House Republicans want to grow the reach of the federal home visiting program – Maternal, Infant and Early Childhood Home Visiting (MIECHV) – by making states match the money dollar-for-dollar with a combination of state, county and private funds.
If the bill marked up by the Ways and Means Committee last week becomes law, states will have to demonstrate an even split on home visiting by the year 2022.
The implicit gambit here is that if states are not already spending enough to match, this legislation will motivate them to do so. The risk, of course, is that a state’s failure to match could spell a downsizing of the federal investment in home visiting.
Youth Services Insider has spent the last few days trying to figure out exactly how this might play out. Here’s what we know so far.
Most States Are Likely Not Matching Right Now
At the markup last week, members were working off of Congressional Research Service (CRS) figures put together to give a current picture of state investments in home visiting. CRS, likely on a short deadline, put together a chart with the following spending figures:
- 2017: State subcommittee reports, and state spending reported to the National Conference of State Legislatures.
- 2016: State funding for Nurse-Family Partnership (NFP) and Healthy Families America (HFA), two widely used home visiting models, and private funds going to state programs using those models.
- 2015: Federal and state funding for home visiting through the Temporary Assistance for Needy Families (TANF) program.
To develop the most generous estimate of states that could match at current spending, YSI combined the TANF figures with the 2016 figures for the two home visiting models. There isn’t 2016 TANF data breakdowns yet, so we did this on the assumption that what was spent in 2015 would be similar to spending the next year.
We then assumed that if a state had a 2017 spending figure or a 2016 figure, this spending was probably made available each year. For example, Florida is a $0 for 2017 on the CRS chart, but spent more than $40 million in 2016. We confirmed through the state’s home visiting lead agency, Ounce of Prevention Florida, that this 2016 total is about the annual average.
With this, the most generous assumption one could make using the CRS figures, there are 35 states that would not match their MIECHV allotment. The 15 that would make the match based on our assumptions of what they spend today are: Arizona, Arkansas, Colorado, Florida, Kansas, Kentucky, Massachusetts, Minnesota, Missouri, New Mexico, New York, North Carolina, Ohio, Oregon and Pennsylvania.
The Match Will Not Be Zero-Sum
So what becomes of the MIECHV funds for the states that cannot match?
Democrats on the Ways and Means Committee slammed the state match structure, and seemed to suggest that failure to fully match would spell doom. Rep. Bill Pascrell (D-N.J.), who offered an amendment to nix the match, said there “is no reason we couldn’t up with something better than, ‘Too bad Harry, your state isn’t in the game.”
Rep. Mike Thompson (D-Calif.) argued that in a state where the match came from county funds, one county’s cut of home visiting funds could negatively affect the rest of the state when it came to the federal program.
They are correct that a state would take a hit by failing to match. But according to Ways and Means staff, it would not be a total freeze-out. MIECHV funds will continue to be available to states in a manner proportional to their population, and the state would only be able to draw the amount it was able to match with state, and private dollars.
Let’s take Texas as an example. The state was allotted $17.2 million in 2016 MIECHV funds. The CRS analysis shows that Texas spent $9.9 million in state funds on home visiting in 2017; so if its 2017 allotment was $17.2 million, they’re well short of the match.
But this would not result in Texas getting cut out of MIECHV completely, according to Ways and Means. If the state can match $9.9 million, it can draw $9.9 million in MIECHV funds.
What is unclear is what becomes of unmatched funds. If Texas leaves about $8 million in MIECHV on the table, is that redistributed to states willing to match higher? Is it just captured as savings?
That is not addressed in the bill language, so perhaps it will be dealt with in program instructions down the line if this becomes law.
States Big and Small Would Take Hits
We combed the CRS numbers to identify two groups of states:
- States of any size that did not appear to spend any money on home visiting;
- States with a very large gap between their home visiting spending and their MIECHV allotment. Obviously, this group tended to be large states with high MIECHV totals.
We identified 10 states where CRS reports no spending of any kind on home visiting that can be credited to a match. With no state spending, these states would presumably lose their full MIECHV allotment, which we’ve noted in the parentheses:
- Alaska ($1.7 million)
- Georgia ($7.5 million)
- Hawaii ($3.5 million)
- Idaho ($3 million)
- Mississippi ($3.1 million)
- Oklahoma ($6.4 million)
- Rhode Island, ($7.2 million)
- Utah ($3.2 million)
- West Virginia ($5.8 million)
- Wyoming ($1.6 million)
YSI identified five states getting large MIECHV allotments that according to CRS, would leave some or all of it on the table. We mentioned Texas in the last section. The others are:
- Indiana, which gets $10.5 million in MIECHV; spent $0 in 2017 and $4.5 million in 2016
- Connecticut, which gets $9.1 million in MIECHV and only spent $100,000 in 2016, which was private funding
- Georgia, which gets $7.5 million in MIECHV and had no spending according to CRS
- Wisconsin, which gets $8.7 million and spends about $1 million each year.
Better Numbers Needed
According to CRS, California and Illinois also spend next-to-nothing on home visiting and would leave their MIECHV allotments unmatched. In California that is a $22 million shortfall; In Illinois, it’s $8.7 million.
But the information for these two states appears to be incorrect, which makes YSI wonder how many states CRS missed spending lines for. Illinois’ 2017 budget clearly outlines $10 million for Healthy Families Illinois.
In California, a recent report on Los Angeles home visiting reported that L.A. County alone spent about $89 million in non-MIECHV funds on home visiting. Not all of that money was spent on models approved for MIECHV, but the entire state certainly would have matched on just the spending in Los Angeles.
As mentioned, CRS probably had to turn this around quickly upon request from Ways and Means members. Though one would also think that, prior to introducing an ambitious match requirement, Rep. Adrian Smith (R-Neb.) would have gotten a much clearer picture of where states stood right now.
As the action on MIECHV turns to the Senate, Finance Committee members might want to do some more research into exactly how many states are in a position to match all or most of their MIECHV allotment. They won’t have long, because MIECHV will expire on September 30 without a reauthorization.
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