As Federal Home Visiting Remains In Limbo, Stress Sets In For Programs

It certainly feels like a long time ago that child welfare advocates were brimming with confidence that a bipartisan reauthorization for Maternal, Infant and Early Childhood Home Visiting program (MIECHV) – the $400 million-per-year federal home visiting program that supports programs pairing professionals with young moms – would sail through Congress.

But what started as a push to embed and augment MIECHV in the federal budget has turned into a time-constrained push to keep it going with any sort of appropriations extender. Every MIECHV advocate Youth Services Insider has spoken with believes that it will ultimately get funded for this year. For what it’s worth, we agree; it still seems hard to believe that the fiscal 2018 spending deal won’t extend CHIP and MIECHV.

But where optimism reigned, angst is starting to set in among state and local operators of home visiting programs.

“We’re not going to panic, and we don’t want locals to be in panic,” said Staci Croom-Raley, executive director of HIPPY USA. “But now we’re starting to have new conversations with locals as to, ‘Tell us the number you may have to stop serving’ without MIECHV. And, ‘How will this affect you in terms of enrolling?’”

“We’re trying to get their stories, and we’re really trying to prepare them for a continued delay,” she said.

For proponents of MIECVH reauthorization, the hope of summer faded in fall, when the House Ways and Means Committee Republicans pushed through their own reauthorization MIECHV. That bill pegs future funding to state’s willingness to match the money, which The Imprint’s research suggests could prompt serious downsizing of MIECHV spending in many states.

Things have only gotten worse since then. The Senate came out with a flat-funded reauthorization without the match, which advocates liked better. But efforts at new health care legislation efforts, and then tax reform, have dominated the Senate for weeks, back-benching MIECHV and the much-larger Children’s Health Insurance Program (CHIP).

“We’re hearing that tax reform is sucking up all the air in the room, so there’s no discussion about MIECHV,” said Croom-Raley, whose Arkansas-based organization oversees expansion and training of sites operating Home Instruction for Parents of Preschool Youngsters (HIPPY), one of the 18 models approved for MIECHV spending.

“We hope to be attached to any legislation moving forward; CHIP, anything like that, we would love to be part of that,” Croom-Raley said.

HIPPY uses trained parent educators to work with parents of children between the ages of 2 and 5. The model was first developed in 1969 and took root in the United States in 1984. There are now 116 HIPPY sites in 19 states.

Nationwide, about 25 percent of all funding for HIPPY programs comes from MIECHV, Croom-Raley said. A loss of that, even for a year, “would make for a harsh reality for our families across the country.”

In Oklahoma, the Department of Health operates a multi-county Nurse-Family Partnership (NFP) program the state calls Children First. NFP pairs professional nurses with new moms before and after their first pregnancy. It is the best-known of the home visiting models, having been identified last year as the only known intervention that has clearly reduced the number of child fatalities in the country.

Oklahoma used MIECHV funds to expand Children First into two new counties (Tulsa and Oklahoma). The program served 3,097 families in fiscal 2016, according to Beth Martin, the department’s interim director of Children First.

About 27 percent of the program’s budget comes from MIECHV, Martin said. And because MIECHV was not spread out across Children First, those expansion counties will bear the brunt of a federal halt on home visiting.

“If there’s a change in federal funding,” she said, the overall funding “would be reduced. Those counties receiving MIECHV would be the ones affected.”

Fran Benton, spokesperson for the national Nurse-Family Partnership organization, said the lag in funding has already created similar instability in other states.

“The level of uncertainty since September 30 [when MIECHV’s authorization expired] has made it very difficult for states to plan,” Benton said. “Most home visiting is funded in part by MIECHV, so state administrators need to know what to expect for next fiscal year. This is hitting the administrators the worst so far.”

In Cumberland County, Penn. (population 235,000 near the state capital of Harrisburg), the Sadler Health Center operates the local NFP program.

“It’s a very effective program that has well-documented outcomes for first time mothers,” said Sadler CEO Kenneth Green. “Getting kids off to a good start is critical. If they are not off to get good start, it often spirals from there.”

Green is keeping tabs on the Beltway battles over health care, tax cuts and government appropriations. But he said he refuses to obsess about it.

“I can’t burn up the mental energy,” Green said. “I have ideas on where I’ll go, but we’re just going to wait and see. Otherwise I’d spend my entire life working on contingency plans.”

The biggest share of Sadler’s NFP program is funded through a local foundation, which kicks in between 40 and 45 percent of the annual budget. About 20 percent of it is funded by MIECHV.

Green said he expects that a loss of MIECHV funds will lead to a proportional cut to enrollment. That could mean up to 40 first-time mothers in the county will not be helped by NFP.

“We’re faced with the possibility of doing some reduction on margin. We’re small, there’s not much backfill for pay increases. Our NFP staff have gone awhile without pay increases.”

While uncertainty looms over Sadler’s NFP program, its very existence is threatened by the prospect of no funding for the Community Health Center Fund (CHC), which like MIECHV has not been reauthorized. Sadler is one of approximately 1,400 such centers, which by federal requirement provide more than two dozen services for low-income families.

A loss of CHC funds could spell a 70 percent budget cut for Sadler, according to Green.

“That could kill us,” Green said. “It could cause us and other health centers to go down.”

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