House Bill Introduced to Reauthorize Home Visiting Program

The House Ways and Means Committee has produced a bill to provide a five-year reauthorization for Maternal, Infant and Early Childhood Home Visiting (MIECHV), a maltreatment prevention program popular with both parties.

MIECHV was initially created as part of the Affordable Care Act, with a five-year window that grew its annual appropriation to $400 million. Since its original authorization expired, MIECHV has been saved with $400 million annual extensions attached to other health care laws, most recently the bill to update Medicare in 2016.

President Trump’s budget pencils in another two-year, $400 million extension for the program. The House bill would reauthorize MIECHV through 2022, but does not specify an annual authorization for the program.

CEOs from several of the national organizations representing home visiting models visited with Congressional staff in late May. They are pushing for a five-year reauthorization that gradually brings annual funding up to $800 million.

Diedra Spires, who is lobbying for reauthorization on behalf of the organizations, said after the meeting that there is substantial bipartisan support for growing MIECHV, but uncertainty still on how it would be paid for.

“That part, the offset game, isn’t our job,” Spires told Youth Services Insider. “But everyone in this environment is worried that a program you love could be used to pay for a program you love.”

There is not a single mention of money in H.R. 2824, which is sponsored by Rep. Adrian Smith (R-Neb.), the chairman of the Human Resources Subcommittee for Ways and Means. But the bill’s language does suggest an interest in shifting the cost of home visiting away from the federal level over time.

Starting in fiscal 2020, MIECHV grantees would have to adhere to an “applicable percentage” rule that ensured a certain portion of the program would be paid for outside of federal dollars. Thirty percent of programs would have to be paid for outside of federal dollars by 2020. By 2022, it would rise to 50 percent.

There is a caveat that the fair-market value of goods, services and facilities could be included in the non-federal calculation, which can potentially drive down the real fiscal burden on a state or county.

The House bill would also ratchet up effectiveness reviews and empower the Department of Health and Human Services to terminate grants for home visiting models that did not improve on agreed-upon benchmarks. It would also permit MIECHV grants to be used in “pay-for-success” structures, in which a government agency commits to paying for home visiting services only after promised results are achieved.

Without a reauthorization bill, MIECHV grantees would face great uncertainty in September, when the current authorization runs out.

“September has to happen so that families keep getting served,” Spires told YSI after the May meeting. Failure to reauthorize by then, she said, risks significant layoffs by home-visiting programs and possible termination of services to at least some clients.

Click here to read the bill.