The home visitation program -- a key piece of the Obama Administration's pledge to strengthen programs for children from birth to age 5 -- received another boost yesterday when the Senate's Finance Committee passed its version of the health care bill. The bill includes language that would establish a program for "maternal, infant and early childhood visitation."
Over the summer, the House committees with dominion over the financing and regulation of the proposed program had already cleared the way for the program. And it appears to have support from both Democrats and Republicans. Rep. Todd Russell Platts (R-PA) was among the authors of the first version to be introduced this year, and Senator Kit Bond (R-MO) has introduced similar legislation in the past. Unless something unexpected happens -- and anything is possible given the overheated environment surrounding health care reform (see our post on Chuck Norris) -- chances are good that any health care bill that passes the House and Senate will bring home visitation along for the ride.
Still, there are differences between the House and Senate versions that will have to be worked through -- especially related to funding. The version that passed yesterday allocates twice as much funding for home visitation than what passed in the House committees. It would provide $1.5 billion in mandatory funding over five years (starting with $100 million in 2010). The version passed by the House committees put the price at $750 million over five years.
Obama's budget, you may remember, had requested $124 million in mandatory funding for fiscal year 2010, with plans to spend $1.8 billion on the program ten years from now. The Administration had estimated that 50,000 additional families could be served in the program's first year, with 450,000 on board by 2019.
Aside from the increase in money, the Finance Committee's version looks similar to what we've described before.
Here's how it would work: The federal government would grant states money each year to support programs that assist low-income pregnant women and mothers with babies who want the help. The assistance would come in the form of a registered nurse or trained paraprofessional who arrives at the mother's home on a regular basis to provide information that encourages healthy pregnancies and infant care.
States who want the grant money would have to fund programs modeled on already-well-researched approaches, such as the Nurse-Family Partnership and the program run by Healthy Families America. The bill also requires states to hit benchmarks if they want to keep their grants, showing improvement in maternal and child health, child injury protection, school readiness, and other factors related to children's well being. States would have to use rigorous research methods to evaluate the programs.
The Finance Committee's version also requires states to conduct a "needs assessment" - a report on how many at-risk families live in the state and what services they lack access to. This report, according to the committee mark-up, would be "separate from but coordinated with" the needs assessments required by agencies that receive Head Start grants. It's encouraging to see a nod to the need to align efforts between Head Start and this program, especially since the Early Head Start program is already designed to offer pregnant women and new mothers a combination of services including center-based child care, parenting groups and home visitation. Here at Early Ed Watch, we wonder if there are other areas of commonality between Early Head Start and home visitation programs that should be examined to promote coordination and avoid redundancies.
Given that smart health-care reform should include as many enticements for prevention and wellness as possible, it makes good sense for home visitation to be included in this bill. And as many experts pointed out at a Brookings Institution forum earlier this month, it's exciting to see the bill's emphasis on rigorous evaluation and the use of programs with strong, scientific evidence of effectiveness. Along with our colleagues at New Health Dialogue, another New America Foundation blog, we'll be watching the progress closely as the Senate and House start their debates. Stay tuned.