rank high enough in a combined ranking of Part B and D drugs (Table 4). However, 7 drugs would not qualify for negotiation at any time because they are a reference product for a generic or biosimilar, including Part B drugs with relatively high average beneficiary liability, such as Rituxan, Alimta, and Herceptin.

Discussion

This analysis shows the potential reach of the BBBA drug price negotiation proposal, under the scenario that negotiated prices for 20 Part B and Part D drugs were to take effect in 2022, rather than in 2028. We find that most drugs selected for negotiation in our simulation would be Part D drugs, not Part B drugs. This is not unexpected since most Medicare-covered drugs are covered under Part D, rather than Part B. We also find that nearly 1 in 5 Part D enrollees in 2019 used one of the 20 negotiated drugs or 42 insulin products in our analysis. In addition, we find that more than half of the 20 Part B drugs and 20 Part D drugs with the highest gross total spending in 2019 would meet the criteria for negotiation between 2025 and 2028 (for Part D) or between 2027 and 2031 (for Part B) if no generics or biosimilars come to market. At the same time, many of the top-spending drugs covered under Medicare currently have generic or biosimilar equivalents, and therefore are not eligible for negotiation under the BBBA criteria.

Overall, our analysis suggests that the negotiation proposal in the Build Back Better Act could help to lower drug prices for some of the top-spending drugs covered under Medicare Part B and Part D, but some of the drugs with the highest total Medicare spending currently would be exempt from the negotiation process. These selection and exclusion criteria help to explain why the Congressional Budget Office estimated significantly lower 10-year federal savings from the drug price negotiation proposal in the BBBA (~$80 billion) compared to earlier legislation (~$450 billion).

For this analysis, we simulated the process of selecting negotiation eligible drugs under the approach proposed in the Build Back Better Act (BBBA), using 2020 as the first year of selecting products for negotiation. Using the same two-year timeframe as the negotiation process in the BBBA, drugs selected for negotiation in 2020 would have their negotiated price available in 2022. We determine whether any of those drugs would be eligible for the negotiation process based on the approval date, orphan drug status and indications, whether the total expenditure exceeds the $200 million expenditure floor, and status as a reference product for a biosimilar/generic.

For top-spending Part B and Part D drugs, negotiation eligible drugs would be a selected drug in 2020 based on the following criteria:

• for biologics, approved/licensed prior to 2009 (since that is at least 11 years from a hypothetical February 1, 2020 selected drug publication date, assuming implementation in 2022 for this analysis)
• for small-molecule drugs, approved/licensed prior to 2013 (since that is at least 7 years from a hypothetical Feb 1, 2020 selected drug publication date, assuming implementation in 2022 for this analysis)
• does not have an approved generic/biosimilar
• is not designated as an orphan drug; has approved orphan drug designations for more than one rare disease/condition; or is past the orphan exclusivity period
• above $200 million in total Part B drug spending and total Part D spending combined
• is not derived from human whole blood or plasma

For drugs with multiple formulations and/or dosage amounts we combine the drugs into one and use the same criteria. We use the earliest, non-discontinued FDA approval date among the combined drugs and consider them to have a generic/biosimilar or orphan exclusivity if any one does. The BBBA provides some latitude to the Secretary of Health and Human Services for handling drugs with multiple formulations and/or dosage amounts which may result in differences with our methodology during a negotiation selection process.

To calculate the spending and count of beneficiaries for a drug, we used 2019 claims data for Part B drugs and 2019 prescription drug event data for Part D drugs from a 20% sample of Medicare beneficiaries, removing drugs taken by fewer than 11 beneficiaries in the sample. Part B claims include beneficiaries in traditional Medicare only; Part D claims include beneficiaries in stand-alone prescription drug plans and Medicare Advantage drug plans. Using HCPCS for Part B drugs, claims were pulled from the outpatient, carrier, and durable medical equipment (DME) files, removing packaged drugs, vaccines, and claims from Maryland hospitals, Critical Access Hospitals, and dialysis facilities. Data on the approval date, generic/biosimilar reference status, and orphan status come from the FDA Orange Book (for small-molecule drugs) and Purple Book (for biologics).

