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

February 8, 2024
Person Testifying: Mary Katherine West
Title: Home Visiting Program Manager, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Oversight Hearing

Good morning Chairperson Henderson and members of the Committee on Health. Thank you for the opportunity to address the Committee as it reviews the Department of Health Care Finance’s performance. 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.

DC Action and the Home Visiting Council appreciate the DC Council’s past support for home visiting programs, including the recent passage of the Home Visiting Services Reimbursement Act. FY24 is the Department of Health Care Finance’s (DHCF) first year supporting home visiting services, and I am excited about the enthusiasm of representatives from DHCF to join the work of the Home Visiting Council. This partnership and collaboration are necessary to deliver effective and sustainable home visiting services to District families. 

My testimony focuses on the critical role of the Department of Health Care Finance in administering Mary’s Center’s Nurse Family Partnership Program and implementing the Home Visiting Services Reimbursement Act through Medicaid. 

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

Home visiting is an individualized service that connects expectant families and 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. 

The District’s 17 locally, federally, and privately funded home visiting programs served 2,628 parents and children across the District, delivering 22,799 home visits in FY23. By assessing family needs, educating and supporting parents, and referring families to community resources, home visitors support the needs of both parents and children.  Home visitors in the District most often helped families navigate income, employment, or financial stress; finding safe, stable, and affordable housing; food insecurity; mental health; immigration; and domestic violence.

Home visiting has the potential to support families to improve priority outcomes for many of the District’s agencies that serve children, including DC Health, Child and Family Services Agency (CFSA), and DC’s education agencies. 

  • Health: At the Committee on Health’s December 2023 Maternal Health Roundtable, DC Health representatives cited home visiting services as a key facet in their strategy to improve maternal and child health in the District. Specifically, home visiting supports the goal of early entry into quality prenatal care. 
  • Child welfare: CFSA sees home visiting as an important strategy in advancing their prevention strategy of keeping families together, improving parent-child relationships, and reducing harm to children.
  • Education: Several of the District’s home visiting programs help families to prepare their children for school, including Early Head Start, Parents as Teachers, and HIPPY programs.

The Nurse-Family Partnership Fills Critical Gaps

The Nurse Family Partnership (NFP) is an evidence-based home visiting model that creates 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. 

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. 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. 

Registered nurses meet regularly with parents during pregnancy to identify and mitigate risk factors associated with maternal mortality. The results of NFP’s randomized control trial show 35% fewer cases of pregnancy-induced hypertension, 18% fewer preterm births, and 79% reduction in preterm delivery among women who smoke cigarettes. 

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. 

One NFP participant, Aujane, who is set to graduate from the program next month when her daughter turns two, shared, “I have learned to never doubt myself while working with my home visitor. I hope the next parent can accomplish everything they say they want to like I have so far and am striving for in the future. I know they can benefit from the home visiting program like I have.”

Beyond improving pregnancy outcomes, NFP improves rates of breastfeeding and immunizations by about 20%. The program also reduces child abuse and neglect, health care encounters and injuries in the first two years, behavioral problems, and emergency room visits.

At Mary’s Center, the four registered nurses in the NFP program are building their capacity to be able to support 100 first-time parents and their families each year. 

The DC Home Visiting Council is excited that the Department of Health Care Finance has taken on the administration of this program. It is essential that the District continue to invest in the Nurse Family Partnership and other home visiting programs. 

Medicaid Reimbursement for Home Visiting is an Opportunity

With the expected enactment of the Home Visiting Services Reimbursement Act, DHCF will take on the role of administering home visiting services reimbursement through Medicaid in FY25. Thank you for your leadership, Chairperson Henderson, in the Council’s passage of this bill. 

After the official passage of the Home Visiting Services Reimbursement Act, the Department of Health Care Finance should work towards a timely implementation of the legislation. This legislation provides an opportunity for DHCF to further support NFP alongside other evidence-based home visiting programs in the District. We look forward to working with DHCF on home visiting reimbursement.

Funding the bill and working toward its timely enactment will serve as an investment in DC families and will also provide a significant cost savings to the District. The bill provides a 70% federal match, which allows the District to stretch the impact of its investment of local funds. With strategic and transparent braiding of local, MIECHV, and Medicaid funding, 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. 

In 2022, Medicaid funded 45% of births in the District. Premature births represent a significant cost, and a preventable one. In 2016, the average medical costs for a full-term baby in its first year of life is around $13,000 while a premature baby or low-birth weight baby costs on average $50,000. Preventing premature births reduces stress for families and provides significant savings for the city. 

The positive impacts of home visiting result in reductions in spending not only on medical costs, but also on services including the child welfare system, food and income assistance, the juvenile justice system, and special education. According to the Center for American Progress, these decreases in public spending provide a return of up to $5.70 for every dollar spent on home visiting. 

DC Action and the Home Visiting Council are excited to support this work and to continue building our partnership with the Department of Health Care Finance to support children and families in DC. I welcome the opportunity to meet with you Chairperson Henderson and partners at DHCF to discuss the implementation of the Home Visiting Services Reimbursement Amendment Act. 

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