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Testimony of Mary Katherine West
Home Visiting Program Coordinator, DC Action
DC Council Committee on Health: Home Visiting Services Reimbursement Act of 2023 Hearing
Good morning Chairperson Henderson and members of the Committee on Health. Thank you for your support for the Home Visiting Services Reimbursement Act and for the opportunity to address the Committee today. My name is Mary Katherine West and I am the Program Coordinator for the Home Visiting Council at DC Action, member of the Under 3 DC Coalition, and Ward 1 resident.
DC Action uses research, data, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. We are the home to DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being and the Home Visiting Council which convenes home visiting programs and stakeholders to build a stronger system for expectant parents and families with young children.
We believe that we can achieve healthy communities through early intervention and prevention services like home visiting. Families need connection, resources, and support to thrive. Home visitors use a curriculum that supports families to reach their goals in pregnancy outcomes, maternal and child health, child and family safety, parenting skills and practices, social emotional and cognitive development for children, and school readiness. One home visiting participant, Amy, shared, “Home visiting has taught me a lot! Because of my age, being a mom has been very difficult for me. My home visitor has been a great support for me and teaches me many things about my baby as she grows, step by step.”
We strongly support the Home Visiting Services Reimbursement Act, which provides an opportunity for DC to garner additional federal funding for home visiting programs. Funding for home visiting programs comes from a variety of federal, local, and private sources. Over 80% of programs receive some public funding either from DC Health, the Center for Family Services (CFSA), the Community Based Child Abuse Prevention grant (CBCAP), Early Head Start, Family First Prevention Services Act, or the Maternal Infant Early Childhood Home Visiting (MIECHV) program. Since 2018 and throughout the COVID-19 pandemic, both public funding structures have been highly variable, forcing programs to adjust and adapt to budget changes and tight budgets.
Alongside other federal and local sources, Medicaid reimbursement would provide an additional and maintained investment into home visiting that programs can count on year after year. In the past year, programs have faced the consequences of uncertain and unstable budgets. One program faced a local budget reduction in response to a position vacancy that they were struggling to hire due to a low salary. The program had to rely on private funds allocated to another program in the organization to cover costs. Between grants, another locally funded program halted in-person visits due to insufficient funds to cover transportation to families homes. The program was able to still provide virtual home visits, but it is harder for home visitors to engage families virtually.
Families bear the consequences of inadequate and unstable funding. Eighty percent of the Districts’ programs struggle to recruit and retain home visitors, citing issues of high stress and low pay. Without a full team of home visitors, programs cannot meet the needs of all families who would benefit from their services. When home visitors leave the workforce, families may be without a home visitor for months, or decide to leave the program entirely. Even if families get a new home visitor, it takes time for them to feel comfortable and trust the new relationship. By strengthening and stabilizing programs, Medicaid reimbursement would facilitate more seamless service provision beyond the almost 1,400 families served in FY 2022.
Based on the language in the legislation, 13 of the District's 17 home visiting programs are likely to meet the evidence-based standards for reimbursement. This includes 12 programs that meet the HOMVEE standards for evidence based home visiting: Bright Beginnings: Parents As Teachers, Community of Hope: Healthy Families America, Community of Hope: Parents As Teachers, Generation Hope: Parents As Teachers, Georgetown: Parents As Teachers, Healthy Babies Project: Healthy Families America, Matha’s Table: Parents As Teachers, Mary’s Center: Healthy Families America, Mary’s Center: Parents As Teachers, Mary’s Center: Nurse Family Partnership, Rosemount Center: Parents As Teachers, The Family Place: Home Instruction for Parents of Preschool Youngsters (HIPPY).
In addition, the home visiting program at Mamatoto’s Village which is working to publish independent and rigorous evidence of effectiveness. Currently, the legislation provides flexibility for the four remaining programs to gain access to reimbursement if they are able to produce rigorous evidence that their program meets a comparable evidence-based standard.
Evidence-based standards demonstrate that, through their personalized and holistic approach, home visiting programs increase school readiness, positive maternal outcomes, child health and development, family economic self-sufficiency, and the parents’ confidence in caring for their children. Home visiting decreases child abuse and neglect, intimate partner violence, preventable childhood health conditions like low-weight births and preterm births, and most importantly, reduces infant mortality rates, which is critically important in the Distrist as our rate is 6.6 out of every 1,000 babies, higher than the national average of 5.4. Infant mortality disproportionately affects Black babies in the District, and eleven out of every 1,000 for Black infants do not make it to their first birthday. Parental health is another key outcome for home visiting programs which has the potential to reduce unacceptable disparities in the District. Between 2014 and 2018, Black parents represented over 90% of deaths from pregnancy and birth complications. Home visiting should be a key resource to the District’s approach to eliminate unacceptable disparities in birthing for Black families.
Home visiting programs help families reach their goals and manage challenging life transitions during the duration of the program, but also represent an investment in children and families’ futures. Because of the positive impacts of home visiting, we are able to address the root causes of many other issues, leading to better outcomes for families, that also result in reductions in spending on social services for foster care food and income assistance, the juvenile justice system, child abuse and neglect, and special education or grade repetition reflect the long term outcomes of investing in home visiting. According to the Center for American Progress, these reductions provide a return for up to $5.70 for every dollar spent on home visiting.
If passed and fully implemented, the District would join 28 other states, including our neighbors in Maryland, who have fully implemented pathways for home visiting providers to receive reimbursement from Medicaid. This is a common sense and practical solution to increasing funding for home visiting that recognizes the value of home visiting for families and their little ones while providing cost savings to the District.
We hope the committee will quickly mark up and the DC Council will pass the Home Visiting Services Reimbursement Act so that the Department of Health Care Finance can begin to create its State Plan Amendment for submission and approval by the Centers for Medicare and Medicaid Services. When creating the SPA, DHCF must engage and listen to the affected programs. DC Action and the Home Visiting Council would be eager to work with DHCF to support a smooth and effective implementation so we can ensure the added Medicaid dollars go to serving families and improving program outcomes. DHCF must establish a reimbursement system that provides desirable rates to cover program costs and incentivize participation as well as desirable methods that do not put undue burden on programs' reporting capacity.
Now is the time to invest in the District’s families. We are excited for the opportunity to strengthen funding and stabilize these essential programs, which families across the District depend on. With coordination in the sector, we can work together to ensure that these investments successfully reach families and help them thrive.
Thank you for your time and consideration. If you have any questions or matters you would like to discuss I can be reached at the contact information below.
Mary Katherine West
Home Visiting Program Coordinator
DC Action
October 10, 2023