First 5s Across the State Explore Fiscal Mapping and Cost Modeling to Build the Future of Home Visiting

Guest Authors: Jeanna Capito, Christin Davis, Jessica Duggan, Prenatal to Five Fiscal Strategies

Home visiting and family support programs are integral services for California’s prenatal to five population. Rooted in relationships, these programs connect with families during the vulnerable prenatal and early childhood periods, supporting perinatal mental health, parenting, and child development and health. However, the current California home visiting system only supports a small portion of families who could benefit from home visiting and family support programs.

To expand home visiting services to meet the unique needs of children and families, a comprehensive home visiting approach is needed - one that employs multiple models to support communities. A key component of strengthening existing home visiting systems in California is developing a clear understanding of the true cost that considers everything needed to run high-quality home visiting programs and ensures a highly trained workforce is compensated with a living wage.

Over the last year and a half, 36 First 5 County commissions partnered with us, Prenatal to Five Fiscal Strategies, to receive technical assistance on home visiting fiscal strategies including fiscal mapping, direct service cost models, and revenue/expense models. We help states and communities design and implement data-informed fiscal, governance, and equity frameworks to build stable, flexible, and well-funded early childhood systems.

• Fiscal mapping identifies the current funding landscape, the total number of children served across different home visiting programs, gaps in services, and opportunities for alignment.

• Direct cost models provide a clear understanding of the true costs associated with operating various home visiting models in a community, including expenses related to providing services for children and families, staffing and management, living wage compensation, and professional development and training.

• Medi-Cal revenue/expense models estimate the additional revenue needed to cover costs and possible revenue generated with Medi-Cal billing.

Why is this work needed?

Home visiting is often underfunded, with programs striving to deliver high-quality despite limited investments. By capturing the current funding landscape and the true cost of delivering high quality services, fiscal mapping and cost modeling enables organizations and policymakers to make informed decisions about resource allocation, program implementation, and funding priorities, ultimately supporting the sustainability and effectiveness of home visiting programs.

Considering the tremendous ongoing transformation in California’s Medi-Cal program, highlighted by a shift towards community-based providers and a focus on the upstream determinants of care, the state has added new benefits that can be leveraged for community programs like home visiting. Benefits such as community health worker services and enhanced care management (ECM) offer a new way to fund home visiting services. In our work we pair fiscal maps and cost models with revenue/expense models to explore ways to close the gap between true cost and current resources. In this project, First 5s were very interested in how Medi-Cal and these new benefits could provide additional revenue to home visiting.

We created Medi-Cal revenue/expense modeling tools to estimate the potential revenue from Medi-Cal and expenses associated with billing Medi-Cal for home visiting. Using these modeling tools, First 5s had the ability to customize inputs based on current and projected Medi-Cal revenues, allowing for direct comparison with the costs of delivering services and the system to support these services and the Medi-Cal revenue approach.

Why First 5s?

First 5s were the original implementors of home visiting in California. As innovators, funders, collaborators, conveners, and direct service providers, First 5s hold a wealth of knowledge about the current landscape of home visiting across the state. First 5s know how home visiting has been delivered in California, what is working and what is not. They can leverage their experience and expertise to shape a policy framework for the expansion of equity-focused home visiting and family strengthening systems across the state.

The tools described above help First 5s be more effective home visiting advocates, supporting with planning, budgeting, and funding resource prioritization. For example, First 5 Santa Clara and partners engaged in fiscal mapping and true cost projections of current services to offer a roadmap for expanding services to meet local need. Using outcomes from this work, Santa Clara County presented key priorities to the Board of Supervisors including maintaining current funding levels with cost-of-living adjustments, leveraging Medi-Cal benefits, and improving workforce training and retention. Additionally, they proposed implementing a "No Wrong Door" system for easier access to services and expanding programs to underserved communities. Their goal was build a more equitable, coordinated, and financially stable home visiting system that increases access, improves service quality, supports the workforce, and better meets the needs of families across the county. 

Santa Clara was able to successfully expand access for families to home visiting programs by contracting to utilize Family Frist Prevention Services Act funding to expand ParentChild+ across the County. They are also actively working to leverage Medi-Cal, for home visiting programs.

The future of home visiting in California

First 5s envisions a future for home visiting characterized by a comprehensive and effective approach to supporting young children and their families. To achieve this, First 5s can strengthen their home visiting systems with the strategic use of the tools described above. Based on the technical assistance and activities implemented so far, California’s regions are advancing home visiting systems that respond to community needs and use cost as a key factor in planning program operations and leveraging new revenue for future growth. Prenatal to Five Fiscal Strategies will continue to be available to support First 5s and the California home visiting system in this innovative work. For more information about our work, please visit our website: https://www.prenatal5fiscal.org/