Pa., expand home visiting

By Topher Spiro

and Meghan O'Toole

How can Pennsylvania address income inequality, improve the lives of mothers and children, and save money - all at the same time? This might sound too good to be true, but the commonwealth can accomplish all of these things by expanding the reach of just one type of program: nurse home visiting.

Home-visiting programs connect parents with nurses, social workers, and other professionals who provide coaching and guidance on healthy child development and link families with other important services. Usually, home-visiting programs target key at-risk populations, such as low-income, first-time, or adolescent mothers.

The results for home visiting are so strong that Pennsylvania should immediately offer the program to all eligible families. If the commonwealth were to devote enough funding to home visiting to serve all those eligible, not only would the lives of thousands of at-risk families improve, but the commonwealth would also put itself on a stronger financial footing.

Research on home-visiting programs has consistently shown that they produce many positive outcomes for children, mothers, and families. Families who participate are healthier and more economically secure. These programs also reduce pregnancy complications, improve children's health and cognitive abilities, and increase mothers' employment and earnings.

In turn, these positive outcomes mean decreased government spending. Fewer mothers and children require government assistance from Medicaid, food stamps, and other programs, and there are fewer costs in special education, criminal justice, and child protective services.

Home-visiting programs not only pay for themselves, but they can also return significant savings to the state. According to an analysis by the Center for American Progress, if Pennsylvania were to enroll every eligible low-income, first-time mother in a home-visiting program over a 10-year period, the state would receive back more than $31 million - even after paying for the program. More importantly, the state would also help to provide a stable start and healthy future for more than 180,000 babies and mothers in that period.

However, there is a large gap between the number of eligible families and the capacity of home-visiting programs in Pennsylvania, with only a small percentage of those in need being served.

One easy way to increase the capacity of home-visiting programs would be for the commonwealth to encourage or require the private insurance companies that provide Medicaid benefits to offer home visiting as a benefit. For example, in Minnesota, companies have voluntarily offered home visiting as a Medicaid benefit because they recognize the cost-effectiveness and value of the programs. Pennsylvania should go further, making the offering of home visits a condition of getting the state's business to serve the Medicaid population.

Alternatively, the state could explore greater use of innovative funding mechanisms. Other states are using pay-for-success public-private partnerships to fund home visiting, in which private investors provide up-front funding for programs and are then paid back by a state or locality only if results are achieved. Taxpayers only pay for services that are effective, and states are able to fund programs and services that they might not otherwise be able to afford.

For example, Republican South Carolina Gov. Nikki Haley is pioneering the use of a pay-for-success contract to increase home visiting for Medicaid beneficiaries. This type of funding structure is not a way to permanently expand home visiting across the commonwealth, but it could demonstrate the benefits and savings from using it in certain areas.

In 2015, Gov. Wolf proposed implementing pay-for-success contracts in Pennsylvania and identified early childhood as one of five high-priority areas. Given home visiting's consistent success in producing positive outcomes and savings, it would be an ideal candidate for the commonwealth's first pay-for-success partnership. As a first step, state lawmakers should pass legislation that would enable pay-for-success contracts.

These two options are easy, low-risk ways to increase the use of home-visiting services across Pennsylvania. When funding is scarce, we should prioritize the programs that are not just proven to improve the lives of families, but that also result in savings for states and communities. Expanding home-visiting programs should be a simple choice.

Topher Spiro is the vice president for health policy at the Center for American Progress. tspiro@americanprogress.org

Meghan O'Toole is a policy analyst for the health policy team at the center. motoole@americanprogress.org