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Updated November 20, 2018
Maternal, Infant, and Early Childhood Home Visiting Program
The Maternal, Infant, and Early Childhood Home Visiting
Participants
(MIECHV) program is the primary federal program that
Under the program, jurisdictions provide home visiting
focuses exclusively on home visiting. The program seeks to
services to eligible families who participate voluntarily. An
strengthen and improve home visiting services to families
eligible family includes (1) a pregnant woman and father-
residing in at-risk communities, while also improving
to-be, if available; (2) a parent or primary caregiver of a
coordination of supportive services in these communities.
child; or (3) a noncustodial parent who has an ongoing
Home visits are made by social workers and other
relationship with, and at times provides physical care for,
professionals to the homes of families with young children,
the child from birth to entry into kindergarten. Jurisdictions
who participate on a voluntary basis. Visitors provide
must prioritize eligible families who have certain risk
services such as parenting education, developmental
factors, such as low-income families and families with a
screenings, and referrals to community supports.
history of child abuse and neglect. As shown in Figure 1,
the number of participants (i.e., parents, other caregivers,
Overview
and children) served and the number of home visits
The MIECHV program is jointly administered by the U.S.
provided more than quadrupled from FY2012 to FY2017.
Department of Health and Human Services’ (HHS) Health
Resources and Services Administration (HRSA) and the
Figure 1. MIECHV Participants and Home Visits,
Administration for Children and Families (ACF). The
FY2012-FY2017
Patient Protection and Affordable Care Act (ACA; P.L.
111-148) established MIECHV under Section 511 of the
Social Security Act and appropriated mandatory funding for
the program from FY2011 through FY2014. Authorization
of the program has been extended multiple times, most
recently by the Bipartisan Budget Act of 2018 (BBA 2018,
P.L. 115-123) from FY2018 through FY2022.
Grantees
MIECHV provides funding directly to the 50 states, District
of Columbia, the territories, and tribal entities. Generally,
the state’s/territory’s public health department or social
service department is the lead agency that administers the
Source: HHS, HRSA, FY2019 Congressional Budget Justifications.
funds. Under the law, HHS may make grants to nonprofit
organizations to carry out a home visiting program in a state
Funding
that did not apply, or receive approval, for a grant as of
The statute provided for mandatory funding, which has
FY2012. Nonprofit organizations operate MIECHV-funded
increased from an initial $100 million in FY2010 to $400
home visiting programs in three states (FL, ND, and WY).
million annually in each of FY2013 through FY2022.
As of FY2017, the program provided funding to 29 tribes.
Funds were subject to sequestration in FY2013, FY2014,
and FY2017. HHS must reserve 3% of the annual
Requirements
appropriation for tribal entities, and another 3% for
The law specifies a variety of requirements for grantees (or
technical assistance, research, and evaluation. MIECHV
jurisdictions) receiving MIECHV funds. These jurisdictions
funding may be expended by the grant recipient through the
were required to conduct a needs assessment by September
end of the second succeeding fiscal year after the award.
20, 2010, to identify communities with concentrations of
The law does not specify how the funds are to be awarded.
poor infant and maternal health and mortality, poverty, and
other risk factors. They had to submit the results of the
In practice, HHS distributes MIECHV funds by both
assessments to HHS and explain how they intended to
formula and competitive grants to states and territories. The
address the identified needs. BBA 2018 directs jurisdictions
formula grants have made up between 29% and 86% of
to update this assessment by September 30, 2020.
obligated funds in each year from FY2010-FY2017 (86% in
FY2017). Funding under the formula grants has been
Jurisdictions must also submit an application for funding to
distributed based in part on the relative share of children
HHS that includes several items, such as how they will
under age five in families at or below the federal poverty
serve high-risk populations as identified by the jurisdiction.
line in each state (including Puerto Rico, effective as of
Jurisdictions must also meet other requirements, such as
FY2018); however, uniform poverty data are generally not
using MIECHV funding to supplement, and not supplant,
available for the territories, which each receive $1 million
other federal funding for home visiting services.
annually. Tribal entities separately receive competitive
program funding.
