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  6. Federal Home Visiting Reauthorization Bill Moves Forward

Federal Home Visiting Reauthorization Bill Moves Forward

September 22, 2022

This week, leaders in both the House Ways and Means Committee and Energy and Commerce Committee introduced the Jackie Walorski Maternal and Child Home Visiting Reauthorization Act (H.R. 8876) which reauthorizes the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. The bill passed out of the House Ways and Means Committee by a vote of 41-0 with one abstention.

It is essential to note that the MIECHV program is a mandatory program, and this bill proposes significant changes to its overall funding. After a careful review by the ASTHO government affairs team, we strongly encourage that state legislative staff and maternal and child health teams carefully review the bill text and summary. This legislation is complex with new maintenance of effort, state matching requirements for a new grant program, and changes to an administrative cap that could uniquely impact state and territorial federal home visiting programs.

The press release, summary of the legislation, section-by-section summary, and bill text are available for review.

Outlook

The full House of Representatives will consider the bill, then move it to the Senate. Offsetting the program’s costs is yet to be addressed and is a priority for Congress. However, this legislation was approved with broad bipartisan support, and the government affairs team believes it may be signed into law before the end of the calendar year. Funding for the current MIECHV program expires at the end of the month. Advocates expect Congress to approve a short-term extension of MIECHV as part of the continuing resolution bill that needs to pass before Sept. 30.

Detailed Summary

Currently, the MIECHV program receives approximately $400 million per year.

  • This legislation proposes an increase in base funding to $500 million for FY23-FY27. The minimum base grant for an entity is $1 million.
  • Starting in FY24-FY27, federal matching grant funds—in addition to base funding—are available to every eligible entity, guided by a formula that will focus on the number of children under five in poverty if they comply with specific statutory requirements on an increasing scale:
    • FY24 $50 million.
    • FY25 $100 million.
    • FY26 $150 million.
    • FY27 $300 million.
  • To draw down its full allotment of federal matching grant funds, an entity must provide non-federal funds above their maintenance of effort requirement such that 25% of the total spending consists of non-federal funds.
    • Unobligated matching funds can be redistributed to another entity that can contribute to the non-federal matching funds.
    • The ASTHO government affairs team recommends carefully reviewing the legislation to see what funds can contribute to this new matching requirement.
  • New maintenance of effort requirement for states and territories is based on the lesser total of non-federal funds expended in 2019 or 2021. The entity is not eligible for base or matching grants if this is not met.
    • The secretary may allow a grace period for an entity to come into compliance.
  • Phased-in additional federal matching funding starting in FY24 is part of the requirement for entities to be eligible for the new federal matching grants, which requires a 25% state match (i.e., for every $1 in state funds, there is a $3 federal contribution). The non-federal matching funds are not applied to the maintenance of effort requirement.
    • The minimum state matching funds are as follows:
      • FY23: Federal matching funds are not required.
      • FY24: $776,000.
      • FY25: $1,000,000.
      • FY26: $1,500,000.
      • FY27: $2,000,000.
    • If a state cannot reach the required amount, the secretary of HHS can proportionately reduce the federal matching amount for that fiscal year.
  • Limits state administrative spending to 10% of grants and an exception for not more than 5% at the discretion of the secretary of HHS.
    • This applies to an entity that directly provides home visits to families and not through a sub-recipient.
    • The entity is expanding services to a new community and has been providing services for fewer than three years.
  • Allows limited ability to conduct virtual home visits and requires entities to demonstrate that they have met specific conditions. Service delivery models must include at least one in-person visit a year to qualify for federal funding.
  • Doubles the tribal set-aside (from 3% to 6%) starting in FY23.
  • Dedicated funding (2% set aside) for workforce support, retention, and case management.
  • Set aside funding for research, evaluation, administration, and technical assistance.
  • Establishes an outcomes dashboard and annual report to Congress on the program.
  • Requires HHS to work with partners to reduce administrative burden.
  • Maintains a strong focus on evidence-based home visiting models and practices.