Home Visiting Legislation
Following the passage of MIECHV in 2010, at least 23 states have passed home visiting legislation of their own. State legislatures are allocating funds and advancing legislation to help coordinate state-administered home visiting programs and strengthen the quality and accountability of those programs.
Some legislators are passing legislation to set program standards and expected outcomes. Others are allocating funds and providing legislative oversight of the state agencies. In addition, some are leading the way to develop comprehensive and connected early childhood systems that include high-quality child care, prekindergarten, early intervention services, home visiting, and other child and family services—all of which require a qualified and supported workforce.
In 2019, the Nevada Legislature enacted AB 430, requiring the Legislative Committee on Child Welfare and Juvenile Justice to conduct a study concerning maternal, infant and early childhood home visitation services. In 2019, Oregon enacted SB 526 to direct the Oregon Health Authority to design, implement and maintain a voluntary statewide program to provide universal newborn nurse home visiting services to all families within the state to support healthy child development and strengthen families.
New Hampshire passed SB 592 in 2018, which authorized the use of TANF funds to expand home visiting and child care services through family resource centers. A year later, New Hampshire passed SB 274 to allow all Medicaid-eligible children and pregnant women access to home visiting programs for children and their families.
Utah passed the Nurse Home Visiting Pay-for-Success Program (SB 161) in 2018 to create an evidence-based nurse home visiting pay-for-success program. The enacted legislation allows a contractual relationship between the Department of Health and one or more private investors. Success payments are provided to investors if the program meets the performance goals outlined in the pay-for-success contract.
In 2016, Rhode Island lawmakers passed the Rhode Island Home Visiting Act (HB 7034), which requires Rhode Island’s Department of Health to coordinate the system of early childhood home visiting services; implement a statewide home visiting system that uses evidence-based models proven to improve child and family outcomes; and implement a system to identify and refer families before the child is born or as early after the birth of a child as possible.
In 2013, Texas lawmakers passed the Voluntary Home Visiting Program (SB 426) for pregnant women and families with children younger than 6. Also in 2013, the Texas Legislature increased funding for at-risk prevention programs for child abuse and neglect prevention leading to the Healthy Outcomes Through Prevention and Early Support (HOPES) program, which began providing services the following year. The bill also established the definitions of and funding for evidence-based and promising practice programs (75% and 25%, respectively). Texas has a history of investing in home visiting dating back to 2007 with SB 156, which required the Health and Human Services Commission to establish a nurse-family partnership competitive grant program to serve approximately 2,000 families in multiple communities throughout the state.
In 2013, Arkansas lawmakers passed SB 491, requiring the state to implement statewide, voluntary home visiting services to promote prenatal care and healthy births. The bill required the state to use at least 90% of funding for evidence-based and promising practice models and to develop protocols for sharing and reporting program data and a uniform contract for providers.
Program standards provide a common understanding of how home visiting services should be delivered to achieve positive, measurable outcomes for infants and toddlers and their families.
Oklahoma’s Family Support and Accountability Act of 2015 requires performance outcomes to be measured and reported annually. New Mexico’s Home Visiting Accountability Act of 2013 established standards and reporting requirements for the home visiting programs receiving state funds. The act also requires that its Children Youth and Family Department create and disseminate an annual outcomes report.
Additional examples of legislative action are available through NCSL’s Early Care and Education Bill-Tracking Database, which contains introduced and enacted home visiting legislation for the 50 states, Washington, D.C., and the territories.
By the Numbers
- In 2017, more than 300,000 families received evidence-based home visiting services over the course of more than 3.5 million home visits. That same year the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant program helped fund services for more than 81,000 families in states, territories and tribal communities.
- About 18 million pregnant women and families (including more than 23 million children) could benefit from home visiting but were not reached in 2017.
- In 2017, nine emerging models provided 406,182 home visits, serving 28,706 families and 28,798 children.
- In fiscal year 2018, MIECHV funding helped serve 150,000 parents and children.
- In fiscal year 2018, MIECHV funding supported more than 930,000 home visits.
- An additional 28,700 families received home visiting services through nine emerging models that do not yet meet the standards of evidence required by the Home Visiting Evidence of Effectiveness project. These nine models provided more than 400,000 home visits in 2017.
According to the U.S. Census Bureau, 20% of the population lives in rural areas. Policymakers have considered increasing access to health care services through telehealth to reach patients in rural communities. Virtual tools are one way to expand the reach of home visiting services to hard-to-reach communities. Parents as Teachers at USC Telehealth, for example, is successfully providing home visiting services from a distance. There are limitations to this approach, however, as home visitors often model nurturing interactions with babies and children and physically demonstrate safe sleep practices.