Blueprints Program Rating: Model
A nurse home visiting program for first-time pregnant mothers that sends nurses to work one-on-one with the pregnant women to improve prenatal and child rearing practices through the child’s second birthday.
The number and variety of approaches to funding Nurse-Family Partnership is very large, with 170 implementing agencies in 32 states. NFP can be supported by federal funding streams aimed at promoting healthy development of young children, including Medicaid, Title V, IDEA Part C, and Title IV-B Child Welfare Services. Many states have allocated general funds to support NFP based on the strong evidence of outcomes and cost/benefit achieved through the model. In addition, the Affordable Care Act made an historic investment in home visiting, allocating $1.5 billion to support states in implementing evidence-based home visiting programs.
Allocating State or Local General Funds
In addition to large commitments of state general fund dollars for Medicaid match and for direct allocations to Nurse-Family Partnership, states and localities have used a variety of state and local funding streams to support NFP:
- Tobacco Restitution funding
- State/Local Partnerships for Children
- Local school system funding
- State education funding
- Dedicated state home visiting funds
Maximizing Federal Funds
Entitlements: As a health promotion intervention, it is not surprising that Nurse-Family Partnership is often funded by Medicaid. However, as a prevention program more than a treatment intervention, NFP is not often funded by Medicaid as a service. Most billing is for some form of targeted case management. There are limitations to Medicaid funding based on allowable costs. Below are some of the Medicaid approaches used by states:
- Targeted Case Management, both for child and mother
- Negotiated rates with Medicaid funded Managed Care Organizations
- State Medicaid “Public Health” program
- State Medicaid “Perinatal Services” program
- Maternal, Infant, and Early Childhood Home Visiting Grants – The Affordable Care Act allocated $1.5 billion over five years to support evidence-based home visiting programs. Funds flow to a state agency designated by the governor to administer the program, which then assesses needs and administers funds to local communities.
- Title V Maternal and Child Health Block Grant which funds public health activities aimed at supporting healthy pregnancy and early childhood.
- Title IV-B Child Welfare Services grant which can be used to fund child abuse prevention activities and services aimed at keeping children in their homes.
- IDEA funds for Infants with Disabilities which supports early intervention services for infants with disabilities.
- Child Care Development Block Grant which is one of the major funding streams supporting child care and can be used for NFP when it is implemented as part of a comprehensive early care and education model.
- Temporary Assistance for Needy Families which is the core funding stream dedicated to providing income support for low income families and can also be used fairly flexibly by states to support four key goals, including assisting needy families so children can be cared for in their own homes.
Discretionary Grants: There are many federal discretionary grants supporting early care and education that can potentially support NFP, including programs within SAMHSA, the Children’s Bureau and The Head Start Bureau within DHHS.
Foundation Grants and Public-Private Partnerships
Below is a sample of the many foundations that have supported NFP. Foundations have funded both start-up costs as well as ongoing expenses.
- March of Dimes
- United Way
- The Duke Endowment
- Blue Cross Blue Shield Foundations
- Baptist Health Fund
- Kellogg Foundation
- Robin Hood Foundation
A promising strategy to promote home visiting is developing partnerships between states with managed care organizations (MCOs) providing Medicaid health services on a capitation basis. A partnership could be formed with the MCOs based upon the assumption that NFP would improve the health of infants and mothers served, lowering future health care costs for the MCOs. An investment in future savings could motivate MCOs to fund NFP.
Generating New Revenue
Many states have created dedicated revenue streams to fund NFP. Some of these are:
- Gambling taxes
- Children’s Trust Funds (e.g., license plates, commemorative documents and tax form check-offs)
- Ballot initiatives such as Proposition 10 in California
- Property tax dedicated to social service issues
Survey and interview with purveyor, Nurse-Family Partnership National Service Office, the purveyor of NFP.