RD834 - Medicaid Home Visiting Workgroup Report – December 1, 2021

Executive Summary:

Home visiting programs are focused, individualized, and culturally competent services for expectant parents, young children and their families. They utilize a research-based strategy, provided within homes and connected communities, dedicated to improving birth outcomes, family self-sufficiency, and children’s early potential.

Virginia has a robust network of home visiting models and providers, with over 72 local programs serving communities across the Commonwealth. These home visiting programs represent eight models: Early Head Start Home-Based Option, Family Spirit®, Healthy Families America®, Health Start/Loving Steps, Nurse-Family Partnership®, Parents as Teachers®, Resource Mothers, and Comprehensive Health Investment Project of Virginia. Each model is designed to meet the specific needs of the people who use them and provide the resources and skills required to raise children who are physically, socially, and emotionally healthy.

The Department of Medical Assistance Services (DMAS), as directed by the General Assembly, established a workgroup to assess home visiting models to determine which to recommend for a Medicaid home-visiting benefit to support member’s health, access to care and health equity. Over several months, the workgroup reviewed home visiting strategies and benefits in other state Medicaid programs and corresponding federal and state regulations. In addition, the workgroup reviewed funding mechanisms for existing home visiting programs in Virginia and funding approaches utilized across the nation.

In line with nationwide practice, home visiting models that meet the US Department of Health and Human Services (HHS) criteria as evidence-based early childhood home visiting service delivery models that also align with payment methodologies supported by Medicaid are recommended to be included in a Virginia Medicaid home visiting benefit. These HHS evidence-based models have demonstrated outcomes which support the DMAS mission to improve the health and well-being of Virginians through access to high-quality health care coverage:

• Nurse-Family Partnership®

• Family Spirit®

• Healthy Families America®

• Early Head Start Home-based Option

While each model has demonstrated outcomes in maternal and/or child health they use different theoretical approaches and services to target their intended population. Due to the differences in requirements across models, individual reimbursement rates have been developed for each of the recommended home visiting models. Virginia’s current home visiting providers’ data were utilized to develop rate assumptions. For purposes of consistency, rate development across all models uses the same salary and administration cost percentage. Variation in the rate is driven by staff role requirements, staff ratios, and number of required visits. As such, the per-visit recommended rate by program is:

• Nurse-Family Partnership®: $310.18/visit and 24 annual visits per family

• Family Spirit®: $295.14/visit and 16 annual visits per family

• Healthy Families America®: $305.56/visit and 36 annual visits per family

• Early Head Start Home-Based Option: $132.76/visit and 68 annual visits per family

The cost estimate over a five-year period for home visiting in Virginia is $131,458,937. The five-year estimate anticipates that the four recommended home visiting models will provide services for Medicaid reimbursement to a maximum of 3,328 families annually by year five, in accordance with the requirements of their model. Currently, home visiting programs serve approximately 2,178 Medicaid eligible families in the Commonwealth each year. While Medicaid funding will expand home visiting for pregnant women and young children in Virginia, it will take time for existing programs to enhance their staffing and administration to meet the increased demand. In addition to the existing Medicaid families currently being served through alternative funding sources, within the first five years it is expected that Medicaid funding for home visiting in Virginia will allow service delivery to an additional 1,150 families.

It is important to note that there are approximately 38,000 Medicaid supported births each year in the Commonwealth. Current home visiting capacity can only meet the needs of an estimated 11% of those who may qualify. It is therefore recommended that DMAS initially target the populations to be served by a Medicaid home visiting benefit to ensure the most at-risk families receive this important service.