In the House Ways and Means Committee, there is bipartisan support for reauthorization of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, a national funding stream that supports efforts to support young and expecting mothers.
But that’s pretty much where the agreement ends.
With the clock running out on a September 30 deadline to reauthorize the program, the committee’s markup yesterday produced a five-year reauthorization bill without a single Democrat in support, and reflected the deep disagreement about how the next five years of MIECHV should look.
MIECHV began as a small pilot project during the George W. Bush administration. Its rise to a program with annual appropriations of $400 million came in the passage of the Affordable Care Act.
“Since 2005, MIECHV has been uniquely bipartisan, until today,” said Rep. Danny Davis (D-Ill.).
At the center of the disagreement, not surprisingly, is how home visiting should be funded going forward. The Democrats endorse the call by the Home Visiting Coalition and other MIECHV advocates: double the federal allotment for the program from $400 million a year to $800 million.
The Republicans – through the Increasing Opportunity Through Evidence-Based Home Visiting Act, authored by Rep. Adrian Smith (R-Neb.) – want states to pony up the money to expand MIECHV. Over the course of the five-year reauthorization approved by the committee last night, states will have to use a combination of state, local and private cash to match every dollar of MIECHV funding by 2022.
That plan portends a potential increase in home visiting spending, but only if states match the federal MIECHV allotment. Because if a state does not match it, and loses the federal share, it is sure to see the closure of home visiting programs.
At yesterday’s markup, Democrats expressed doubt that all states could live up to the match, which means the shift to such a structure could jeopardize home visiting programs in those states. Rep. Bill Pascrell (D-N.J.) introduced an amendment to strip out the state match from the bill.
“In 2016, New Jersey got $10.5 million in funding [from MIECHV], and New Jersey invested $4.2 million,” Pascrell said. “Based on the current fiscal situation, I’m not confident they’d come up with the money [to match].”
Pascrell and other Democrats also pointed to the several states affected by hurricanes Irma and Harvey, questioning the likelihood that they would have funds to free up.
“The states dealing with major disasters may need to focus state resources on recovery,” Pascrell said. “Perhaps by diverting funds previously funding home visiting. A match doubles that penalty anytime home visiting is withdrawn.”
Smith noted that state and private spending on home visiting currently totals $340 million.
“The fact of the matter is, this product is the result of months of work with stakeholders,” said Smith. “I think it’s important not to be let down by a rather arbitrary opposition.”
Rep. David Schweikert (R-Ariz.), said his home state provides $8 million more in home visiting funds than it gets from MIECHV.
“So we’re fine,” he said. “If you don’t have some skin in game, you don’t pay attention to details. This will bring more creativity and discipline” to MIECHV.
Ways and Means Chairman Kevin Brady (R-Fla.) said his state spent $48 million on home visiting last year, well over its MIECHV allocation. But Rep. Mike Thompson (D-Calif.) argued that Florida’s spending, which is mostly county funding, epitomizes the risk of a state match.
“So if one county shifts enough money out of home visiting, it might cost all the counties in a state,” Thompson said.
Pascrell’s amendment, along with every other amendment offered by the Democrats yesterday, was defeated.
A small conciliation on the match structure was struck between Republicans before the markup even began. At the request of Rep. Kristi Noem (R-S.D.), Smith delayed any requirement that Native American tribes match MIECHV funds.
Another point of contention yesterday was over the bill’s provisions on demonstrating effectiveness. It requires that states show improvements on four out of six indicators tied to MIECHV. One of those six indicators is earnings and employment, which Democrats objected to.
Davis criticized the effectiveness standards as “unrealistic outcome standards” that constitute “failure by design for home visiting.”
So what happens now? The clock is running out on MIECHV, which expires at the end of September without a reauthorization bill. YSI highly doubts it will come to that, as the program is popular with both parties.
Expect the House version approved yesterday to pass quickly, leaving the Senate Finance Committee to make the next move in coming weeks. There has been some discussion in that chamber of rolling the MIECHV reauthorization into the reauthorization of the much-larger Children’s Health Insurance Program (CHIP), which was established in 1997 and co-sponsored by current Finance Chair Orrin Hatch (R-Utah). CHIP, like MIECHV, expires on September 30.
After taking in yesterday’s markup, YSI has a hard time believing a boost in federal funds for MIECHV is possible, even if the Senate includes it. House leadership appear committed to paying for the program with offsets and leaving the cost of expansion to states.
So the big question is whether the Senate will endorse the state match plan, or take the House Democrats’ view that state matches are more risk than reward for home visiting.