Maternal and infant mortality rates in the United States have been steadily rising over the past decade, with stark racial disparities between White and Black mothers and their babies. Black infants are twice as likely to die than White infants, and Black mothers are four-times more likely to die from pregnancy-related causes than White women.
Research shows home visiting programs improve overall maternal and infant health outcomes, increase maternal depression screenings, reduce child abuse and neglect, promote child development and school readiness, and improve coordination and referrals for community resources.
To support these programs, states use an array of private and public funds, including Medicaid and the CHIP funding, to support home visiting services. Specifically, CHIP HSIs are available to states to support a range of child health services, including home visiting since CHIP’s inception in 1997. Recently, there has been an uptick in the number of states using HSIs with 45 federally approved HSIs established between 2016 to 2019.
The Centers for Medicare & Medicaid Services (CMS) approve state HSIs through a state plan amendment that includes performance metrics to measure impact and outcomes of the programs. CHIP HSIs are designed to serve children under age 19 who are eligible for Medicaid or CHIP, but they can be designed to improve the health of a broader population of children beyond those eligible for Medicaid or CHIP.
HSIs can focus on direct services, public health initiatives, or ongoing social, behavioral health needs. Funding for HSIs comes from a combination of state and federal funds. A state draws federal funds from its CHIP administrative allocation, which is 10 percent of its CHIP block grant spending, to help fund an HSI. These funds are provided at the state’s CHIP match rate. States must consider all of their administrative expenditures, including those required to operate their CHIP programs, such as staff, managed care fees, systems upgrades, etc. to ensure there are remaining funds, within a 10 percent cap, before committing funds to an HSI project.
As of 2019, there are 71 approved HSIs in 24 states. At least three states currently have HSIs that include home visiting services and one state recently received CMS approval to start an HSI that includes home visiting services.
- Alabama’s State Plan Amendment was approved in September 2019 to implement an HSI to provide case management and care coordination to low-income, high-risk pregnant women and their infants in three counties to improve pregnancy outcomes and infant health for up to one year postpartum. The case management services include home visits.
- The Arkansas SafeCare program is a structured, evidence-based and in-home parenting program that has a home visitor and parent work together to create a safe home environment. The home visitor assists the parent in providing structure and routines, while encouraging systematic health decision-making to keep children safe in their homes. Parents are provided with useful tools, such as books, thermometers, childproof safety locks, and other learning materials to use in their family environment to keep children safe. The home visitor delivers weekly or biweekly home visits for approximately 18 to 22 weeks. More information can be found about the state plan amendment here.
- Massachusetts has two CHIP HSIs that include home visiting services. The first, Healthy Families, is a newborn home visiting program that provides home visits, a six-week neonatal and postnatal parenting education support group series, and parent-child interaction groups to support positive parent-child relationships. The HSI is designed to serve families with at-risk newborns. The Young Parent Support program is another CHIP HSI that provides funding for community-based organizations that provide outreach, home visits, mentoring, and parent groups to strengthen the skills of young parents.
- Missouri’s newborn home visiting program serves at-risk, low-income pregnant and postpartum women and their children up to five years of age. Clinical staff and other trained professionals provide a range of services to families, including group training sessions and connection to needed resources. The CHIP HSI’s goal is to increase healthy pregnancies and positive birth outcomes, as well as decrease child abuse and neglect through its home-based services.
States are implementing evidence-based home visiting programs to improve health outcomes for women, children, and their families. CHIP HSIs are one of many funding mechanisms states can use to help expand their home visiting services and continue to improve the lives of children and their families, especially at a time when the COVID-19 pandemic has brought new challenges for states and families. In spite of these challenges home visiting remains an important service for women, children, and families.
States will soon be faced with critical budget challenges brought on by the COVID-19 pandemic and will have to make tough decisions about funding for home visiting services. CHIP HSIs provide one funding source states may want to use to help support home visiting services.
- For more information on financing home visiting, read the NASHP report, Medicaid Financing of Home Visiting Services for Women, Children, and Their Families.
- And for additional information on CHIP HSIs, explore NASHP’s report, Leveraging CHIP to Improve Children’s Health: An Overview of Stare Health Services Initiatives.