By Mary Katherine West
On June 9th, 2023, Council Member Nadeau introduced Bill 25-321, The Home Visiting Services Reimbursement Act, to the DC Council with co-sponsors Allen, Lewis-George, Parker, and R. White. As outlined in the bill, Medicaid reimbursement for the District’s qualifying home visiting programs could provide critical support for providers and families. Home visiting services improve outcomes for children and families, especially Black mothers and infants who face disproportionate rates of maternal and infant mortality due to historical and structural racism. Passing and implementing this legislation supports home visiting services for the District’s children and families by drawing down federal dollars alongside local funds. Twenty-eight states already made this vital investment, and DC should be the next.
About Home Visiting
Home visiting is an evidenced-based intervention that, among other proven benefits, improves birth outcomes, child health and development, and maternal physical and mental health outcomes. Services are free and voluntary for expecting parents and families with children under five. In addition, home visiting is an essential component to the District’s strategy to address racial disparities in birth outcomes among Black mothers.
However, a lack of sustainable funding strains home visiting programs' ability to provide services to eligible families. Each year, providers are susceptible to cuts in local funding and stagnation in the face of inflation.
The Proposed Legislation
Leveraging federal funds through Medicaid will increase stability and sustainability for home visiting services. The proposed legislation directs the Department of Health Care Finance (DHCF) to provide Medicaid and Alliance coverage for evidence-based home visiting by October 1, 2024.
In DC, 13 of 17 home visiting programs in the District could be eligible for reimbursement through Medicaid. The legislation gives DHCF the ability to define which providers will be eligible based on criteria including length of program establishment, association with an organization that has comprehensive home visiting standards, and demonstrated program efficacy to produce desired outcomes.
Potentially Eligible Programs:
Bright Beginnings: Parents As Teachers, Community of Hope: Healthy Families America, Community of Hope: Parents As Teachers, Generation of Hope: Parents As Teachers, Georgetown: Parents As Teachers, Healthy Babies Project: Healthy Families America, Martha’s Table: Parents As Teachers, Mary’s Center: Healthy Families America, Mary’s Center: Parents As Teachers, Mary’s Center: Nurse Family Partnership, Mamatoto Village: Mothers Rising; Rosemount Center: Parents As Teachers, The Family Place: Home Instruction for Parents of Preschool Youngsters (HIPPY)
The Council must retain support for all home visiting models in the District to meet the diverse needs of District families. Increasing and diversifying funding streams will help increase more DC families access home visiting and increase home visitors’ salaries to promote retention in the field.
Presently, twenty-eight states reimburse home visiting programs with Medicaid funds and nine states are actively working toward plan approval or implementation. Multiple studies and data from existing programs demonstrate the benefits of Medicaid reimbursement including expanding access to home visiting and cost-savings.
After New Mexico implemented Medicaid reimbursement in 2021, more families received home visiting services and the state associated the policy with improved birth outcomes. Further investments would allow home visiting services to reach beyond the 1,374 DC families served in 2022.
Ensuring sufficient investment in home visiting programs results in cost-savings for the District. National analyses estimate that investing in home visiting as preventative care decreases overall healthcare costs by decreasing the rate of neonatal intensive care unit (NICU) visits by low-birth weight babies. The District has the third-highest rate of low-birthweight babies in the nation, so decreasing NICU visits is both a critical health outcome and saves thousands of dollars per child in healthcare costs.
Additionally, for every dollar spent in home visiting, there is an estimated return of up to $5.70 in savings. Cost savings stem from associated reductions in social services spending for foster care, food and income assistance, the juvenile justice system, child abuse and neglect, and special education or grade repetition.
To achieve the benefits of reimbursement, the DC Council and affected stakeholders must complete several steps to implementation by October 1, 2024. Bill 25-321 currently resides in the DC Council’s Committee of Health which will hold a hearing for the legislation on October 4th, 2023. This hearing is an opportunity for home visiting programs and recipients to share the impacts and importance of home visiting to the council and influence the legislation’s passage by the Council. After passage, DHCF must consult with home visiting organizations and other stakeholders to create a State Plan Amendment (SPA) that details the District's proposed process of reimbursement. DHCF must submit the SPA to the Center for Medicaid Services (CMS) within six months of the bill’s enactment, and CMS must approve the SPA before October 1, 2024.
Testimony is vital to the success of this legislation. For information about the hearing process and signing up to testify or for support in writing your testimony, contact DC Action’s Home Visiting Program Coordinator, Mary Katherine West at email@example.com.