Budget Summary: Maternal, Infant, and Early Childhood Home Visiting
Alice Fitzgerald | December 1, 2023
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is a federal program that provides federal funds to states, territories, and tribal nations for voluntary, evidence-based home visiting services.
The supported services pair families, who often have limited support and resources, with trained home visitors who help lay the foundation for the health, education, development, and economic self-sufficiency of the entire family.
Decades of scientific research has shown that targeted home visiting, particularly during early parenting stages, helps improve the lives of children and families by:
- Preventing child maltreatment;
- Supporting positive parenting;
- Improving maternal and child health;
- Promoting child development; and
- Increasing school readiness.
The MIECHV program was established in 2010 by Congress to provide voluntary home visiting services for expectant and new parents with children through kindergarten living in communities that are at-risk for poor maternal and child health outcomes.
The nationwide program, funded by the Health Resources and Services Administration of the U.S. Department of Health and Human Services, allocates federal grants to support more than 20 evidence-based service models, which are selected and implemented to best suit the specific needs of their communities.
States often contract with local implementing agencies to provide home visits by nurses, social workers, early childhood educators, and other trained personnel for health check-ups and referrals, parenting advice and counselling, and guidance with navigating other supportive programs and resources.
The Kansas MIECHV program (launched in 2011) is administered by the Kansas Department of Health and Environment (KDHE) targeting Wyandotte County (encompassing Kansas City) and rural parts of Southeast Kansas, which includes Cherokee, Labette, Montgomery, Neosho, and Wilson counties. These areas face some of the highest rates of poverty, child abuse, domestic violence, teen and single parenthood, and unemployment in the state.
Kansas also operates the Maternal and Child Health (MCH) Universal Home Visiting program, which has some overlap with MIECHV, but is less targeted and has less emphasis on evidence-based program development.
The program funds four evidence-based home visiting models in Kansas:
- Early Head Start (EHS) – To help pregnant women and newborns thrive, infants and children thrive, children live in stable and supported families, and children enter school ready to learn.
- Healthy Families America (HFA) – To reduce child maltreatment, improve parent-child interactions and children’s social-emotional well-being, increase school readiness, promote children’s physical health and development, promote positive parenting, promote family self-sufficiency, increase access to primary care medical services and community services, and decrease children’s injuries and emergency department use.
- Parents as Teachers (PAT) - To increase parent knowledge of early childhood development and improve parenting practices, provide early detection of developmental delays and health issues, prevent child abuse and neglect, and increase children’s school readiness and school success.
- Team for Infants Endangered by Substance Abuse (TIES) – To reduce parental alcohol and other drug use, build parenting capacity to support child development, address health and behavioral health care needs of parents and children, and improve access to stable income and safe, affordable housing. (Currently available only in Wyandotte County.)
Participants in the MIECHV program tend to be low income and at increased risk for adverse economic, social, and health outcomes compared to the rest of the state.
Federal funding for the MIECHV program is currently based on a formula that provides a base amount proportional to the prior year’s funding, as well as the share of children under age 5 in families at or below 100% of the federal poverty line in each state. The formula also ensures that the fluctuation of formula funds is limited to 5% or less.
In FY 2022, the MIECHV Program awarded a total of $337 million in funding to 56 states, territories, and nonprofit organizations. Kansas has typically received about $4.8 million a year, although FY 2022 included an additional $1.6 million from the American Rescue Plan Act (ARPA) to allow for additional service provisions during the COVID-19 pandemic. The FY 2023 award is estimated to increase to $5.5 million following a $100 million increase in the total federal award amount passed by Congress in 2022.
Additional funding for the four evidence-based models used in Kansas comes from various sources, including federal Temporary Assistance for Needy Families (TANF) and the Children’s Initiatives Fund (CIF), which is funded through the state’s portion of the Tobacco Master Settlement Agreement. The FY 2023 state budget appropriated just under $17 million to these programs spread across the MIECHV and MCH programs.
Reauthorization and Funding Changes
The 2023 Consolidated Appropriations Act passed by Congress included a five-year reauthorization of the federal MIECHV Program, as well as a change to the funding formula for years to come.
Among other provisions, the law:
- Provides the first-ever funding increase for MIECHV. Federal funding will double over the next five years, beginning with a $100 million increase in base funding in FY 2023.
- Doubles the tribal home visiting set-aside from 3% to 6% beginning in FY 2023.
- Phases in a state-matching requirement beginning in FY 2024. States will be required to provide a 25% match to receive additional federal funding.
- Establishes clear, predictable “maintenance of effort” requirement for states and territories.
- Establishes “base funding,” which will not be subject to the new state match.
Beginning in federal fiscal year 2024 (which starts October 1, 2023), a new state matching requirement will take effect so that for every $1 in new state investment, there will be $3 of federal contributions. Any funding not drawn down by states under the new matching requirement will become available to eligible entities in succeeding fiscal years.
The table below shows the breakdown of the increases to federal MIECHV funding over the course of the five-year reauthorization period.
Three years of strong tax revenues and their resulting (and forecasted) surpluses, along with sensible budget management, have enabled the state to achieve fiscal stability for the first time in years. As varied proposals are made on how these funds should be spent, the MIECHV program should be a priority across the political spectrum.
The significant federal match, the already studied and proven success of the evidence-based program, and the opportunity to provide a lifeline to rural communities with further supports makes complete fiscal and practical sense. Lawmakers must allocate State General Fund dollars to demonstrate that Kansas is willing to invest its own money in the well-being and care of its residents.
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