As we’ve sought to identify concrete ways Medicaid can better support young children’s development, one of the clearest opportunities of high interest to policymakers is expanding home visiting programs for pregnant women and young children. Using Medicaid for home visiting is not a new concept, but a number of factors have raised the profile of the strategy in recent years: heightened interest in the critical period of early brain development (see: NY First 1,000 Days), a strong evidence base for home visiting program models, new investments created by the ACA (called Maternal, Infant, and Early Childhood Home Visiting Program, or MIECHV), and CMS 2016 guidance signaling support for ways states can use Medicaid to fund home visiting.
Of course, it’s one thing to want to unpack Medicaid to pay for needed and relevant services; how best to do it is not always clear, given wide state variation in Medicaid. But Kay Johnson, a long-time expert in the intersections between Medicaid and maternal and child health systems, recently released a new paper that offers additional clarity on possible pathways, based on many years of experience in more than a dozen states.1
Home visiting (not unlike mental health) is itself not a covered service in Medicaid, but Medicaid does reimburse—based on state design—many services provided as part of home visiting (e.g. screenings, case management). A few takeaways of note:
Most children or pregnant women served by home visiting programs are enrolled in Medicaid or CHIP—an important foundational reason to explore ways Medicaid can support specific services.
There is no one way to do this; states have flexibility in design of systems and financing approaches. For example, most states use targeted case management (TCM) services within home visiting programs through a state plan amendment. Others use waivers to pilot approaches for specific children or specific communities, or to integrate home visiting into Medicaid managed care arrangements (See Table). Some states allow managed care plans to support home visiting, but do not necessarily have a state-level policy or approach. There’s potential for states to do more under Medicaid benefit categories as well: in case management, EPSDT, prenatal/pregnancy benefits, and preventive services for adults.
Medicaid can help to expand capacity of programs and reduce unmet need, in concert with other federal and state dollars. Medicaid can’t pay for the full cost of a home visiting program, but it can pay for full visits. MIECHV helped to strengthen state capacity and create an infrastructure for home visiting that offers an opportunity to look at system alignment and identify specific areas where Medicaid can pay for eligible services to Medicaid-enrolled children and pregnant women.
Any state serious about making home visiting available to more pregnant women and young children should unpack opportunities to leverage Medicaid funding. This paper provides a new tool for state policymakers seeking to roll up their sleeves and get started.