To derive the top 20 separately payable Medicare Part B drugs and top 20 Medicare Part D drugs by total spending in 2019, we adjust the spending and beneficiary counts to be representative of the population. For drugs with multiple formulations and/or dosages, we add the individual total spending amounts together and count the number of unique beneficiaries (if a beneficiary switched between formulations during the year, they would only be counted once). Total spending includes the amount paid by Medicare and the beneficiary liability amount. Part D spending does not account for rebates; however, under the BBBA, Part D drugs would be ranked based on total gross spending not accounting for rebates.

Key Takeaways

The COVID-19 pandemic created unprecedented health and education challenges for children with disabilities, many of whom receive special education services. Recently, the Omicron variant, slowing vaccination rates among children, and state bans on school mask mandates have impacted school operations during the new year as well as the health, safety, and educational progress of children with special education plans. Many children receiving special education services have substantial health care needs, and services available through a child’s health insurance plan, such as Medicaid, can complement special education services. This brief describes how Medicaid and special education services work in meeting children’s needs, explores how the pandemic has affected children who receive special education services, and identifies key issues to watch moving forward. Key findings include the following:

• If a child is eligible for both special education services and Medicaid, federal law requires state Medicaid programs to pay for services that are both educationally and medically necessary.
• Medicaid/CHIP covers half of all children with special education plans. Children with special education plans covered by Medicaid/CHIP are more likely to have greater health needs compared to those with private insurance only.
• The onset of the pandemic and ensuing school closures created disruptions and challenges in how children received special education services. Many children with special education plans experienced missed or delayed services and loss of instructional time during the pandemic.

Students with special education plans may be entitled to compensatory services to make up for lost skills due to pandemic related service disruptions, and some children, such as those with disabilities related to long COVID, may be newly eligible for special education services. Medicaid can play an important role in ensuring that children receive preventive services that may have been delayed during the pandemic and access services to address needs that may have arisen due to the pandemic.

Introduction

The COVID-19 pandemic has had a disproportionate impact on people with disabilities, including children, whose health and functional needs place them at increased risk of severe illness or death from COVID-19 and who may require special education services that may not be adequately provided in education settings modified by the pandemic. There are an estimated 6.7 million children¹ , or 9% of all children in the U.S., who currently have special education plans² , and over two-thirds of these children have special health care needs.³  Throughout the pandemic, these children have experienced delayed or missed services and losses in instructional time, which can have implications for their ability to continue to progress in their education. As a major health insurance provider for children with special education plans, Medicaid can provide important services to these children as well as ensure that children receive other preventive services that may have been delayed during the pandemic and access services to address needs that may have arisen due to the pandemic, such as mental health treatment.

While students have largely returned to in-person learning this school year, challenges for children receiving special education services remain. A number of lawsuits are challenging state bans on school mask mandates, arguing that these bans violate the right of children with disabilities to safely attend school. Further, the recent, rapid spread of the Omicron variant has created additional instability for students and some schools have temporarily switched to remote learning, a move that may make it difficult to provide all needed services to children with special education plans. While the Pfizer-BioNTech COVID-19 vaccine is now authorized for school-aged children, vaccination among young children is not yet widespread. This brief explains how Medicaid and special education services intersect, explores the pandemic’s implications for children receiving special education services, and identifies key issues to watch moving forward. For additional context, the appendices provide information on what is required under federal special education law and includes supporting data tables.

What is the intersection between Medicaid and special education services?

If a child is eligible for both special education services and Medicaid, federal law requires state Medicaid programs to pay for services that are both educationally and medically necessary. This is an exception to the general rule that usually makes Medicaid the payer of last resort when other sources of coverage are available. If a device or service included in a child’s special education plan under the Individuals with Disabilities Education Act (IDEA) is also medically necessary, then Medicaid is obliged to pay before the school district.⁴  For more on what is required under the federal IDEA, see Appendix A. Children also may qualify for additional services covered by Medicaid, beyond what is required by the IDEA. For example, a child with cerebral palsy may need physical therapy to improve mobility and manage muscle contractures. The IDEA might require the school district to provide physical therapy so that the child can access and progress in their education, such as therapy targeted to moving around the school or developing skills related to their educational goals. If the child requires additional physical therapy for other purposes, such as to facilitate their ability to transfer in and out of a wheelchair at home or skills needed to access the community outside of school, such services could be “medically” but not “educationally” necessary and therefore available under Medicaid.

