Grafton warns Winchester City early‑intervention program faces growing funding shortfall

Grafton officials told the Winchester City Council Public Health & Safety meeting on March 18 that their Infant and Toddler Connection of Shenandoah Valley program has expanded sharply since Grafton became the local lead agency in 2010 and is now serving hundreds of children across the region.

"As of today, there are 421 children on our roster for the Infant and Toddler Connection of Shenandoah Valley," said Charlene Stowers, director of early intervention at Grafton and local system manager for the program. "Of that 421, 128 of those children reside in Winchester, so about 35%." She said Grafton’s service area includes Winchester City and Frederick, Clarke, Page, Warren and Shenandoah counties.

Stowers described early intervention as a family‑focused coaching model for children birth to age 3 and said the agency reached compliance with state and federal guidelines after taking over the program in 2010. "When we took over the program, there were 92 children in the service area," she said. "So that's real significant growth and shows that there were a lot of children underserved during those years."

Angela Brown, who identified herself as Grafton’s chief financial officer, told council members the program faces mounting fiscal pressure because federal and state Part C funds flow through DBHDS and Medicaid reimbursement rates have not kept pace with costs. "The rate established in 2008 was $150 per service and only had one increase in 2021," Brown said. She added that, with higher enrollment and flat or shrinking grant dollars, Grafton has absorbed deficits that "have accumulated to almost $900,000."

Brown and Stowers described operational steps Grafton has taken — stabilizing the provider pool, deploying resources across the catchment, and pursuing Medicaid and commercial insurance billing where appropriate — but said shortfalls remain. They also said the program cannot maintain wait lists: "If they are found eligible for services, we have to provide services," Stowers said.

In response to council questions, Stowers said referrals have shifted over time. "Right now we're seeing mostly marijuana," she said, noting prior waves of opioids, cocaine and methamphetamine. She said about half of referrals are substance‑exposed infants and that Winchester Medical Center refers substance‑exposed newborns and NICU infants to the program.

Council members asked about staffing and city support. Stowers said the program comprises about 28 people (speech‑language pathologists, service coordinators, developmental specialists, occupational therapists and a physical therapist) and that most families pay nothing because services are mandated. Brown said the City of Winchester acts as the administrative conduit for grant dollars and handles disbursement, and singled out an administrative staffer (Mary Blue) for monthly grant‑disbursement support.

Both presenters asked for help raising awareness with other localities and at the state level to pursue changes in Medicaid reimbursement and grant allocation. "It is our goal to reach out to all the localities and have these kinds of conversations and make sure everyone is aware," Brown said. No formal action or vote on additional city funding was taken at the meeting.

The program’s policy context and funding sources were discussed in the meeting: Stowers cited the Individuals with Disabilities Education Act (IDEA) framework for early intervention and Brown referenced distribution through DBHDS (Department of Behavioral Health and Developmental Services).