Congress is set for yet another showdown on federal spending to avert a government shutdown this week. The last go-round shored up funding for the Children’s Health Insurance Program (CHIP).
Another popular – albeit less politically visible – federal program has received less attention in the budget rounds: the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, which pairs professionals with new and expecting young parents to help them with the transition into parenthood. MIECHV was piloted under the Bush administration, grew as part of the Affordable Care Act, and until this year was funded at $400 million.
The program expired on September 30, the same day as CHIP, and no extension has been included in the budget discussions thus far. And while national advocates still exude the general belief that MIECHV will ultimately be saved, confidence is starting to crumble at the state level where the funds are managed.
Nancy Krause, statewide early childhood director at Lutheran Services in Iowa since 2008, sat down with Youth Services Insider to discuss the state’s home visiting history and what impact the MIECHV delay could have (and already has had) in Iowa.
Tell me about Lutheran Services’ role in Iowa’s home visiting field.
We, as an organization, are implementing a couple models, Healthy Families America and Parents as Teachers, and we have a subcontract with Genesis Hospital to do Nurse-Family Partnership.
We operate in about one-third of the counties [there are 99 in Iowa]. Some of it is paid for through MIECHV and others through state dollars.
As a state, Iowa has more state funding than MIECHV funding. We have some models that are only state funded. Some are only MIECHV, although most MIECHV programs have some combination.
What’s the history of home visiting in Iowa? Has MIECHV spurred a significant amount of growth in the state?
We were an earlier state. We started really small in a number of counties getting dollars for Healthy Families America programming.
After a couple years, the state liked what it saw. We expanded programming and developed Early Childhood Funding Boards in each county.
So in 1992 we started to invest statewide. In 2008, the state made a large increase in its investment, but then after the recession, probably 2010, they pulled back on the additional investment.
We have never been able to fully rebuild that. But MIECHV actually was able to target the highest-need counties and serve a larger proportion of families at risk.
So Iowa spends more on home visiting than the federal government does through MIECHV. Would the state do all right under the House Republican MIECHV plan, where the state would ultimately have to match all federal dollars?
I’d be a little concerned; it would depend on the details of it. In today’s environment, we have a system that has a lot of local control. Funding boards determine the needs and what models to use. And there are some that choose local models.
I believe there could be some opposition if the proposal moved local control to the state. Potentially, if there were details on how those state dollars are spent … that would change the landscape of Iowa.
I also know not every state across the country invests to the degree that Iowa does.
That is true, and it seems unclear if states are able to do that right now.
In Iowa, we are facing additional budget cuts; this will continue to decrease the state’s spending. Last year, we took a funding cut.
The other thing is that MIECHV has always had a maintenance-of-effort requirement so that a state would not decrease its spending because of these dollars. That makes states accountable without a match.
Tell me what you’re hearing now from the state. What conversations are going on about what happens if MIECHV isn’t part of the next funding bill?
One of the real possibilities, if this does not get reauthorized in the next continuing resolution, is that programs may have to suspend the enrollment of new families. There are real ethical concerns if we do not have a guarantee that we will be able to serve families on a long-term basis.
When you bring in families with past trauma, trust and consistency are critical. You actually can end up harming them more than when you found them.
There is also potential there would be hiring freezes as a result of this. A lot of states have had carryover money that’s helped programs to continue without reauthorization. The reality is, we’re at point where it now has to be reauthorized or we won’t be able to plan into the future without it.
Do you suspect the state will reallocate its own money to protect all of the home visiting models, or would the ones mostly funded by MIECHV bear the brunt of it?
I do not believe the state would reallocate. I believe they’d either end an entire program of MIECHV models or greatly downsize them.
Have you heard similar stories from folks in other states here? What are you hearing in the hallways from colleagues?
Yeah, I think that’s fairly true for most states, I don’t think Iowa is overly unique in that way.
We’ve been talking about just the uncertainty that programs are dealing with. I have staff that are currently looking for other jobs, and not because we’ve asked them to.
We’ve done a lot of work around advocacy and looked forward to several [funding] deadlines. Staff are now saying, “We’ve seen way too many of these days come and go, you can’t make any assurances.”
So your nurses, mentors, are really plugged in and following this?
They are. Most of them, I can’t say 100 percent. We just did an interview for an open position, a person who came to us mid-career. And she really was savvy enough to look into, what does this reauthorization mean?
She comes with enough experience that she’d be a great hire to support these programs, and she turned down our offer.
Based mostly on uncertainty?
Yep, absolutely. Qualified, experienced people who will not accept a job, and we need the best of the best.
And this is a pretty tight labor market, not a lot of unemployed people looking for jobs.
Absolutely. Filling open positions takes a little longer now because people can be a little choosier.
What else is jeopardized by this delay in MIECHV?
Just the instability of not having that reauthorization, the impact on community relationships.
We have referral sources, and they begin to lose the faith that making a referral to you is a good option if you can’t deliver long-term.
Integrity comes into question with these lapses. So we need immediate reauthorization, but even with that we will have some need to rebuild these relationships and show that our programs have stability.