Families participate on a voluntary basis. In FY2017, the MIECHV program served 156,297 individual parents and children who participated in 942,676 home visits. In practice, it generally entails visits to the homes of families on a regular basis (e.g., weekly or monthly) over an extended period (e.g., six months or longer). Depending on the program model, visits may be conducted by nurses, mental health clinicians, social workers, or paraprofessionals who have received specialized training. The programs can help achieve positive benefits for children, parents, and possibly their communities. Overview of the MIECHV Program

The Patient Protection and Affordable Care Act (ACA, as amended; P.L. 11-148) established the MIECHV program under Section 511 of the Social Security Act. The program—jointly administered by the U.S. Department of Health and Human Services' (HHS's) Health Resources and Services Administration (HRSA) and Administration for Children and Families (ACF)—seeks to strengthen and improve home visiting services and support to families residing in at-risk communities, while also referring families to services outside of the program. The most recent reauthorization of the program, the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123 ) extended funding through FY2022. Jurisdictions must give priority to serving eligible families who meet any of the following criteria: 
reside in communities that are in need of home visiting services, as identified in the needs assessment conducted by the jurisdiction and accounting for other factors (staffing, community resources, and other requirements) that are necessary to operate at least one approved home visiting model in those communities; are low-income; include a pregnant woman under the age of 21; have a history of child abuse or neglect or have had interactions with child welfare services; have a history of substance abuse or need substance abuse treatment; have users of tobacco products in the home; have children with low student achievement; have children with developmental delays or disabilities; or individuals who are serving, or formerly served, in the Armed Forces, including such families that have members of the Armed Forces who have had multiple deployments outside of the United States. The authorizing law requires that 3% of the annual funding is to be reserved for Indian tribal entities, and another 3% is to be reserved for selected technical assistance, research, and evaluation. The law does not specify how the funds are to be awarded, though the most recent reauthorization of the program under BBA 2018 included language that directs HHS to use the most accurate data available for eligible jurisdictions if funding is awarded on the basis of relative population or poverty considerations. In practice, HHS has distributed MIECHV funds by both formula and competitive grants to states and other jurisdictions. BBA 2018 extended funding of $400 million for the program for each of FY2017 through FY2022. Jurisdictions are required to update the needs assessment by October 1, 2020. These jurisdictions were required to conduct an initial needs assessment to identify communities with concentrations of poor infant health and mortality, poverty, and other negative outcomes. Jurisdictions must also ensure that the program
adheres to a clear, consistent home visiting model that meets the requirements for being research-based (discussed further in the next section) and is linked to the benchmark areas and outcomes for individual families; employs well-trained and competent staff, as demonstrated by education or training (such as nurses, social workers, educators, and child development specialists) and provides ongoing and specific training on the home visiting model; maintains high-quality supervision to establish "home visitor competencies"; demonstrates strong organizational capacity to implement the activities involved; establishes appropriate linkages and referral networks to other community resources and supports for eligible families; and monitors how the home visiting model is implemented to ensure that services are implemented with fidelity to the model. Home Visiting Evidence of Effectiveness (HomVEE)

In 2009, prior to implementation of ACA, HHS/ACF created the Home Visiting Evidence of Effectiveness (HomVEE) initiative to determine which home visiting models have shown evidence of effectiveness. The evaluation, known as the Mother and Infant Home Visiting Program Evaluation (MIHOPE), is examining programs that use the four most common evidence-based home visiting models: Early Head Start-Home Visiting (EHS), Healthy Families America (HFA), Nurse-Family Partnership (NFP), and Parents as Teachers (PAT). Legislative History of Home Visiting
Federal Efforts to Establish a Home Visiting Program
Congressional and executive branch interest in early childhood home visiting programs predated the Affordable Care Act and implementation of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. 111-148 .
The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program supports home visiting services for families with young children who reside in communities that have concentrations of poor child health and other indicators of risk. Home visits are conducted by nurses, mental health clinicians, social workers, or paraprofessionals with specialized training. Generally, they visit the homes of eligible families on a regular basis (e.g., weekly or monthly) over an extended period (e.g., six months or longer) to provide support to caregivers and children, such as guidance on creating a positive home environment and referrals to community resources. Families participate on a voluntary basis. Research on the efficacy of home visiting has shown that some models can help improve selected child and family outcomes, such as reducing child abuse. In FY2017, the MIECHV program supported 156,297 individual parents and children involved in 942,676 home visits.
The Patient Protection and Affordable Care Act (ACA, as amended; P.L. 111-148) established the MIECHV program under Section 511 of the Social Security Act in March 2010. The program is jointly administered by the U.S. Department of Health and Human Services' (HHS's) Health Resources and Services Administration (HRSA) and the Administration for Children and Families (ACF). The ACA, and amendments to the act, have directly appropriated mandatory funding for the program. Most recently, the Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123) provided $400 million annually through FY2022.
The law is silent about how funds are to be distributed under the program, except to require that HHS reserve 3% of the annual appropriation for Indian tribal entities and another 3% for training, technical assistance, and evaluations. BBA 2018 directs HHS to use the most accurate data available for eligible jurisdictions if funding is awarded on the basis of relative population or poverty considerations. In practice, HHS has distributed MIECHV funding based on a formula that accounts for poverty and based on a competitive award process. States, territories, and tribes must carry out their home visiting programs as specified in the law. Among other requirements, these jurisdictions had to carry out a needs assessment by September 20, 2010, to identify communities with concentrations of poor infant health and other negative outcomes for children and families; the availability and use of home visiting services; and the capacity for providing substance abuse treatment and counseling in the jurisdiction. BBA 2018 directs jurisdictions to update this assessment by October 1, 2020. Under the program, these jurisdictions are required to achieve gains in four of six "benchmark" (outcome) areas pertaining to family well-being and coordination of community resources.
The law requires that the majority of annual funding (a minimum of 75%) for jurisdictions that administer home visiting programs must be used to support a program model that has shown sufficient evidence of effectiveness. The remaining 25% of funds may be used to implement models that have promise of effectiveness. HHS has established criteria for determining whether home visiting models are effective and reviews home visiting models on an ongoing basis via the Home Visiting Evidence of Effectiveness (HomVEE) project. The project has determined that 18 models are evidence-based. Generally, these models have shown impacts in one or more outcomes in maternal and child health; early childhood social, emotional, and cognitive development; family/parent functioning; and links to other resources.
In FY2017, jurisdictions had implemented 10 of the 18 models using MIECHV funding: Child First, Early Head Start-Home Visiting (EHS-HV), Family Check-Up (FCU), Family Spirit, Health Access Nurturing Development Services (HANDS) Program, Healthy Families America (HFA), Home Instruction for Parents of Preschool Youngsters (HIPPY), Nurse-Family Partnership (NFP), Parents as Teachers (PAT), and SafeCare Augmented.