Securing state funding to grow the reach and impact of home visiting programs was a top priority for Alliance for Early Success ally Idaho Voices for Children. Prior to 2018, the state did not invest in home visiting, but extensive advocacy efforts paid off in 2019 when home visiting became listed as a permanent line item in the budget at $1M.
Last year, advocates working with the legislature secured a third year of state funding for home visiting that not only doubled the state’s investment to $2 million, but directed the state to pursue billing Medicaid for home visiting services. The advocates made good on their commitment to legislative champions and Medicaid coverage of home visiting began in 2021.
How did this growth and support for home visiting happen? Advocacy.
First, there was legislative advocacy. The initial legislative support for home visiting in 2018 came from four bi-partisan legislators who were working on foster care reform legislation. Advocates framed home visiting as a child abuse prevention strategy — and agreed to join the work on foster care reform if these legislators would include funding for home visiting to address child abuse and neglect. Forty percent of children in the Idaho child welfare system are between the ages of one and three, and these early champions in the legislature realized home visiting is an effective strategy for supporting these young families who are struggling. The full Foster Care Reform Legislation package passed unanimously, including $1M for home visiting. (Read more about home visiting in Idaho here.)
Then came administrative advocacy. After the 2020 legislative session ended, advocates and leaders of the two home visiting programs in Idaho, Parents as Teachers (PAT) and Nurse Family Partnership (NFP), connected with the Department of Health and Welfare to help develop a plan and timeline for the state to submit a Medicaid State Plan Amendment (SPA) for home visiting. With programs utilizing telehealth and virtual home visits to reach new parents who were isolated and in financial crisis, the COVID-19 pandemic added extra pressure to get the SPA approved as quickly as possible.
In order to meet the goals of equity and inclusion, advocates facilitated conversations between department officials and the home visiting models to ensure both models would be included in the SPA. They also drafted a sign-on letter that expressed support for an inclusive Medicaid benefit that ensures adequate access to home visiting services and coverage of home visiting services for all provider models that are evidence-based. The national presidents of both PAT and NFT signed the letter, which advocates believe marked the first time the two models have collaborated publicly for a state-level policy.
Thanks to the diligent work of advocates and home visiting providers, the department accepted and included all their recommendations (#20-0015 and #20-0016) for the SPA proposal. It was submitted in July 2020 and was approved in November 2020. The billing for Medicaid is under the case management category and there is an agreed upon hourly rate for all models.
Upon approval, Idaho Voices for Children facilitated a virtual meeting between all home visiting program providers, department administrators, and model representations to discuss how to successfully implement Medicaid billing. Seventy people participated in the meeting, which helped clarify the process and connect providers to administrators. In Idaho, all home visiting programs are housed in seven Public Health Districts and are already Medicaid approved. Home visiting programs in every district of the state were ready to begin billing Medicaid as they headed into 2021.
While advocacy played a huge role, advocacy doesn’t get all the credit, says Christine Tiddens, Director of Idaho Voices for Children. “Idaho Voices for Children is a facilitator, and we can bring leaders and providers to the table to make things happen.”