Formula Grant (X02)
This announcement solicits applications for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) formula grant program, established by the Affordable Care Act (ACA), to continue the delivery of voluntary early childhood home visiting program services in response to a statewide needs assessment. This program is being undertaken as part of the shared commitment of the Health Resources and Services Administration (HRSA) and the Administration for Children and Families (ACF) to comprehensive family services, coordinated and comprehensive voluntary statewide home visiting programs, and effective implementation of high-quality evidence-based practices.
The MIECHV formula grant program is designed to: (1) strengthen and improve the programs and activities carried out under Title V of the Social Security Act; (2) improve coordination of services for at-risk communities; and (3) identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities. The statute reserves the majority of funding for the delivery of services through use of one or more evidence-based home visiting service delivery models. In addition, it supports continued innovation by allowing up to 25 percent of funding paid to the entity for a fiscal year to be used for service delivery through promising approaches that do not yet qualify as evidence-based models.
Note: To ensure that the required statutory distribution is maintained, HRSA requires that all MIECHV programs demonstrate that they are being delivered in conformity with the approved service delivery models. This fidelity is demonstrated by programs that have the requisite designation and/or approval from a model developer to provide evidence-based home visiting services. MIECHV-funded programs must maintain the requisite designation and/or approval from the model developer while receiving MIECHV funding.
Since the inception of the MIECHV program, states have been required to ensure substantial involvement in the project planning, implementation, and evaluation by representatives of the agencies listed below:
• Director of the state’s Title V agency;
• Director of the state’s agency for Title II of the Child Abuse Prevention and Treatment Act (CAPTA);
• The state’s child welfare agency (Title IV-E and IV-B), if this agency is not also administering Title II of CAPTA;
• Director of the state’s Single State Agency for Substance Abuse Services;
• The state’s Child Care and Development Fund (CCDF) Administrator;
• Director of the state’s Head Start State Collaboration Office; and
• The State Advisory Council on Early Childhood Education and Care authorized by 642B(b)(1)(A)(i) of the Head Start Act.
To ensure that home visiting is part of a continuum of early childhood services, HRSA and ACF also strongly urge states to seek consensus from:
• The state’s Individuals with Disabilities Education Act (IDEA) Part C and Part B Section 619 lead agency(ies);
• The state’s Elementary and Secondary Education Act Title I or state pre-kindergarten program; and
• The state’s Medicaid/Children’s Health Insurance program (or the person responsible for Medicaid Early
Periodic Screening, Diagnosis, and Treatment (EPSDT) Program).
The state is encouraged to coordinate this application to the extent possible with:
• The state’s Domestic Violence Coalition;
• The state’s Mental Health agency;
• The state’s Public Health agency, if this agency is not also administering the state’s Title V program;
• The state’s identified agency charged with crime reduction;
• The state’s Temporary Assistance for Needy Families agency;
• The state’s Supplemental Nutrition Assistance Program agency; and
• The state’s Injury Prevention and Control (Public Health Injury Surveillance and Prevention) program (if applicable).
ACA Outreach and enrollment activities are tied to benchmarks 1, 5, and 6 (see http://mchb.hrsa.gov/programs/homevisiting/ta/resources/guidanceoct2012.pdf). To support their accomplishment of these benchmarks, MIECHV programs should assist families in enrolling in expanded health insurance coverage, using clinical preventive services and accessing primary health care, and providing information to families regarding the ACA consumer protections.
Working closely with Title V MCH Directors and State Medicaid Directors, MIECHV State Project Directors should ensure that Home Visitors have the state-specific information necessary to connect individuals with Navigators (Federally-facilitated Marketplace) or Non-Navigator Assistance Personnel (State based Marketplace or State Partnership Marketplace) and Certified Application Counselors. These Navigators and Non-Navigator assistance personnel play a vital role in helping consumers prepare electronic and paper applications in order to establish eligibility. This includes steps to help the individual find out if they qualify for insurance affordability programs such as premium tax credits, cost sharing reductions, Medicaid, or CHIP. Certified Application Counselors will provide many of the same tasks as Navigators and Non-Navigator assistance personnel, including educating consumers and helping them complete an application for coverage.
