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Time Runs Low for Home-Visiting Act as Congress Debates State Buy-In

Supporters of federally-funded home-visiting programs have cleared one set of hurdles as the law nears a Sept. 30 expiration date: Both houses of Congress have introduced legislation that would keep the program going for five additional years, at $400 million each year. 

But there's a major difference between the two bills. In the House bill, states would have to eventually match every dollar of federal money they receive with state, local, or private contributions. The bill passed the House Ways and Means Committee on Sept. 13, with every Republican on the committee voting in favor of the reauthorization plus state-match provision, and every Democrat voting no. 

On Tuesday, a bipartisan group of Senators released a home-visiting reauthorization bill that offers the same amount of money, but doesn't carry the state-match provision. 

The question now: which vision of home visiting's future will prevail? 

Advocates hope that the bipartisan Senate bill can make it over the finish line in time.

"We're really excited about the Senate bill," said Karen Howard, vice president of early-childhood policy at the advocacy organization First Focus. "From both chambers, there's been a feeling of not if it should be done, but how it should be done." First Focus is one of the organizations that has convened the Home Visiting Coalition, which supports continuation and expansion of the federal program.

The federal home visiting program—its formal name is the Maternal, Infant, and Early-Childhood Home Visiting program, or MIECHV—began as a small program during President George W. Bush's administration. However, it received a big boost during the Obama administration. It received $1.5 billion as a part of the Affordable Care Act in 2010, and when that funding expired in 2015, the program received an additional $800 million over two years as a rider to a Medicare doctor-payment bill. That second extension is what will expire on Sept. 30. 

States use the money to send medical professionals and trained counselors to the homes of vulnerable families, using one of several research-based models of home visiting.

Supporters of the state-match provision believe it would strengthen the partnership between the federal government and the states. David Schweikert, an Arizona Republican who supports the state-match provision, said "if you don't have some skin in game, you don't pay attention to details," reported the Chronicle of Social Change

Democrats on the House committee said during the bill markup that states just might not be able to meet that provision.

And even if they could, states could face a need to shift funding priorities, and then risk losing all the federal home-visiting support, Howard said. "Look at Florida with [Hurricane] Irma, look at Texas with [Hurricane] Harvey." 

The Senate bill comes closest to matching the desires of states and families, while keeping in mind the desires of the House for more program accountability, said Diedra Henry-Spires, the chief executive officer of the Dalton-Daley Group and a co-convener of the Home Visiting Coalition.

"They have reflected the best thinking of a multiplicity of voices," Henry-Spires said. "This is a product that is a pathway to reauthorization." 


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