Most people, which included myself just a few months ago, don’t know what home visiting is or that it even exists. The name suggests that it has something to do with the more well-known visits by Child Protection Services, making it seem like a scary and daunting thing. The good news is that home visiting is actually an awesome service for mothers, children and families!
The goal of home visiting programs is to give moms and families the knowledge and tools for a safe and healthy pregnancy and a happy family. Their unique model of coming to the home makes their nurturing and education much more personal. Each family’s specific needs are met with care, and one-on-one attention helps them make a routine of healthy behaviors.
Despite all of these benefits, moms, babies and families are at risk of losing access to home visiting services. The League recently released a fact sheet detailing the relationship between different funding sources for home visiting. The Maternal and Infant Health Program (MIHP), which is completely funded by Medicaid, has the most Michigan locations of any home visiting program; however, only Medicaid-eligible pregnant moms and infants can access their resources. Other home visiting programs, such as those funded by grants under Title V of the Social Security Act, serve populations with low incomes but do not have any Medicaid eligibility requirements.
As of January 1, 2020, individuals enrolled in the Healthy Michigan Plan, the state’s expansion of Medicaid, must report 80 hours of work a month in order to continue receiving health care coverage. Unfortunately, as we learned from Arkansas’ adoption of Medicaid work requirements, these changes lead to significant numbers of people losing their access to healthcare. Most concerning is the fact that many lost coverage because of the red tape involved in reporting work hours or documenting that they were actually exempt from the requirements due to chronic illness or responsibilities as students or caregivers.
With the introduction of work requirements for Michigan’s Medicaid expansion population we expect that some will lose their coverage. This will leave a significant impact on home visiting in the state as well because people must be eligible for Medicaid in order to receive MIHP home visiting services. If someone loses their Medicaid coverage, they also lose access to the largest provider of home visiting in the state.
The demand for home visiting services won’t disappear, however. Instead, mothers and families will turn to Title V organizations, which have significantly fewer resources to offer. The Maternal, Infant and Early Childhood Home Visiting Grant (MIECHV) within Title V provides about one-third of the funding that Medicaid supplies through MIHP. While MIHP is located in almost every county in Michigan, only 15 out of 83 counties have Title V home visiting organizations. The MIECHV organizations will be strained as more people come to their doors for help, and people who can’t travel will be left without any resources to assist them.
Furthermore, home visiting programs are key sources of referrals to clinics that provide family planning and reproductive health services to families with low incomes under Title X of the Public Health Service Act. Thus, the work requirements could have an even broader impact on the health and economic security of mothers and children.
The benefits of home visiting can’t be stressed enough. Home visitors cover any and every topic about pregnancy and raising a family, from prenatal vitals and breastfeeding to safe sleep and age-appropriate play. This wide range of information helps ensure that moms, children and entire families know what to expect and how to care for themselves, improving health outcomes for all.
As these short videos featuring Michigan mothers Danielle and Whitney show, home visiting is beneficial for families in a wide variety of situations. Even with a strong family network, some parents need more support in caring for themselves and their kids so everyone can lead a healthy, happy life. Home visiting programs give parents the skills they need to be confident in their children’s growth.
Success stories like these are at risk because of Medicaid work requirements. These stories prove that personal, in-home education provides a unique advantage in protecting the health and welfare of both moms and babies. Without the impact of home visiting, families will face many more obstacles to good health during pregnancy and child-raising.
It is of the utmost importance, then, to minimize the effect of Medicaid work requirements in Michigan. The League has compiled many resources that explain the work requirements to prepare residents for the changes. The state also must work with home visiting organizations to alert those they serve. In the long term, Michigan also should ensure that Title V home visiting organizations are equipped to serve families and consider greater coordination between those organizations and Title X health facilities.