This program is authorized by the Social Security Act, Title V, § 511(c) (42 U.S.C. § 711(c)), as added by § 2951 of the Patient Protection and Affordable Care Act (P.L. 111-148).
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act (Affordable Care Act ) (P.L. 111-148), historic legislation designed to make quality, affordable health care available to all Americans. Through a provision authorizing the creation of the MIECHV program, the Act responds to the diverse needs of children and families in communities at risk and provides an unprecedented opportunity for collaboration and partnership at the Federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs. The funds are intended to assure, on a voluntary basis, effective coordination and delivery of critical health, development, early learning, child abuse and neglect prevention, and family support services to these children and families through home visiting programs. This program plays a crucial role in building high-quality, comprehensive statewide early childhood systems to support pregnant women, parents and caregivers, and children from birth to five years of age – and, ultimately, to improve health and development outcomes.
In Federal fiscal year (FY) 2010, $91 million in funding was awarded by formula to states and eligible jurisdictions under the MIECHV program. In FY 2011, $124 million in funding was allocated to these entities by formula, with the base allocation increased to $1 million and no entity receiving less than 120 percent of the FY 2010 allocation. Approximately $125,000,000 was awarded to states in FY 2012, as further set forth in the authorizing legislation, using the same formula as in FY 2011. In FY 2013, $118,625,000 in formula funding was available; and $116,000,000 was awarded in FY 2014.
Congress has appropriated $400 million in funding for the Maternal, Infant and Early Childhood Home Visiting (Home Visiting) program for the period from October 1, 2014 through March 31, 2015 as part of the Protecting Access to Medicare Act of 2014. All FY 2015 funds must be obligated by HRSA prior to March 31, 2015. Funds awarded to a grantee for a fiscal year under this funding opportunity announcement shall remain available for expenditure by the grantee through the end of the second succeeding Federal fiscal year after award.
Any grantee receiving federal funding is required to monitor subrecipient performance for compliance with federal requirements and programmatic expectations. Applicants must demonstrate how they will effectively manage subrecipients of MIECHV funding in an effort to guarantee success of the MIECHV program, including annual site visits of all subrecipients. Effective management of MIECHV subrecipients will ensure enrollment and retention of eligible families in home visiting services, comprehensive evaluation of home visiting models, and proper spending of funds.
Expansion Grant (D89)
The Nevada Home Visiting (NHV) program expansion has extended home visiting services to needy families in three rural counties, one of which is relatively remote, in the north/northeastern portion of the State, and has strengthened the peer learning network of existing providers. This expansion strengthened and enhanced the role that Nevada’s existing statewide home visiting program fulfills as an integral part of the State’s comprehensive early childhood system. The expanded implementation of select evidence-based home visiting models will result in overall improvements in:
a) maternal and child health;
b) child safety and wellbeing;
c) school readiness and achievement;
d) access to community-based services and supports for Nevada’s most vulnerable families.
A component of NHV is the development and implementation of a Continuous Quality Improvement Process (CQI). The goal of CQI is to identify strengths, challenges, and results during program implementation in order to build on strengths, address challenges, and revise the program to better serve the target populations and the communities in which they live.
These additional funding resources has solidified the infrastructure of NHV through the development of statewide standards, competencies, benchmarks, professional development opportunities and better linkages between state and community agencies and providers. Through this expansion, Nevada has achieved the following objectives:
1.Provide home visiting to more vulnerable families, particularly in rural northern Nevada, utilizing the following three evidence-based models that have been specifically selected to meet the needs of the target population;
• Home Instruction for Parents of Preschool Youngsters (HIPPY) program - (Elko County)
• Early Head Start Home Visiting Program – (Elko County)
• Parents as Teachers – (Lyon and Storey Counties)
2.Strengthen statewide collaboration to support a coordinated continuum of early childhood services, which features home visiting as an integral part of the continuum; and
3.Increase capacity of community-based providers in rural communities to deliver evidence-based home visiting services and to participate in ongoing collaboration, peer support, and continuous quality improvement.
With this expansion funding, NHV anticipates serving an additional 190 families statewide.