The Medicaid program provides health coverage to low-income families and communities and individuals, including children, parents, pregnant women, seniors and people with disabilities. It is funded jointly by the federal government and the states, and each state operates its own Medicaid program within broad federal guidelines. As a result, states have a great deal of flexibility in how they design and administer their programs, and so eligibility and benefits often vary widely between states.
Since Medicaid is the primary health care program for low-income pregnant women and children, some states already use Medicaid to support home visiting programs, which promote positive health and wellbeing outcomes among these vulnerable populations.
In 2016, the Center for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA) identified the various funding sources that states can use to cover the costs of services provided as part of a home visiting program, including the flexibility states have to finance home visiting with Medicaid.
States use Medicaid to finance home visiting services for three primary reasons.
The Medicaid program is a good funding option for states who wish to both support existing home visiting services and expand access to home visiting services. Although Medicaid cannot pay for the full cost of a home visiting program, it can potentially pay for a significant portion. Mechanisms to support home visiting services using the Medicaid program include targeted case management (also known as medical assistance case management), administrative case management, enhanced prenatal benefits, traditional medical assistance services, managed care, Medicaid preventive services, the use of waiver authorities, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) among others.
Eleven states have reported using Medicaid to support a portion of their Healthy Families America (HFA) budgets.[3] Medicaid spending on HFA has increased from just under $100,000 in 2001 to $5.5 million in recent reports. In four states, Medicaid funding currently approaches or exceeds $1 million, and overall makes up approximately 3% of HFA site funding nationally.
Medicaid remains an underused option to support home visiting programs. While states have been able to support some aspects of home visiting using Medicaid funding, Medicaid coverage and payment rates fail to cover the full cost of services, and administrative challenges inhibit broader access. For this reason, braiding Medicaid with other funding streams can lead to the most efficient and robust use of funds and extend the reach and benefits of home visiting programs to the largest number of children and families. There is no “one way” to use Medicaid to support home visiting services; each state should determine what makes the most sense for the needs of its population of children and families, its service array and financing options.
In addition, many state Medicaid rules require the Medicaid home-based provider to be a nurse. In these instances, state Medicaid rules must be amended to include reimbursement to non-nurse home visiting models, and HFA sites will need to work directly with Medicaid stakeholders in their states to establish a reimbursement structure that supports the HFA model.
Other potential challenges to using Medicaid for home visiting include integrating payment for home visiting services into managed care financing; creating the infrastructure required to bill Medicaid for services, obtaining buy-in from key stakeholders such as agency administrators, lawmakers, and service providers; and improving the accuracy of reimbursement rates by providing training and technical assistance to home visitors.
For any assistance or for questions, please reach out to Kelly Crane, State Policy Specialist, or Marissa Morabito, Chief Government Affairs & Policy Officer.
This resource highlights the status of the Child Abuse Prevention and Treatment Act (CAPTA) reauthorization by Congress. PCA America supports a strong and comprehensive reauthorization bill that includes significantly higher funding levels, increases transparency and accountability in the program, increases the focus on primary prevention and family support services, and promotes race equity.
This resource was developed to provide information on the investment in the Child Tax Credit expansion, as well as additional expansions in tax credits for working families, included in the recent pandemic relief measure, the American Rescue Plan Act of 2021.
This resource answers frequently asked questions about the The American Rescue Plan Act, specifically addressing the provisions related to emergency funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and the Child Abuse Prevention and Treatment Act (CAPTA).