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link to page 2 Maternal, Infant, and Early Childhood Home Visiting Program
Home Visiting Models
Research and Evaluation
Jurisdictions may use no less than 75% of MIECHV
The MIECHV law requires HHS to conduct an evaluation
funding to implement a home visiting model that has shown
of the home visiting program. With input from an HHS-
sufficient evidence of effectiveness based on criteria
appointed advisory panel, ACF (in partnership with HRSA)
established by HHS. The remaining 25% of funds may be
is conducting an evaluation of the program known as the
used to implement models that have promise of
Mother and Infant Home Visiting Program Evaluation
effectiveness (grantees must rigorously evaluate such
(MIHOPE). The evaluation is examining how home visiting
models). HHS has established criteria for determining
services are provided to more than 4,000 families across 12
whether home visiting models are effective and reviews
states who are randomly assigned to receive services. It is
home visiting models on an ongoing basis via the Home
also looking at the effects of the program on family
Visiting Evidence of Effectiveness (HomVEE) project. The
outcomes, and analyzing program costs and cost
project has determined that 18 models meet the criteria.
effectiveness. The 2018 implementation study reported that
Generally, these models have shown impacts in one or more
families participated in the home visiting program for an
outcomes in maternal and child health; early childhood
average of eight months. In general, families and home
social, emotional, and cognitive development; family/parent
visitors commonly discussed mental health, positive
functioning; and links to other resources. In FY2017, states
parenting behavior, child preventative care, child
and territories implemented 10 of the 18 models (Table 1).
development, and economic self-sufficiency.
Table 1. Home Visiting Models Used, FY2017
In a required report to Congress, HHS provided preliminary
information about how states planned to use MIECHV
Number of
funds to implement the four models (EHS-HV, HFA, NFP,
Model Determined by HHS to Be
States/Territories
and PAT) studied in MIHOPE. The report showed that
Evidence-Based
Using Model
states chose communities with high poverty and other risk
factors for MIECHV funds. Nearly 70% of enrolled
Nurse-Family Partnership (NFP)
38
families included a pregnant mother and that the average
Healthy Families America (HFA)
37
age of mothers generally was 23, among other findings.
HHS anticipates that final reports on the evaluation will be
Parents as Teachers (PAT)
35
available in late 2018.
Early Head Start-Home Visiting (EHS-
15
Technical Assistance
HV)
The law directs HHS to provide technical assistance (TA)
Home Instruction for Parents of
5
to grantees, specifically with regard to home visiting
Preschool Youngsters (HIPPY)
activities, and to support any grantee that is required to
implement an improvement plan because it failed to
Family Spirit
4
improve in the benchmark areas. Jurisdictions receive TA
SafeCare Augmented
2
from federal staff, developers of home visiting models, and
TA providers contracted with HHS.
Family Check-Up (FCU)
1
Child First
1
Reauthorization Activity
Following a hearing in March 2017 by the House Ways and
Health Access Nurturing Development
1
Means Subcommittee on Human Resources, the full
Services (HANDS) Program
committee marked up legislation (H.R. 2824) to reauthorize
Source: CRS correspondence with HHS, August 2018.
the MIECHV program. A major feature of H.R. 2824 was a
proposal that jurisdictions provide matching funds as a
Benchmarks
condition for receiving MIECHV funding. The House
The MIECHV statute requires grantees to demonstrate
passed H.R. 2824 in September 2017. That same month, a
improvements among eligible families in what the law
reauthorization bill (S. 1829) was introduced in the Senate.
refers to as six “benchmark areas.” These six benchmark
It did not include the matching requirement.
areas are desired outcomes for participants and relate to
health, child abuse, crime and safety, economic self-
BBA 2018, enacted on February 9, 2018, incorporated all of
sufficiency, academic readiness, and community referrals.
S. 1829 and a provision in H.R. 2824 that directs HHS to
These outcome domains are similar, but not identical, to the
use the most accurate relative federal population and
outcome categories used in the HomVEE review. The law
poverty data if HHS awards funds based on these factors.
requires jurisdictions to show that they are making
Under BBA 2018, jurisdictions may also begin using up to
improvements in at least four out of six benchmark areas
25% of their MIECHV grants for a pay-for-outcomes
three years after the law is implemented. As of FY2017,
initiative to support home visiting approaches that result in
HHS uses 19 items to measure the performance of each
cost savings.
jurisdiction. One grantee (from the first cohort of tribal
grantees) was not awarded funds due to performance and
Adrienne L. Fernandes-Alcantara, Specialist in Social
compliance concerns. No jurisdictions are currently on
Policy
improvement plans.
IF10595
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Maternal, Infant, and Early Childhood Home Visiting Program
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