Home Visiting Reauthorization: The First Trimester

April 13, 2022 | Carolyn McCoy, Jazmyn Covington

Smiling doctor on a home visit with her happy, pregnant patientHome visiting is an essential prevention strategy to support the well-being of mothers, children, and families and aims to prevent, protect, and promote health, especially in those families in communities that are identified as most vulnerable. In March 2010, Congress passed—and President Obama signed into law—the Maternal, Infant, Early Childhood Home Visiting (MIECHV) federal program. MIECHV provides voluntary, evidence-based home visiting services to women during pregnancy and to parents with young children up to kindergarten entry. The program was reauthorized in 2018 to continue providing critical services to families. Congress allowed certain program adjustments, such as visits conducted over video rather than in person, during the declared COVID-19 public health emergency in 2021.

The current underlying authorization of the MIECHV program expires at the end of September 2022, and supporters of the program are in the early days of advocating to renew it. In fact, the White House released a fact sheet last month lauding the benefits of the program with particular reference to improving mental health in young children and families and further indicated that it will propose ongoing funding in its FY23 budget. Congress funded the home visiting with mandatory funds, increasing funding from $100 million in 2010 to $400 million in 2013, and it has been level-funded since.

The Health Resources and Services Administration (HRSA) and the Administration for Children and Families (ACF) direct grants to all fifty states, six territories, and jurisdictions serving Washington, D.C., Puerto Rico, Guam, the U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa. Some non-profit organizations are eligible to apply if the jurisdiction they are located in did not apply in 2020. A portion of funding is awarded through competitive grants to states and territories to implement innovative programs.

So, what exactly does the MIECHV program do? It supports home visitors and families in developing solid relationships and trust by meeting regularly and addressing families’ unique needs to support healthy pregnancies through early childhood development. Home visiting prides itself on meeting families where they are, allowing home visitors the flexibility to reach those at the most significant risk of experiencing adverse outcomes. In a House Committee on Ways and Means hearing on March 16, 2022, a parent enrolled in the program complimented her home visitor: “She’s helped me put steps in place to achieve all my goals, and now she helps me stay on track or get back on track. She encourages me all along the way.”

In addition to the concrete support of navigating stressful life experiences, home visiting addresses social determinants of health and improves the home environment to ensure all children and families are healthy and able to thrive. The hearing also highlighted the support for the program among the members of the committee. Like most legislation, figuring out how to provide more families with quality services while also strengthening the home visiting workforce will need to be addressed in the reauthorization process and fund allocation through the years.

Importantly for ASTHO members and MIECHV programs, having the reauthorization in place before the current authorization expires supports robust planning and the ability for staff to remain on the payroll.

This year, ASTHO is proud to collaborate with organizations such as the Association of Maternal and Child Health Programs (AMCHP), the American Academy of Pediatrics (AAP), and more than 40 other advocates urging Congress to reauthorize the program through increased funding, expanding funding required for tribes, and allowing the continued use of video visits that were implemented during the COVID-19 pandemic.

ASTHO supports sustainable state and federal funding for home visiting programs integrated with existing maternal and child health services providing comprehensive care for women, children, and families. In addition to the stated policy, ASTHO works to support states in determining how approaches such as home visiting fit into their overall early childhood development strategies and examine how they are using home visiting to influence the health and well-being of families and children.

In ASTHO’s primer State Home Visiting Approaches Improve Early Childhood Outcomes and Systems, one state noted, “If we can—in tandem—provide home visiting for [participating] families and make those systems changes that improve the community, we feel like we’re making the most optimal changes for families, whether they’re part of home visiting or not.”

As the reauthorization process continues, there will likely be additional committee hearings (e.g., House Energy and Commerce, Senate Finance) to explore possible changes to the law in the following passage. The Home Visiting Coalition will continue to support reauthorizing the program before it expires and work with Congress to share convincing and essential data with lawmakers to get the MIECHV bill to the finish line. ASTHO has joined regular meetings with the Coalition and federal lawmakers and their staff in past authorizing processes. Overall, it is working to promote and support this necessary program.