As more states adopt Medicaid’s postpartum extension, making health coverage work for postpartum people and their newborns requires dedicated attention by states on the best ways to ensure mom and child get the right care at the right time.
One popular, evidence-based intervention for young families is home visiting. The approach typically includes some combination of the following services that vary by model:
- screenings or broader health assessments of the mother or child, using results to provide or connect families to additional services;
- parent education or coaching designed to promote a child’s social-emotional development;
- a connection point and sustained care coordination to link and refer to needed services, including mental health supports in response to screenings; and
- home-based treatment, such as dyadic or family therapy, that supports parent-child relationship building.
States have used Medicaid to fund home visiting for many years, with approaches varying from state to state. But the added urgency of the nation’s mental health and maternal health crises– both of which also threaten early childhood brain development– demand renewed leadership on upstream interventions like home visiting. Two new resources detail opportunities for federal and state leaders to do more.
Federal Opportunities to Scale Home Visiting Through Medicaid
I was honored to work with former federal Medicaid Director Vikki Wachino on a new policy brief, “Promoting the Mental Health of Parents and Children by Strengthening Medicaid Support for Home Visiting.” The piece, originally published in Psychiatric Services, is part of the Think Bigger, Do Good series supported by a collaboration of funders seeking to improve mental health policies. (View the webinar here.)
The paper argues that the nation’s mental health crisis, combined with (also) overdue attention on maternal and early childhood health, calls for urgent action on proven, upstream interventions like home visiting. With its reach and purchasing power, Medicaid can do much more to advance and scale home visiting as a key strategy to address mental health of perinatal people, young children and their families. The paper details home visiting’s role in federal policy, including the ACA-created Maternal, Infant, and Early Childhood Home Visiting program (MICHEV), Medicaid policy connections, and detailed table of home visiting models and specific outcomes related to maternal and child mental health.
Finally, we outline specific recommendations for federal policymakers seeking to do more to scale home visiting through Medicaid.
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Make evidence-based home visiting programs a required state benefit during pregnancy and through the child’s first year of life, with the state option to extend the benefit for children up to age 6.
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Clarify the ways states can effectively coordinate a variety of federal funding streams that support home visiting. With a new Medicaid requirement, it will be important for federal policymakers to clarify the ways federal funding streams can be used together, with Medicaid as the first (as opposed to final) payer.
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Direct HHS to provide technical assistance to states on ways to advance home visiting across child-serving agencies.
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Identify strategies to maximize the reach of Medicaid-funded home visiting alongside other home-based parent and/or early childhood mental health services.
More than half of states already use Medicaid to fund home visiting
States don’t need to wait for a federal requirement to support home visiting– more and more states are doing this today. We used previous scans to show that 20+ states use Medicaid to support home visiting. A new and timely 50–state analysis from the National Academy for State Health Policy shows that momentum continues to grow, with now more than half of states leveraging Medicaid for home visiting – 28 by their count! NASHP also released a detailed companion table on the specific ways each state uses Medicaid to fund home visiting models – most (22) through their Medicaid state plan for benefits including targeted case management (10 states), extended services to pregnant women (5 states), and/or EPSDT (3 states).
Home visiting is one of a constellation of strategies to ensure young children and their families get the help and support they need to thrive. Scaling home visiting through Medicaid is not a silver bullet, but an important part of the solution. Medicaid can do more to scale this proven strategy to more effectively address the health and mental health needs of pregnant people, young children and their families during a high-stakes period of family change and early childhood development.