The scope of services that must be provided to children under federal Medicaid law is broader than what is required under the IDEA’s definition of “related services.” The Early Periodic Screening Diagnostic and Treatment (EPSDT) provision requires state Medicaid programs to cover all services that are “necessary. . . to correct or ameliorate. . .  physical and mental illnesses and conditions. . . .”⁵  Like the IDEA, EPSDT applies to Medicaid enrollees from birth through age 21. To receive federal matching funds, state Medicaid programs must cover a minimum set of services for adults (such as inpatient hospitalization and physician services) and can choose to cover additional services (such as private duty nursing and rehabilitative services). However, EPSDT means that there are no “optional” services for children; instead, if medically necessary, all services must be covered for children, regardless of whether the state chooses to cover them for adults.

Medicaid, together with the Children’s Health Insurance Program (CHIP), covers half of all children with current special education plans (Figure 1). Medicaid/CHIP is the only source of coverage for nearly four in 10 children nationwide receiving special education services, while over one in 10 have Medicaid/CHIP to supplement private insurance. Medicaid covers services that private insurance typically does not, including long-term services and supports (LTSS) and home and community-based services (HCBS), and has cost-sharing protections that help keep health care affordable for families. The share of children with special education plans covered by Medicaid/CHIP varies by state, ranging from 26% to 71%, reflecting variation in state choices about optional Medicaid eligibility pathways for children with disabilities (Appendix B Table 1).

A majority of children with special education plans covered by Medicaid/CHIP alone are children of color and live in low-income households (Appendix B Table 2). Medicaid/CHIP-only children with special education plans are more likely to be non-Hispanic Black or Hispanic compared to children with private coverage only. Medicaid/CHIP-only children with special education plans also are more likely to live in a household with an income at or below 138% of the federal poverty level (FPL, less than $29,974/year for a family of three in 2020) when compared to those with private insurance only. Additionally, most children (68%) receive their first special education plan between the ages of 4 and 11 regardless of health coverage type.

Children with special education plans covered by Medicaid/CHIP are more likely to have greater health needs compared to those with private insurance only. Medicaid/CHIP-only children with special education plans are more likely to have multiple chronic conditions and multiple functional difficulties, with over half of the Medicaid/CHIP-only group reporting four or more functional difficulties or four or more chronic conditions, compared to 38% of those with private insurance only (Appendix B Table 2). Further, children with special education plans covered by both Medicaid/CHIP and private insurance are more likely than children covered by Medicaid/CHIP alone to have four or more functional difficulties, four or more chronic conditions, or three or more service needs. These children are also more likely than children with Medicaid/CHIP alone to have special health care needs and health that usually or always affects daily activities somewhat or a great deal. Medicaid coverage can address gaps in private coverage, and children covered by both Medicaid/CHIP and private insurance often have complex health needs and are more likely to be eligible for Medicaid through a disability-related pathway. Further, parent/caretakers of Medicaid/CHIP-only children with special education plans are also more likely to parent alone and face challenges with their own physical and mental health compared to those with private insurance only.

How has COVID-19 affected children’s access to special education services?

Many children with special education plans experienced missed or delayed services and loss of instructional time during the pandemic. One report estimates that school attendance and engagement has declined since the start of the pandemic, with early data suggesting larger declines for children with disabilities. A survey released early in the pandemic (May 2020) found 40% of parents of students with special education plans reported their child was not receiving any support, and only 20% reported their child was receiving all the services they required. School districts reported it was more or substantially more difficult to provide hands-on instruction accommodations and services such as speech, physical, or occupational therapy during pandemic school closures. Students with disabilities experienced a loss of instructional time, and may have started the 2021 school year up to one year behind. Remote learning may have also been hindered by a lack of access to the internet and assistive technology to which students with disabilities have access when attending school in-person. Low-income children and children of color faced increased health and economic challenges during the pandemic, and children with special education plans within these groups, many of whom are covered by Medicaid/CHIP, likely faced additional barriers to learning and accessing services during the pandemic.

