When Sara Howard was a Nebraska state senator, she learned the power of looking into lesser-known funding sources to find state money for services that support children and families. She also learned the power of bringing lawmakers to see effective programs in action.
Both of these strategies proved essential in Nebraska’s recent policy win to increase funding for home visiting programs, which continue the expansion of free, voluntary, evidence-based home visiting services.
The victory came after a 2023 effort to increase funding for home visiting fell short at the end of the session, largely because legislators did not fully understand how the program or its financing worked.
To prepare for the 2024 session, Howard, now a policy advisor at First Five Nebraska, helped bring together a statewide coalition of home visitors and advocates to identify senators to invite along on individual home visits.
One of the first senators they invited had just returned from maternity leave herself. After the visit, she said she had “no idea” how receptive families were to the support offered, said Kerry Kernen, assistant health director for the Lincoln-Lancaster County Health Department, who was part of the home visiting coalition.
“I think it’s one thing for us to talk about the programs, but it’s a whole other reality when the senators are interested and willing to really see that real life experience for the families that we’re serving,” Kernen said.
At the same time that senators across the state were seeing home visiting programs in action, Howard worked with a longtime legislative champion for home visiting, Sen. Tony Vargas, to identify an untapped resource for additional state MEICHV matching funds– the state’s unique Medicaid managed care “excess profit fund.”
With technical assistance from national Alliance partners, including Medicaid policy experts at Georgetown University Center for Children and Families, Howard and Vargas confirmed that money from the excess profit fund was indeed eligible to be used for the state’s MIECHV matching funds. (For more background on the fund and how it works, see these blogs from Georgetown CCF here and here.)
Lawmakers then approved $900,000 for home visiting from the excess profit fund, which, with the increase in available federal matching funds, nearly doubled the state’s available home visiting funds for FY24.
Ensuring that lawmakers heard directly from families served in home visiting programs, combined with the coalition’s technical policy expertise, was the winning combination for advocates.
“The timing worked out perfectly for these state funds to pull down additional federal funds through the new state MIECHV match,” said Elisabeth Burak, senior fellow at the Georgetown University Center for Children and Families, referencing the additional funds made available in FY24 by the federal MIECHV reauthorization passed in December 2022. Under the reauthorized MIECHV, for every $1 a state contributes, the federal government will provide $3 in matching funds.
Nebraska lawmakers also tapped the Medicaid managed care excess profit fund for a separate $500,000 budget line item to cover community-specific universal nurse home visiting programs, and to finance additional case management services for high-risk pregnant women enrolled in Medicaid.
Taken together, leveraging the Nebraska Medicaid managed care excess profit fund will help thousands of Nebraska families access supportive services to help them live healthier lives. Their successful efforts also prompted Howard and the team at First Five Nebraska to contract with an auditor to better understand all the cash funds available in the state and determine which funds might be leveraged to support other programs that can benefit Nebraska families.
Having this technical knowledge can be helpful to advocates navigating tough budget conversations, Howard said.
“Understanding these funds can help you be creative when somebody tells you, ‘oh, we don’t have money for that, or, we can’t help you with our state match,’” Howard said. By knowing how these funds work, “you won’t just have to take that at face value,” said Howard. National technical assistance from Alliance partners also gave the team the confidence to move ahead, Howard said.
“The Alliance network really helped us, because the senators are relying on us to know these things, and with the Alliance’s help, we could answer confidently and understand the function of these funds we wanted to use,” Howard said.
Nebraska’s home visiting coalition members are hopeful that the new funding will help them reach families living in the state’s most rural and underserved regions, including families living near the Pine Ridge Reservation, which stretches from northwest Nebraska into South Dakota.
Ensuring that lawmakers heard directly from families served in home visiting programs, combined with the coalition’s technical policy expertise, was the winning combination for their advocacy, said Dez Brandt, a coalition partner and Healthy Families program manager with the Panhandle Public Health District.
“Senators have a lot on their plate, so the more we can educate them and invite them to our sites to see the work, talk to the families, and see the impact, the more they’ll remember and prioritize these programs,” Brandt says. “No one tells their story like a family tells their story.”
