Federal, Tribal, State/Local

Federal

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program supports states and territories in providing voluntary, evidence-based services to new and expectant parents. MIECHV is administered by the Health Resources and Services Administration (HRSA) in collaboration with the Administration for Children and Families (ACF). Most MIECHV funds are distributed as formula grants to states and territories based on the proportion of children under age 5 in families with household incomes below the federal poverty threshold.

MIECHV is designed to promote evidence-based practice while giving states the flexibility to invest in what works for them locally. Awardees must use the majority of MIECHV funds to implement one or more home visiting models with proven results and report on benchmarks to monitor their progress. They can dedicate up to 25 percent of funds for innovation by implementing and rigorously evaluating promising approaches that do not yet qualify as evidence-based models.

Congress first authorized and funded MIECHV for 5 years in 2010. In 2015, the program received 2 more years of funding at $400 million annually through the Medicare Access and CHIP Reauthorization Act (Public Law 114-110). MIECHV expired in September 2017 but was reauthorized in February 2018 for 5 more years. In December 2022, the year-end FY23 omnibus spending package reauthorized MIECHV yet again—this time with increased funding—through FY27.

The most recent reauthorization included continued support for research, evaluation, and administration at 3 percent of overall funds. The legislation also doubled the amount of funds dedicated to support the Tribal MIECHV Program from 3 percent to 6 percent. Recognizing the need to support the home visiting workforce, the reauthorization included dedicated funding (2 percent) for workforce support, retention, and case management. The reauthorization renews the commitment to evidence-based home visiting, increases opportunities for workforce development, and supports states and territories providing services to improve maternal and child health.

Tribal

The Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV) supports the delivery of culturally appropriate home visiting models in tribal communities. Funds are awarded to individual tribes, tribal organizations, consortia of tribes, and urban Indian organizations to implement models informed by evidence and local interests. For example, awardees may incorporate traditional teachings and focus on community assets such as strong, extended families.

Tailoring models can help tribal communities build on their strengths while working to reduce health and developmental disparities associated with poverty and other factors.

Tribal MIECHV awardees develop benchmarks to monitor their progress, and they contribute new knowledge to the field about promising approaches. Awardee programs are located on and off reservations, from remote Alaskan villages to the rural Midwest to the urban Southwest. To learn more about families served by tribal-led organizations implementing evidence-based home visiting, view the NHVRC Tribal Profile.

State/Local

A variety of state and territory agencies administer home visiting programs, including agencies focused on health, human services, early childhood, and justice. They typically work with local agencies to deliver services to families. Local agencies may be operated by state or local government, schools, hospitals or clinics, tribal organizations, nonprofit organizations, and faith-based organizations.

Agencies may offer a mix of evidence-based and innovative, locally developed home visiting models. They connect families to a program in the community that meets their needs.

Many agencies elect to participate in national home visiting initiatives. The Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) helps teams from local agencies across the country to collaborate on best practices and areas for improvement. The Home Visiting Applied Research Collaborative (HARC) brings together programs and researchers in the Practice-Based Research Network.