Child welfare advocates seemed certain in recent weeks that there would be bipartisan movement on reauthorization, and perhaps even expansion, of the Maternal, Infant and Early Childhood Home Visiting (MIECHV), a maltreatment prevention program created as part of the Affordable Care Act.
It is still a possibility. But it is now far from a certainty.
A group of six House Ways and Means Republicans left those advocates reeling when, late last week, they introduced a MIECHV reauthorization without any Democrats in tow, and with several significant provisions that had not been discussed in recent discussions with leaders of several home visiting models.
Among the provisions that had not been discussed with MIECHV advocates before the bill was introduced: a gradual shift of half the cost of programs to states, and an evaluation structure that requires almost constant improvement on certain metrics.
“This took us by surprise,” said Diedra Spires, CEO of the Dalton Daley Group, a nonprofit group that has helped coordinate advocacy on MIECHV. “I think it was a really close-hold situation.”
The Home Visiting Coalition, a group of 50 organizations that Spires helps coordinate, has yet to release a statement on the bill. Spires said she personally hopes for dialogue soon with leaders in both chambers and parties on shaping the legislation.
“We have a coalition of over 50 organizations coming to grips with this, it kind of caught them by surprise,” Spires said. “We knew something was brewing, but not the content of this.”
The coalition has been pushing for a doubling of the MIECHV program to $800 million. It is a tough ask in this fiscal climate, but advocates felt confident they had the bipartisan buy-in to try.
MIECHV “is one of the few initiatives that seems to have enjoyed genuine bipartisan support,” said Rep. Lloyd Doggett (D-Texas), in an interview with The Imprint in January. “I view this really as empowering families legislation. It is about helping parents be the parents they want to be.”
Not only does the House Republican bill pass on increasing the federal expenditure, it takes a clear view that over time, states should become an equal partner on federally-supported home visiting programs.
The bill creates an “applicable percentage” rule that ensured a certain portion of the program would be paid for outside of federal dollars. Thirty percent of programs would have to be paid for outside of federal dollars by 2020. By 2022, it would rise to 50 percent.
“It might look like states can cover match now, but we’re not in a bubble,” said Spires. “If we’re looking at the possibility of different cuts in Medicaid and other programs, will that match be as easy as people think it is?”
Also of concern, she said, is a provision that requires states to continue to show improvements on at least four of the six basic benchmarks for MIECHV. These are:
- Improved maternal and newborn health
- Reduction of emergency room visits related to maltreatment
- Improvements in school readiness and achievement
- Reduction in crime and/or domestic violence
- Improvements in family self-sufficiency
- Improved coordination of referrals to community supports
The provision is not a new concept: states were required to show improvement on these during the original authorization period for MIECHV. The view expressed in this bill is home visiting should continue to yield ever-increasing social dividends.
“There are whole other fields of human services that aren’t evidence-based at all,” said Spires. “There’s work to be done, but it’s not all in MIECHV.”
Spires was recently in Washington with six CEOs from some of the national home visiting organizations in the Home Visiting Coalition, who met with Republican and Democratic staff from both chambers. State matching and performance outcomes were not mentioned.
“The state match had not come up, nor had the new evidentiary tier, when they had the six of them gathered there,” said Spires.
To the extent that this is a legislative starting point, Spires said it was encouraging that things were starting to move and that the reauthorization period was five years. MIECHV faces the end of a two-year authorization in September; President Trump’s budget pencils the program in for another two-year stretch.
“Five years is really good,” she said. “That is a strong moment for Republicans, particularly with the president’s budget saying two.”
So what comes next? Surely the Home Visiting Coalition will weigh in, as will House Democrats. Noticeably absent from the bill’s co-sponsors is David Reichert (R-Wash.), a Ways and Means Republican with an interest in child welfare issues who used to chair the Human Resources subcommittee.
Spires said more than anything at this point, she hopes for dialogue with the Ways and Means majority leaders, soon.
“What we’re saying more than anything else is let’s sit down and have a conversation,” she said. “I don’t want to guess at what they’re getting at. I don’t doubt the intentions are good, I just think there’s some unintended consequences.”