Early Childhood

Medicare Bill Contains Prize for Home-Visiting Advocates

By Christina A. Samuels — March 24, 2015 2 min read
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The House and Senate are ever-so-close to passing a bill that would bring to an end more than 20 years of a broken payment system for doctors under Medicare, as well as provide an additional $800 million for the Maternal, Infant, and Early-Childhood Home Visiting Program, known as MIECHV.

The home-visiting money would be for fiscal years 2016 and 2017; $400 million for funding in this fiscal year, 2015, has already been allocated.

Now all the bill has to do is pass. But political observers say that the measure, hammered out between House Speaker John Boehner, R-Ohio, and minority leader Nancy Pelosi, D-Calif., offers a rare bit of common ground between lawmakers. If it fails, Medicare payments to doctors would face deep cuts after March 31.

This legislation would also be a permanent fix to the issue of doctor payments, instead of a perpetual irritant for lawmakers. Seventeen times over the past 12 years, Congress has passed a series of short-term measures to keep doctors’ payments intact instead of addressing the problem at its root.

And that’s where home visiting comes in, though it is unrelated to doctor payments under Medicare.

MIECHV gives federal dollars to states, which use that money along with state funds to pay for nurses and trained workers to make home visits to families who face economic and social struggles. The program was funded at $1.5 billion from 2009 to 2014. In 2014, with home-visiting money set to expire, legislators added funding to that year’s Medicare doctor-payment patch.

That’s why language related to home visiting has come to be associated with this particular Medicare bill, and why advocates have been watching this legislation closely. Karen Howard, the vice president for early-childhood policy for the Washington-based advocacy group First Focus, said her organization was happy with the prospect of additional funding.

“Our expectations from Congress have been tamped down over the past few months,” Howard said. A longer funding stream would be wonderful, but “we’re never going to look a gift horse in the mouth,” she added.


The Medicare bill, if it passes, would also extend for two years the Children’s Health Insurance Plan, or CHIP. When Congress passed the Affordable Care Act, it extended money for CHIP only through Sept. 30, 2015. The idea was that the private programs would take over coverage for the children currently served by CHIP.

But if CHIP goes away, up to 1.9 million children could lose coverage, because of complicated formulas that the Affordable Care Act uses to calculate just what kind of coverage is “affordable.” (Family plans are often much more expensive than individual plans.) Democrats have sought a four-year extension of CHIP but, according to some news reports, have not come out and said a two-year extension is a deal-breaker.

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Photo: House Speaker John Boehner kisses House Minority Leader Nancy Pelosi after Rep. Boehner was re-elected to a third term as speaker during the opening session of the 114th Congress in January.—Pablo Martinez Monsivais/AP-File

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A version of this news article first appeared in the Early Years blog.