Certain Home Visitation Models Will Expand Under Health Reform

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The health care reform law signed by President Barack Obama last month will significantly increase federal resources for programs that assist poor, first-time parents.

The Patient Protection and Affordable Care Act includes $1.5 billion over the next five years for states to start and support home visitation programs, which take health professionals and parenting experts into the homes of expectant or new mothers to help prepare them to raise a child.

Home Visitation is part of the Maternal and Child Health Block Grant program at the Department of Health and Human Services. It was only appropriated $13.5 million in fiscal 2009.

Home visitation might not have been funded at all this year if the health care reform bill had not passed. Now, states will receive $100 million for 2010, $250 million in 2011, $350 million in 2012 and $400 million in 2013 and 2014.

The proposal to expand the home visitation program was widely supported by youth advocates, including family preservation advocates.

“The key is that this is purely voluntary,” said Richard Wexler, executive director of the National Coalition for Child Protection Reform. “It’s an offer of help to mothers who might be at risk.”

The law does not appear to require states to match the federal funds, home visitation experts say.

But one part of the new grant program that could stir some controversy is the caveat that states that apply for funds must have a “maintenance of effort.” That means if the state is already spending its own money on a home visitation program, the federal grants must be spent in addition to those funds; the federal money cannot replace state funds. The requirement appears to make it easier for states that have not implemented home visitation programs to use federal funds.

Several states, including Colorado, Louisiana, Oklahoma and Pennsylvania, have statewide home visitation programs.

Two major models in the home visitation field are nurse-family partnerships and Healthy Families America. The nurse-family partnership model, which sends nurses into homes during pregnancy, has programs in 31 states and a national service office based in Denver. Most of the partnerships are run through county or city health departments.

As federal resources increase, the immediate goal will not be to expand to all 50 states, said Peggy Hill, director of program development for Nurse-Family Partnership (NFP), the Denver-based nonprofit that helps local programs. “We want programs planted well in communities that need it, wherever we have concentrated poverty,” she said.

Healthy Families America, a Chicago-based program launched in 1992 by Prevent Child Abuse America, partners with local affiliates to train staff to help new or expectant parents develop parenting skills and make connections to health care and immunizations.

Other programs expected to see an increase in replication through the federal funds are Parents as Teachers, The Parent-Child Home Program and Home Instruction for Parents of Preschool Youngsters (HIPPY).

For information on national home visitation models, visit:

Nurse-Family Partnerships – http://www.nursefamilypartnership.org;

Healthy Families America – http://www.healthyfamiliesamerica.org;

Parents as Teachers – http://www.parentsasteachers.org;

The Parent-Child Home Program – http://www.parent-child.org;

HIPPY – http://www.hippyusa.org.