Walworth County considers outsourcing Birth to 3 therapists amid budget pressures

Walworth County Health and Human Services Board members discussed a proposal June 18 to convert four county-employed Birth to 3 therapists to contract employees as part of the department's 2026 budget planning, an option officials say would reduce levy dependence and address staffing vulnerability.

The proposal matters because Birth to 3 is a statutorily required early-intervention program for infants and toddlers with developmental delays; the HHS administrator told the board the county currently contributes about $990,000 in levy to the program, including a required maintenance-of-effort match of about $458,000 and a state grant of roughly $194,000, while program revenue runs near $240,000.

During the meeting four therapists who work in Walworth County's Birth to 3 program urged the board to keep the staff as county employees and described potential service impacts if they were moved to contracted employment. Carlene Liberto, one of two speech-language pathologists in the program, said the team has "dedicated our careers and time to the children and families of Walworth County for more than 20 years" and described losses that could follow contracting, including county vehicles, county cell phones used for family communication, and a roughly 40% cut in mileage reimbursement.

Jeanne Lutke, an occupational therapist, described in-home services she provides "during the most critical stage of development birth to age 3" and said county employment gives the team "direct access to all information needed" and local accountability. Heather Abels, a physical therapist with 25 years in the program, said private agencies "have historically struggled" to hire and retain therapists and noted that a large for-profit rehab agency serving multiple counties currently had nine open pediatric physical-therapist positions.

Carlo Nabokosi, the department head who presented the budget option, told the board the idea is intended to reduce levy reliance and to address what he described as program vulnerability because the county's four specialized therapists are difficult to replace or scale around vacancies. "Contracted providers have efficiencies that we don't in that they're not bound by county lines," Nabokosi said, adding a contractor that responded to the county's request for information serves 13'14 other counties and has achieved the state's "meets requirement" status for Birth to 3 in those jurisdictions. He also said the vendor expressed interest in hiring the four therapists "at their same hourly rate," but that benefits, mileage and vehicle access, and other details differ by employer and cannot be guaranteed without a contract.

Board members asked whether staff had explored alternatives such as sharing positions with neighboring counties or improving local billing systems. Nabokosi said some options exist but that contracting rose to the top of his list because a multi-county provider can scale staff regionally and because the county's billing unit is small; he acknowledged the therapists were not involved in earlier billing discussions and said county staff have taken steps to improve revenue capture. Supervisor discussion also flagged the county's repeated "needs assistance" status under the state's status-determination tool; Nabokosi and the program supervisor said the state's tool does not always capture short-term child progress, which contributed to an unfavorable status in prior years.

No formal motion or vote occurred on the outsourcing proposal during the June 18 meeting. The board asked staff to return with additional information for discussion in July, including: (1) follow-up conversations with counties that contract Birth to 3 services to learn how contractors manage continuity of care and family-level outcomes; (2) more detail on the vendor referenced in the RFI and what benefits/operational differences a contract would create; and (3) invitations for families served by the program to speak to the committee about continuity of care.

Next steps: the item will be listed on the July committee agenda so the public can comment and the board can receive the additional vendor/county information; the department head said he must finalize his recommendation in August for the administrator and finance director, and the county budget is due to the board in September.