Pregnancy and the birth of a baby are significant occasions that also bring many challenges. Providing support to new parents and caregivers during this time, and through early childhood, is essential to give all children and families a strong start in life. California’s Medi-Cal transformation provides an opportunity to consider expanding home visiting services to support the needs of our most vulnerable population. As home visiting continues to adapt to meet the moment, it is important to first understand the current state of home visiting in California.
California has a complex home visiting landscape. Prior to 2018, California did not invest state funds directly in voluntary, evidence-based home visiting. Today, according to data reported by the California Department of Public Health (CDPH) and the California Department of Social Services (CDSS), 44 counties participate in home visiting programs administered by those state departments, with a blend of state and federal funding. Nine additional counties implement a home visiting program separate from CDPH and CDDS administered or funded by the local public health department or county First 5s. In total, 53 counties in California implement some kind of home visiting program.
Home visiting services are primarily funded through four sources: (1) CDPH California Home Visiting Program (CHVP); (2) CalWORKs Home Visiting Program (HVP); (3) Early Head Start, Home-Based Option (EHS-HBO); and (4) First 5 County Commission Funding. In fiscal year (FY) 2022, these programs provided home visiting services for over 20,000 families. The EHS-HBO represented the largest home visiting model in the state. Funding for the EHS-HBO comes from the Federal Office of Head Start at the U.S. Department of Health and Human Services (HHS). EHS grants are funded by the federal government and flow directly to local programs. EHS grants funded almost 14,000 EHS-HBO slots in FY 2022. The EHS program does not publish annual data on the number of county home visiting programs funded by EHS grants. Per data from the CHVP and CalWORKs HVP, we know the EHS-HBO model is implemented in 45 counties.
The CalWORKs HVP served almost 3,000 families across 42 counties during FY 2022. This voluntary program serves parents receiving assistance through the CalWORKs program. For counties to receive funding through this program, they must use a home visiting model with demonstrated evidence of effectiveness, as classified by HHS. Counties can use one, or a combination, of the following HHS classified evidence-based models: EHS-HBO, Nurse-Family Partnership (NFP), Healthy Families America (HFA), or Parents as Teachers (PAT). Within the CalWORKs HVP, the PAT model is the most common home visiting program, currently in use in 19 counties. HFA operates in 17 counties, NFP in 13, and EHS-HBO in 7. Counties can also use local models, so long as they meet the HHS standards of home visiting effectiveness. Four counties utilize local home visiting models.
Thirty-four counties participate in the CHVP, which is funded through federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds and augmented with State General fund dollars. In FY 2022, CHVP conducted over 22,000 home visits and served approximately 2,500 families and 2,000 children. Counties receiving CHVP funding must use the HFA, NFP, or PAT models. The NFP model is the most common home visiting model used within the CHVP. The NFP model is currently in use in 9 counties, while HFA is administered in 7, and PAT in one. A component of MIECHV is the Tribal MIECHV program, which funds the Family Spirit home visiting model for Indigenous communities across the State. There are 7 active Family Spirit affiliates across California.
California’s home visiting landscape was not always this extensive. Until 2019, the largest investment in home visiting programs was by First 5 county organizations. First 5s have been early adopters, designers, funders, and champions of voluntary home visiting services across the state. First 5s still play an active role in home visiting today, with 42 First 5s indicating active involvement in home visiting through providing technical assistance, financial support, and direct home visiting service provision.
While California has made significant strides to expand home visiting services and promote an array of culturally congruent home visiting models, we still have insufficient capacity to fully support even the highest-need families with home visiting. New Medi-Cal benefits like the Community Health Worker (CHW) and Dyadic Care benefits provide opportunities to expand home visiting services to support the highest-need families. As California builds out its Medi-Cal system to provide more person-centered care, it is critical that state leaders prioritize expanding the settings in which care can be delivered to meet families where they are. Home visiting services in California have come a long way, and we will continue to protect and build on our hard work to strengthen family services.
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