Los Angeles County Leaves Money on the Table for Home Visiting – But Not for Long

By Michaela Ferrari, MPH, Policy Director at LA Best Babies Network and Coordinator of the Los Angeles County Perinatal and Early Childhood Home Visitation Consortium

In response to the Board of Supervisors’ motion to support and expand home visiting in Los Angeles County, the L.A. County Perinatal and Early Childhood Home Visitation Consortium and its partners have conducted a broad review of how other states and jurisdictions fund and implement home visiting, with an eye to applying best practices to our efforts in L.A. County. This review found that our county has several untapped funding sources, and pilot projects are now underway to explore how these sources might be used.

Temporary Assistance for Needy Families

According to the Progress Report submitted to the Board in June, 26 states across the country use Temporary Assistance for Needy Families funding (TANF, or CalWorks in California) for home visiting programs. TANF – which is allocated by the federal government in block grants to states ($5.3 billion per year for California) – has never been used for home visiting in L.A. County.

That may be about to change. A new pilot project will work with CalWorks clients who are pregnant or have children up to age three, referring them from the DPSS office in Region V (SPA 6) to First 5 LA-funded evidence-based home visiting services and DCFS-funded Prevention and Aftercare Services. The pilot will assess how well these families meet the objectives of the GAIN program, in the hopes of demonstrating a rationale for using TANF funding for home visiting in the future.

Medicaid Targeted Case Management

Because home visiting is linked to several positive health outcomes, several programs in other states use Medicaid money (specifically, Medicaid Targeted Case Management, or TCM) to help fund home visiting. Currently, TCM only partially finances one home visiting program in L.A. County, but the Department of Public Health is working with the County Local Governing Authority (which administers TCM) to expand access for community-based organizations to participate in the program.

Accordingly, First 5 LA is launching a pilot with a few of its home visiting grantees to test the process of administering and billing for TCM, which requires programs to access the state’s drawdowns of federal funds. (TCM can only be billed as a match for non-federal dollars.) After navigating the red-tape thicket, the pilot programs can share what they’ve learned with other local home visiting agencies so that this funding stream can be fully maximized.

Medicaid Waivers

While they require significant buy-in and collaboration with state government, Medicaid waivers are another funding option for home visiting programs. States and localities use waivers to test new strategies and approaches, and when the results demonstrate cost efficiencies, they can lead to long-term funding. Luckily, L.A. County now has the opportunity to explore this option, as the County’s recently approved Whole Person Care Pilots application – a Medicaid Section 1115 waiver – includes funding to provide home visiting to participants in the L.A. County Department of Health Services MAMA’s Neighborhood program. Home visiting services will be offered to prenatal clients in the program beginning in January 2018, providing an opportunity to evaluate the impact of home visiting on medically high-risk pregnant women, and the viability of using Medicaid waivers as a long-term funding source.

Maternal, Infant, and Early Childhood Home Visiting

Finally, the Consortium, First 5 LA, and the County have been engaged in ongoing advocacy efforts to promote the reauthorization of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program that expired at the end of September. This federal funding source provided $400 million annually to home visiting programs throughout the country. While MIECHV funding was a fairly small proportion of total funds for home visiting in a county the size of Los Angeles, advocates hope to double the funding to $800 million annually, which could allow for an increase locally.

In response to the Board of Supervisors’ motion, L.A. County groups are working to secure more sustainable funding sources so that every family in the County has the opportunity to receive home visiting services. It’s a small price to pay to ensure that families with young children have the resources they need to succeed.