Students with special education plans may be entitled to compensatory services to make up for lost skills due to school closures or other pandemic related service disruptions. The Department of Education (DOE) guidance advises special education teams to make individualized decisions about the needs for additional services as schools return to normal operations. The American Academy of Pediatrics noted the “critical” role of school-based services such as physical, occupational, and speech-language therapies and mental health services which often were disrupted during the pandemic. Other researchers have found service disruptions in these areas during the pandemic, noting that some services “may be challenging or even impossible to deliver virtually,” leaving children with special health care needs who could not receive in-person services with unmet needs. Further, according to DOE guidance, some children may be newly eligible for special education services, as those with disabilities related to long COVID can qualify for services under the IDEA or Section 504. For more information about eligibility under both laws, see Appendix A.

What are key issues to watch going forward?

As most schools returned to in-person learning in the fall of 2021, lawsuits have been filed in a number of states challenging government bans on school mask mandates as violating the rights of children whose health conditions put them at increased risk of severe illness or death from COVID-19. Although the CDC recommends distancing and masks for all staff and students regardless of vaccination status for in-person learning, some state and local governments have prohibited school districts from adopting school mask mandates. Multiple lawsuits have been filed arguing that these bans prevent children with disabilities from attending school safely in person, in violation of the Americans with Disabilities Act and Section 504. Federal district courts in Iowa, South Carolina, and Tennessee have granted preliminary injunctions blocking governors’ bans on school mask mandates. On the other hand, the 5^th Circuit Court of Appeals has put on hold a Texas federal district court’s permanent injunction that blocked a governor’s ban on school mask mandates, which means that the ban will go into effect while the appeal is pending. Additionally, a Florida federal district court denied a motion for a preliminary injunction in a case seeking to block a similar governor’s ban. All of these cases are currently on appeal.

Some school districts are struggling to stay open amid the rapid spread of the Omicron variant. Despite calls from the Biden Administration, governors, and mayors for schools to remain open, many school districts have decided to temporarily return to remote learning following the recent spike in COVID-19 cases. School districts are facing high case rates among students and staff, making it difficult to re-open and maintain student safety. At the same time, returning to virtual learning makes it more difficult for school districts to provide all needed services to students with special education plans and may put these children at further risk for falling behind.

COVID-19 vaccine uptake among young children has slowed. Children ages 5 and older are now eligible to be vaccinated against COVID-19. Following an initial wave of enthusiasm and a slight uptick for a period in December, vaccine uptake among 5-11 year-olds, who recently became eligible, has declined. As of January 12, 2022, 27% of 5-11 year-olds and 64% of 12-17 year-olds have received at least one dose of the COVID-19 vaccine. There may be unique challenges to vaccinating young children, particularly those from low-income families who may face additional barriers to access, and Medicaid can play a role in facilitating access to vaccines for these children. Further, the US Food & Drug Administration’s (FDA) recently authorized booster shots of Pfizer-BioNTech’s COVID-19 vaccine for children ages 12 to 15.

Children who receive special education services already faced disparities compared to their non-disabled peers and lost instructional time and disruptions in access to related services during the pandemic have exacerbated those differences. Medicaid, together with CHIP, covers half of children with special education plans, and these children have greater health needs compared to children with special education plans covered by private insurance. This means Medicaid supports children with special education plans by providing both educationally and medically necessary services as well as ensuring that children receive the other medical and preventive services they need.

Appendix A

What does federal special education law require?

Under the federal Individuals with Disabilities Education Act (IDEA), school districts must provide children with disabilities with the services necessary to receive a “free appropriate public education.” ⁶  The IDEA applies to children from birth through age 21⁷  and also provides federal funds to assist states with meeting these obligations. Under the IDEA’s “child find” requirement, states must identify and evaluate all children with disabilities, including those who are homeless and those who attend private schools.⁸  A parent also may request an evaluation for their child. A team of “qualified professionals” and the child’s parent then reviews the evaluation findings to determine whether the child meets the IDEA’s definition of a “child with a disability.”⁹  Children qualify if they are in need of special education and related services due to an intellectual disability, hearing impairment, speech language impairment, visual impairment, emotional disturbance, orthopedic impairment, autism, traumatic brain injury, another health impairment, specific learning disability, deaf-blindness, or multiple disabilities.¹⁰ 

In addition to special education services, children with disabilities may be entitled to “related services” such as therapies or other supportive services. “Related services” include transportation as well as “developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education.”¹¹  Types of related services include speech-language pathology and audiology, interpreting, psychological, physical and occupational therapy, recreation, counseling, orientation and mobility, school health and school nurse, social work in schools, and parent counseling and training. Related services do not include medical services, unless used for diagnostic or evaluation purposes.

