A Closer Look at the President’s Budget: Home Visitation

On May 7 the Office of Management and Budget released the President’s budget proposal for fiscal year 2010. As Early Ed Watch reported at the time, that budget includes funding for several new early education programs, including Title I Early Childhood Grants, Early Learning Challenge Fund, Early Literacy Grants, and Home Visitation. Previous installments have considered Title I Early Childhood Grants, the Early Learning Challenge Fund, and Early Literacy Grants. Our final installment zeros in on Home Visitation.

During the 2008 Presidential campaign, then-Senator Barack Obama proposed creating a new program to provide “nurse-home visitation” to more than 570,000 new mothers annually. The proposal was inspired by David Olds’ Nurse Family Partnership Program, in which trained nurses visit first-time pregnant and new mothers to help them make healthy decisions when they are pregnant, support their young child’s development, plan future childbearing, and attain economic self-sufficiency. Numerous studies have shown that these programs improve outcomes for both mothers and children, reducing rates of preterm birth, abuse and neglect, and improving children’s cognitive and behavioral outcomes. Approximately 17,600 families are now enrolled in Nurse Family Partnership programs in 28 states.

The President’s fiscal year 2010 budget request for the Department of Health and Human Services (through the Administration for Children and Families) includes funding for a Home Visitation program that will provide matching grants to states for programs targeted to low-income pregnant women and new mothers. As proposed, the program would not restrict funding to states that use nurse-home visiting, as in the Olds model. But it would require states to provide evidence that the model they use is effective, as well as explain how they will ensure it can be replicated without watering down its effectivness. Most grants would go only to programs based on models that already have strong evidence of effectiveness. But some funding would also be available to implement models that are promising but do not yet have evidence that they are effective. Funds will also support rigorous evaluation of these promising models.

The administration is requesting $124 million in funding for this program in fiscal year 2010, which it estimates would provide home visiting services to 50,000 families. Funds would be distributed to states on a formula basis.

One thing worth noting about this proposal is that the administration is seeking to fund this program with mandatory, rather than discretionary funds. Mandatory funds are not subject to the annual Congressional appropriations process, but are set in legislation passed by authorizing committees. This program would be what is known as a “capped entitlement,” meaning that the funding level is capped in law at a certain amount each ear. Over time, the administration intends to grow this program to serve some 450,000 families in fiscal year 2019, at a cost of $1.8 billion.

This proposal requires Congressional authorizing legislation that would establish the Nurse Home Visiting Program and mandatory funding levels for it. It is possible that this program could be included in larger health care reform legislation that Congress is currently considering. It is also possible that Congress could pass its own Home Visiting program—home visiting legislation has already be introduced in the Senate—and fund it using discretionary rather than mandatory funds.