Testimony of Mary Katherine West, Home Visiting Program Manager, before the Committee on Health

April 29, 2024
Person Testifying: Mary Katherine West
Title: Home Visiting Program Manager, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Budget Hearing

Good morning Chairperson Henderson and members of the Committee on Health. Thank you for the opportunity to address the Committee as it conducts this budget oversight hearing for the Department of Health Care Finance. Thank you, Chairperson Henderson for your ongoing support for families in the District. My name is Mary Katherine West, and I am the Chair of the DC Home Visiting Council and Program Manager for Early Childhood at DC Action. I am a member of the Under 3 DC Coalition, and a Ward 1 resident.

DC Action uses research, data, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. Our collaborative advocacy initiatives bring the power of young people and all residents to raise their voices to create change. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being. 

​The DC Home Visiting Council is a body of home visiting providers, local government agency representatives, early childhood advocates, managed care organizations, and other partners that works to strengthen the understanding, implementation, and sustainability of home visiting as a strategy to support positive child and family outcomes in the District of Columbia. 

We thank the Mayor and the Department of Health Care Finance for the addition of a recurring $225,000 home visiting grant in the FY25 budget, which will support the Nurse Family Partnership program. However, this year, this program needs additional one-time funding of $475K. 

We also want to thank you for working with us over the past several months to adjust the FIS for the Home Visiting Services Reimbursement Act. We hope that the OCFO will make these adjustments, and ask that the Council fund this bill at $137K for FY25.

Home visiting plays a valuable role in the District’s early childhood system.

Home visiting is an individualized service that connects expectant families through families with children five and under with a trained professional to create a safe and stable environment for child development and for parents to reach their parenting goals. To learn more about the scope of home visiting programs in the District, please refer to my performance oversight testimony.

The Nurse-Family Partnership Fills Critical Gaps

The Nurse Family Partnership program is an evidence-based home visiting model that is over 50 years old. NFP programs create an alternative pathway for families to access quality health care by matching expecting parents with registered nurses. Families enroll in the program prenatally and their nurse delivers high-quality visits and interactions through the child’s second birthday. To learn more about NFP’s evidence base, refer to my performance oversight testimony.

With support from the District, the Nurse Family Partnership began in the District in 2021 and has been operating successfully as a pilot program over the last three years. 

In the District, the Nurse Family Partnership supported positive health outcomes for families. In 2023, 98% of pregnant Nurse Family Partnership participants took prenatal vitamins, 84% attended all recommended prenatal visits, 94% received perinatal mental health screenings and 100% received mental health referrals when appropriate, attending postpartum visits, 0% of babies were very low birthweight, 99% had a medical home, 71% used safe sleep practices, 99% engaged in breastfeeding, and 100% children receive up-to-date immunizations at 6 months. 

Supporting these positive health outcomes is vital as the District works to combat maternal and infant health disparities, especially in the context of high adverse birth outcomes for Black women and their babies, as compared to other demographics. DC Health data show that over the past six years, severe maternal morbidity, defined as the “outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health,” has increased across all demographics. Black women in DC continue to experience severe maternal morbidity at almost double the rate of all other races. A failure of our health systems, inadequate access to health care for Black families, and racism in health care drive these disparities. The Nurse Family Partnership works to combat both of these problems by delivering high-quality care and support in ways that align with families’ needs and goals. 

NFP nurses not only address risk factors in the home, but serve as a support for parents in the health care system. Nurses help parents learn to navigate interactions with medical professionals and advocate for themselves if their concerns are being dismissed. 

Without additional funding, the District is at risk of losing the program entirely, or the majority of the nurses in the program. The District is currently experiencing a nurse shortage, and without guaranteed funding, nurse home visitors may worry about supporting their own families, and can easily find work elsewhere. 

Abby Goldstein, the supervisor for the NFP program, shared that it takes a unique person to be a nurse home visitor. You can’t just plug any registered nurse into this job and expect that they will be successful. The program worked very hard to staff to capacity, and find skilled nurses who have the interpersonal skills and dedication to do this job. 

One nurse home visitor, Jen, shared, “I have had the great opportunity to provide my participants to unveil their strengths and confidence, to take back control of their lives. Some participants remained or enrolled in a higher education when at first they did not believe they could do so while pregnant or with a child. Other participants found the strength in them to leave their abusive relationships, knowing they and their child deserve better. I have assisted some participants with building their resumes, resulting in them being accepted to a few jobs.”

Nurse home visitors have committed to serving District families who face some of the greatest barriers. If we lose this program or funding to support the all program staff, these nurses will no longer be able to support the families they have made a commitment to for the first two years of a first-time parent’s journey and the well-being of their child. Losing nurse home visitors will be detrimental to families in the program and costly for the program to replace and rebuild the program in the out-years. As Black women and children continue to be disproportionately harmed by our health system’s failures and racism, we cannot afford to lose one of the few services meant to ensure that they are safe, healthy, and supported.

As we approach the end of the pilot, funding for NFP is expected to lapse. While we are thankful for the Council’s allocation of a $225,000 grant to support home visiting in DHCF, this is not sufficient to support the program for an entire year. We ask the Council to invest one-time funding of $475,000 to sustain the program for FY25. For the $475,000 investment to be a one-time investment in the program, the Council must begin the implementation of the Medicaid Reimbursement Bill to provide a pathway for sustainable funding for NFP and other home visiting programs. 

Medicaid Reimbursement for Home Visiting is an Opportunity

Thank you for your leadership, Chairperson Henderson, in the DC Council’s passage of the Home Visiting Services Reimbursement Act of 2023. This bill represents an exciting opportunity for the District to stretch the impact of its investment of local funds in home visiting and gain additional federal support. 

With consistent, long-term investments, the District can maximize impacts for families and create a path to achieving long-term stability for home visiting program budgets so that they can best serve families.

We believe that the OCFO has overestimated the cost of this program. We appreciate the coordination with the Council and the OCFO over the past several months to reconsider the original analysis. 

We believe the current fiscal impact statement fails to account for other federal program dollars that support home visiting, overestimates the cost of covering Alliance beneficiaries, expects significantly higher growth rate of programs than historical growth patterns support, and includes an incorrect number of eligible programs. In addition, the Council could delay the implementation of the State Plan to Q4 of FY25 to provide time to establish reimbursement and support program take-up, which would reduce the number of quarters the funding would need to cover in FY25. If, in partnership with the OCFO and the Council, we can make these adjustments and lower the FIS, the funding needed in FY25 would be approximately $137K and FY26 and FY27 will be under $950K.

To support the critical services that home visiting programs provide to District families, we ask the Council to fund the Nurse Family Partnership’s $475K funding gap in the FY25 budget, and to update the program’s FIS, and fund the Home Visiting Services Reimbursement Act of 2023 Medicaid Reimbursement for home visiting based on corrected cost estimates. 

Thank you for the opportunity to testify today, and I welcome any questions.