Maternal, Infant, and Early Childhood Home Visiting Program

Maternal, Infant, and Early Childhood Home Visiting Program

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Updated August 29, 2023
Maternal, Infant, and Early Childhood Home Visiting Program
The Maternal, Infant, and Early Childhood Home Visiting
poverty, one-in-five reported a history of child abuse and
(MIECHV) program is the primary federal program that
maltreatment, and one-in-ten included a pregnant teen.
focuses exclusively on home visiting. The program seeks to
provide and strengthen home visiting services to families
Funding
residing in at-risk communities, while also improving
MIECHV’s current authorizing law appropriates mandatory
coordination of supportive services in these communities.
funding for the program. The American Rescue Plan Act of
Early childhood home visiting is a strategy for delivering
2021 (ARPA; P.L. 117-2) provided additional one-time
services to improve health, well-being, and education
funding in FY2021 in response to the COVID-19 public
outcomes for vulnerable families with young children.
health emergency. In certain years, MIECHV funding has
Families voluntarily participate and receive periodic home
been subject to sequestration. From the program’s start in
visits from nurses, social workers, and other professionals.
FY2010 through FY2022, funding increased the first few
Visitors try to build strong, positive relationships with
years before stabilizing at a pre-sequester funding level of
families and provide tailored services such as parenting
$400 million annually. During this period, HHS used its
education, caregiver well-being and child development
then statutorily permitted discretion to distribute the bulk of
screenings, and referrals to community supports.
funding through a mix of allocation formulas and, in select
years, competitive grants to entities.
Overview
The MIECHV program is jointly administered by the U.S.
The 2022 reauthorization law increased funding and
Department of Health and Human Services’ (HHS’) Health
established new procedures for FY2023-FY2027, including
Resources and Services Administration (HRSA) and the
separate appropriations for base grants and matching grants
Administration for Children and Families (ACF). The
(Table 1). From these amounts, funding is reserved for
Patient Protection and Affordable Care Act (P.L. 111-148)
tribal entities (6%); technical assistance (2%); home
established MIECHV under Section 511 of the Social
visiting workforce-related activities (2%); and research,
Security Act and appropriated mandatory funding for the
evaluation, and federal administration purposes (3%). HHS
program. The authorization and funding have been
traditionally uses its discretion under statute to award tribal
extended multiple times, most recently for FY2023 through
funding through competitive cooperative agreements.
FY2027 by the Jackie Walorski Maternal and Child Home
Visiting Reauthorization Act of 2022 (§6101 of the
Table 1. MIECHV Mandatory Appropriations, FY2023-
Consolidated Appropriations Act, 2023, P.L. 117-328).
FY2027
(dol ars in mil ions)
Eligible Entities
The MIECHV program provides funding to the 50 states,
Fiscal Year Base Grants
Matching Grants
Total
District of Columbia, five territories, and tribal entities.
Generally, the entity’s public health department or social
2023
$500
$0
$500
service department is the lead agency that administers the
2024
500
50
550
funds. Under the law, HHS may make grants to nonprofit
organizations to carry out a home visiting program in a state
2025
500
100
600
that did not apply, or receive approval, for a grant. In
2026
500
150
650
FY2022, nonprofit organizations were fully or partly
administering MIECHV in three states (FL, ND, and WY).
2027
500
300
800
As of FY2022, 36 tribal entities had ever received funding.
Source: CRS analysis of Section 511 of the Social Security Act.
Participants
Notes: FY2024-FY2027 amounts shown do not reflect (potential for)
sequestration. FY2024 post-sequester funding total = $518.7 mil ion.
Entities provide home visiting services to eligible families
who participate voluntarily. An eligible family can be
Allotments
comprised of (1) a pregnant woman and father-to-be, if
Under current law, after accounting for the funding
available; or (2) a parent or primary caregiver of a child
reservations and potential effects of sequestration, the
from birth to entry into kindergarten (including a qualifying
remainder of FY2023-FY2027 base and matching grant
noncustodial parent). Entities must prioritize families who
funding is to be distributed through separate processes to
have certain risk factors, such as low income or a history of
non-tribal entities. These entities must meet a maintenance-
child abuse and neglect. In FY2022, the MIECHV program
of-effort requirement to receive any grant funding.
served more than 69,000 families, provided over 840,000
home visits, and reached nearly a third of all U.S. counties.
Base grant funding is to be awarded according to a formula
Approximately two-thirds of participating families were in
that takes into account each entity’s share of children under
age 5, FY2021 formula grant amounts, and other factors. In
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link to page 2 Maternal, Infant, and Early Childhood Home Visiting Program
practice, the formula adjusts but approximately maintains
each entity’s share of
Most Widely Used Home Visiting
Number of
total annual base grant funding at its
Models in MIECHV
States/Territories
share of FY2021 total formula grant funding.
Home Instruction for Parents of Preschool
5
Entities are also eligible for a minimum matching grant
