New Home Visiting Entitlement

Many thanks to our friend Tom Birch at the National Child Abuse Coalition for the following write-up about the new home visitation entitlement, which was included in the just-enacted health reform law.

The Alliance for Children and Families is a proud member of the National Child Abuse Coalition. The following excerpt is taken from the Coalition’s Washington Memorandum and is reproduced here by permission.

For the first time, federally mandated funding dedicated for prevention to support home visitation services will be available to states through provisions in the health care reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590; Sec. 2951, page 561), signed into law by President Obama on March 23. 

The new measure authorizes $1.5 billion over five years – with $100 million in 2010 – for Maternal, Infant, and Early Childhood Home Visiting Programs funded through Title V, the maternal and child health block grant, to support a range of voluntary home visitation services to pregnant women, young parents and their children. A three-percent share of the funds would be reserved for grants to Indian tribes.

Priority for services would go to low-income families, including pregnant women under age 21, living in communities in need of services.  Eligible families would also include those with:

  • a history of child abuse or neglect or involved with child welfare services,
  • a history of substance abuse,
  • children with low student achievement,
  • children with disabilities or developmental delays, and
  • family members serving in the military, including those “who have had multiple deployments outside the United States.”

Family members eligible for the home visitation services include a child’s parents or primary caregivers, such as grandparents or other relatives of the child, foster parents, and a noncustodial parent with an ongoing relationship with the child.

Within six months of enactment of the bill, states are required to conduct a statewide needs assessment to identify communities at risk, those with concentrations of:

  • premature and low birth-weight infants, infant mortality, including death due to neglect;
  • poverty;
  • crime;
  • domestic violence;
  • high rates of high school dropouts;
  • substance abuse;
  • unemployment; or
  • child maltreatment.

The needs assessment must also evaluate the quality and extent of existing early childhood home visitation services, including numbers of families already receiving services and the gaps in home visitation services. States must also assess the capacity for providing substance abuse treatment and counseling. (If a state does not apply, or is not approved for a grant, HHS may award funds otherwise available for that state to a nonprofit organization with an established record of providing early childhood home visitation programs.)

The law directs states, in conducting a needs assessment, to coordinate with and take into account other needs assessments already ongoing, including those required by the Maternal and Child Health Block Grant, Head Start, and Title II of the Child Abuse Prevention and Treatment Act (CAPTA).

In applying for the home visitation grants, states must establish quantifiable benchmarks to demonstrate improvements at intervals of three and five years for families participating in the program in:

  • maternal and newborn health;
  • prevention of child maltreatment;
  • school readiness;
  • reduced crime or domestic violence;
  • family economic self-sufficiency; and
  • coordination with community support services.

If, after three years, improvements are not demonstrated in at least four of the six benchmarks, HHS may provide technical assistance to the state to move toward progress.

The new grant program would require that 75 percent of the funding to a state for home visitation would support models that are well-designed, research-based, and rigorously evaluated through randomized control trials or quasi-experimental research designs. The remaining 25 percent of grant funding could go to support promising and new approaches yet to be evaluated by a similar rigorous process.

The law specifies that the Maternal and Child Health Bureau and the Administration for Children and Families, both in HHS, must “collaborate” in reviewing and analyzing the statewide assessments needs assessments, the awarding of grants, and the program evaluations. The statute does not specify or instruct the governors of the states applying for home visitation funds to designate a lead state agency. Collaborations at the state level presumably will be in order, and guidance from HHS on these and other issues would be appropriate.

The entitlement funding for the program would increase from $100 million in 2010 to $250 million in 2011, $350 million in 2012, and $400 million in each of 2013 and 2014.

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