Home visiting is an important and long-standing strategy for improving the health and well-being of women, children, and their families. Home visiting programs deliver and help connect individuals to critical social, health, and educational services. They can include screenings for physical, social-emotional, and developmental issues, case management services, and family support and counseling. Studies have shown that home visiting programs can reduce child maltreatment and intimate partner violence and improve maternal and child health outcomes, including positive parenting and child development. These programs also show long-term cost savings, with benefits exceeding costs by an amount as high as 200 percent. Other areas of savings include a reduction of unnecessary emergency department visits and decreased use of public assistance programs such as Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and Medicaid.
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is the primary source of federal funding for home visiting programs and is administered through the Health Resources and Services Administration (HRSA). HRSA awarded approximately $341 million in September 2020 to 56 states, territories, and nonprofit organizations to support the provision of voluntary, evidence-based home visiting services.
In addition to MIECHV, states leverage multiple state and federal funding streams to finance home visiting programs. Prominent sources of funding include Medicaid and the Children’s Health Insurance Program (CHIP), TANF, the state Title V Maternal and Child Health (MCH) Services Block Grant, state general revenue funds, and private foundation support. In addition to these sources, the Family First Prevention Services Act authorized new optional funding under Title IV-E of the Social Security Act for prevention services for mental health, substance abuse, and in-home parent skill-based programs, and may also serve as a prominent source of funding in the future.
At least 20 states use Medicaid to support home visiting programs. Targeted case management is the most common federal Medicaid authority that states use to support these programs. In a 2016 Joint Informational Bulletin on Coverage of Maternal, Infant, and Early Childhood Home Visiting Services, the Centers for Medicare & Medicaid Services (CMS) and HRSA encouraged states to use Medicaid and other federal and state funding sources to support home visiting programs. In 2019, the National Academy for State Health Policy, with support from the Maternal and Child Health Bureau, HRSA, convened state and federal Medicaid, public health, and home visiting leaders to discuss key opportunities, challenges, and innovative approaches to enhance public insurance financing of home visiting services. Participating states identified many questions and considerations for use of Medicaid to cover home visiting services. These considerations include:
- how to best integrate public insurance financing as part of state health reform efforts in Medicaid and CHIP, including strategies to move towards value-based payment (VBP);
- how to best braid multiple private, state and federal funding sources including Medicaid; and
- how to ensure providers meet qualified provider requirements in Medicaid programs, while still maintaining fidelity to the specific home visiting model.