View from Washington

The MIECHV Program: An Example of Evidence-Based Policy in Action and a Glimpse into the Future

By Brent Ewig, MHS
Director of Policy, AMCHP

A few years ago, the Association of Maternal & Child Health Programs vigorously advocated for the creation of the MIECHV Program, which was enacted as part of the Affordable Care Act in 2010. The new program provides a total of $1.5 billion over five years (fiscal years 2010 to 2014) for evidence-based home visiting. When it passed, AMCHP joined many MCH advocates in celebrating this addition to the Title V statute and hailing it as the single largest new investment we are likely to see in the foreseeable future for MCH programs outside of the ACA insurance coverage expansions.

Since March 2010, state MCH leaders and their partners have been working diligently to optimize this investment and ramp up programs serving some of the most vulnerable mothers, children and families in our nation. For those on the front lines, this work has been so all-encompassing that it seems impossible to believe that in just 18 short months the MIECHV program will reach the end of its first five-year authorization!

Before turning to what we are doing to ensure the program continues, it is worth noting how this program is providing a real-time case study in the evolution toward evidence-based policy. As specified in the statute, MIECHV relies on a tiered evidence structure that focuses investments in programs that have been rigorously evaluated and shown to have positive impacts on children and families, while also supporting the development and evaluation of other promising approaches.

A commentary from then White House Office of Management and Budget Director Peter Orszag crystallized the issue:

This design differs from the typical approach. We haven’t simply created a block grant and told states they can do whatever they want, nor have we dictated a particular program design and told everyone to follow it. Instead, we’ve said that we’re flexible about the details of the program; we only insist that most of the money go toward the programs backed by the best available evidence, and the rest to programs that are promising and willing to test their mettle. – Former White House Office of Management and Budget Director Peter Orszag, June 2009

Turning to the future – and with apologies to Abraham Lincoln – we are about to embark on a great public policy debate testing whether this or any program so conceived and so dedicated, can long endure. Rhetoric aside, the stark reality is that congressional action is needed to extend the program beyond fiscal year 2014 when the current authorization expires. The challenges are clear and convincing a deeply divided Congress preoccupied with deficit reduction to extend any spending will not be easy.

To meet this challenge, AMCHP has begun participating in a newly emerging national coalition comprised of advocates, home visiting service providers and others to begin strategizing and supporting MIECHV reauthorization. Thankfully, the recent budget proposal from the Obama Administration gave this work a huge boost and set the stage for reauthorization by including a proposal to expand home visiting by $15 billion over 10 years as part of a comprehensive plan to promote early education from birth to five.

In the months to come, AMCHP will be working through this coalition to make the case for continuing MIECHV. We need your help to share the stories and information that demonstrate value and will be calling on those who are able to help us convince policymakers why this is a sound and indispensible investment. Stay tuned for updates and let’s look forward to celebrating another victory for MCH!