Youngsters (HIPPY)
amount, and a share of any remaining match funding based
on each entity’s share of children under age 5 experiencing
Source: HHS, HRSA, FY2021 MIECHV State Fact Sheets.
poverty. Federal matching grants are available subject to a
Note: Another eight models were each used by one to two states in
rate of 75% federal funds and 25% non-federal funds (i.e.,
FY2021.
$3 in federal funds for every $1 contributed in qualifying
non-federal funds, up to certain limits). There is a
Performance Improvement Benchmarks
reallocation procedure for any unclaimed matching funds.
The MIECHV statute requires entities to periodically
demonstrate improvements among eligible families in what
Entities may expend MIECHV funds through the end of the
the law refers to as six “benchmark areas.” These areas are
second succeeding fiscal year after the award. Their
desired outcomes for participants and relate to health, child
administrative costs are generally limited to no more than
maltreatment, academic readiness, crime and safety,
10% of funding. Entities may also use up to 25% of their
economic self-sufficiency, and community referrals. Since
MIECHV grants for a pay-for-outcomes initiative to
FY2017, HHS has used 19 items to measure the
support home visiting approaches that result in cost savings.
performance of each entity (or jurisdiction) across the
benchmark areas. For example, 81% of MIECHV
Requirements
caregivers were screened for depression within three
The authorizing statute specifies a variety of requirements
months of enrollment or service delivery as of FY2022.
for entities receiving MIECHV funds (and requires HHS to
Among children enrolled in MIECHV that year, 79% were
set similar rules for non-state entities). Entities have been
reported as having a family member who read, told stories,
required to conduct needs assessments to identify service
and/or sang with them on a daily basis.
capacity and communities with concentrations of poor child
and maternal health, poverty, and other risk factors.
The law requires jurisdictions to show that they are making
Assessments are submitted to HHS with explanations of
improvements in at least four out of six benchmark areas. If
how identified needs will be addressed. Entities were last
an entity fails to demonstrate improvements, they must
required to update these assessments by October 1, 2020.
develop and implement a corrective action plan subject to
HHS approval or risk grant termination. In FY2020, all
Entities must also submit an application for funding to HHS
state/territory entities met the statutory requirement.
that includes various assurances and information, such as
how high-risk populations will be served. Entities can only
The 2022 reauthorization requires HHS to establish a
use MIECHV funding to support targeted, intensive home
publicly accessible dashboard for reporting jurisdiction
visiting services, and they must comply with several
outcomes and other data, as well as an annual report to
requirements if they wish to support virtual home visits.
Congress covering the outcome data and other detailed
information on the MIECHV program.
Home Visiting Models
The authorizing law directs entities to use a majority of
Research and Evaluation
MIECHV funding to implement home visiting models that
A large body of research suggests that some home visiting
have shown sufficient evidence of effectiveness based on
models or services can benefit children and their parents.
criteria established by HHS. HRSA has determined that 23
The authorizing law requires HHS to conduct an evaluation
models met the evidence and other statutory criteria for
of MIECHV. The resulting large-scale random assignment
MIECHV implementation as of FY2023. Entities may also
study is known as the Mother and Infant Home Visiting
use up to 25% of funding to implement and evaluate models
Program Evaluation (MIHOPE). Among other findings, the
that have shown promise of effectiveness (entities must
evaluation has concluded that the home visiting programs
rigorously evaluate such models). In FY2021, states and
primarily served at-risk families, were implemented well,
territories implemented 10 evidence-based models, as well
and produced positive effects for families on some
as 3 models under the promising standard (Table 2).
outcomes around the time children were 15 months old.
Study of longer-term outcomes is ongoing. HHS also
Table 2. MIECHV Home Visiting Models, FY2021
sponsors research on other home visiting topics, including
model assessment, tribal home visiting, family engagement
Most Widely Used Home Visiting
Number of
in services, the home visiting workforce, programs in rural
Models in MIECHV
States/Territories contexts, and efforts to foster family economic well-being.
Nurse-Family Partnership (NFP)
37
Technical Assistance
Healthy Families America (HFA)
37
The law directs HHS to provide technical assistance (TA)
to entities with regard to home visiting activities and, if
Parents as Teachers (PAT)
35
applicable, any performance improvement plan or
Early Head Start Home-Based Option (EHS)
12
necessary compliance with a requirement regarding virtual
home visiting. Entities receive TA from federal staff, model
developers, and TA providers supported through HHS
contracts or grants. The 2022 reauthorization also requires
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Maternal, Infant, and Early Childhood Home Visiting Program
HHS to consult with eligible entities and analyze, report on,
Patrick A. Landers, Analyst in Social Policy
and reduce the paperwork and other burdens on entities
associated with administering the MIECHV program.
IF10595

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