Children who qualify for special education must be served in the “least restrictive environment.” This means that children with disabilities must be educated with their nondisabled peers “to the maximum extent appropriate.” Children with disabilities may be placed in separate classes or separate schools or otherwise removed from the regular education environment “only if the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.”¹² 

A team determines the services that a child receives and the child’s educational placement. The team includes the child’s parent, a regular education teacher, a special education teacher, a school district representative, and someone who can interpret the instructional implications of evaluations. The team also may include other individuals with knowledge or special expertise, such as related services personnel, and should include the child “whenever appropriate.”¹³  Notably, a child with a disability under the IDEA does not have to receive all of the special education and related services that would enable them to achieve their maximum potential. Instead, according to the U.S. Supreme Court, school districts only must provide services that are “reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.”¹⁴ 

Children who do not qualify for special education services under the IDEA may be eligible for reasonable accommodations under Section 504 of the Rehabilitation Act. This federal law prohibits disability-based discrimination in programs or activities that receive federal financial assistance, including public schools. Students qualify under Section 504 if they have a physical or mental impairment that substantially limits one or more major life activities. Examples of major life activities include caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.¹⁵  Children with disabilities who are eligible under Section 504 may receive “regular or special education and related aids and services designed to meet the[ir] individual educational needs. . . as adequately as the needs of students without disabilities are met.”¹⁶  Examples of reasonable accommodations that may be in a Section 504 plan, depending on a child’s needs, include extra time to take tests or materials in alternative formats.

Appendix B

1. KFF analysis of 2020 National Survey of Children’s Health. ↩︎
2. Defined as children receiving special education services under special education or early intervention plan (often an Individualized Education Plan or Individualized Family Service Plan) as identified by a parent. ↩︎
3. As defined by the U.S. Department of Health and Social Services, these children “have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and also require health and related services of a type or amount beyond that required by children generally.” U.S. Department of Health & Human Services, Health Resources & Services Administration, Maternal & Child Health, Children with Special Health Care Needs (Date Last Reviewed: March 2019), https://mchb.hrsa.gov/maternal-child-health-topics/children-and-youth-special-health-needs#ref1. ↩︎
4. 20 U.S.C. § 1412 (a)(12)(A); 42 U.S.C. § 1396b (c); 34 C.F.R. § 300.142 (a)(1). ↩︎
5. 42 U.S.C. §§ 1396a (a)(43); 1396d (r)(5). ↩︎
6. 20 U.S.C. § 1401 et seq. ↩︎
7. Children from birth until age 3 may receive early intervention services through an “individualized family service plan,” while those ages 3 through 21 may receive special education and related services through an “individualized education program.” 20 U.S.C. § 1414 (d); 34 C.F.R. § 300.320. ↩︎
8. 34 C.F.R. § 300.111. ↩︎
9. 34 C.F.R. § § 300.301-300.306. ↩︎
10. 34 C.F.R. § 300.8 (a). ↩︎
11. 34 C.F.R. § 300.34 (a). ↩︎
12. 34 C.F.R. § 300.114. ↩︎
13. 34 C.F.R. § 300.321. ↩︎
14. Endrew F. v. Douglas Cty. Sch. Dist., 137 S. Ct. 988, 999 (2017). ↩︎
15. 34 C.F.R. § 104.3(j)(2)(ii). ↩︎
16. U.S. Dep’t of Education, Office for Civil Rights, Protecting Students with Disabilities, Frequently Asked Questions About Section 504 and the Education of Children with Disabilities (last accessed Nov. 18, 2021), https://www2.ed.gov/about/offices/list/ocr/504faq.html. ↩︎