EVIDENCE-BASED HOME VISITING PROGRAMS
WHAT ARE EVIDENCE-BASED HOME VISITING PROGRAMS AND WHY ARE THEY IMPORTANT?
Home visiting programs, which provide support and education to parents in the home through a trained professional (e.g., nurse or social worker) or paraprofessional, have expanded over the last couple of decades as a state-based investment to support parents and children.1
Supporting Families in the Early Years Produces Long-Term Benefits
Parents play a critical role in shaping children’s early development.2 Positive long-term child development is promoted through improving parents’ knowledge, social support, and coping and problem-solving skills, as well as connecting families to community and health resources during the prenatal and early childhood periods.3 In addition, teaching parents the skills for warm and responsive caregiving can buffer the long-term negative effects of childhood stress and adversity.4
Traditional and Virtual Home Visiting Services Provide Multiple Ways to Keep Families Engaged
For some families, the convenience of home-based service delivery can maximize the likelihood that they will participate in services by eliminating or reducing barriers such as transportation costs and child care needs.5 In-home support may make it easier for the entire family to participate, and this delivery method may facilitate more personalized, individual attention, which potentially increases families’ engagement in the programs.6
Further increasing accessibility, many home visiting programs have added options for virtual sessions. The availability of virtual sessions, although not yet studied rigorously, makes home visiting an option even to those parents who may have opted out of traditional home visiting services because of personal or cultural preferences.
Rigorous Research Demonstrates Home Visiting Programs Build Parenting Skills
Many home visiting programs have been evaluated with randomized controlled trials across a range of child and family outcomes. Although rigorous research has examined the impact of home visiting on a range of outcomes, the scope of this review is intentionally limited to parenting outcomes, the policy goal for which the most robust and consistent evidence on home visiting exists, across program models.
14 Home Visiting Program Models are Designated as Effective at Enhancing Parenting Skills
The Home Visiting Evidence of Effectiveness (HomVEE) project thoroughly reviews early childhood home visiting programs that serve families with expectant and new parents and their young children. Program models are designated as evidence-based if they meet the rigorous HomVEE criteria for evidence of effectiveness. States must use the vast majority of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds they receive from the federal Health Resources & Services Administration (HRSA) on programs designated as evidence-based and can allocate a small portion to promising programs that will be evaluated.
HomVEE identifies 21 evidence-based program models as having favorable impacts on parenting skills. Four programs, Early Start (New Zealand), Preparing for Life (Ireland), Video-Feedback Intervention to promote Positive Parenting (the Netherlands), and Video-Feedback Intervention to promote Positive Parenting-Sensitive Discipline® (the Netherlands) do not operate in the US, and another, the Home Instruction for Parents of Preschool Youngsters (HIPPY), has only been evaluated for its impacts on preschoolers. Additionally, HealthySteps and Family Connects are considered “low touch” in service delivery, and thus more closely align with comprehensive screening and connection programs than evidence-based home visiting programs.
The remaining 14 evidence-based home visiting program models listed below are designed for pregnant women or infants and toddlers, have a significant impact on improving parenting skills, are “high touch,” and operate in the US:
- Attachment & BioBehavioral Catch-Up,
- Early Head Start-Home Based Option,
- Family Check-Up for Children,
- Family Spirit,
- Healthy Beginnings,
- Healthy Families America (HFA),
- Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT),
- Maternal Early Childhood Sustained HV Program (MESCH),
- Maternal Infant Health Outreach Worker (MIHOW),
- Nurse-Family Partnership,
- Oklahoma’s Community-Based Family Resource and Support (CBFRS) Program,
- Parents as Teachers,
- Play and Learning Strategies (PALS) – Infant, and
- Promoting First Relationships – Home Visiting Intervention Model.
Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on evidence-based home visiting programs.
WHAT IMPACT DO EVIDENCE-BASED HOME VISITING PROGRAMS HAVE AND FOR WHOM?
Participation in evidence-based home visiting programs leads to small but positive impacts on parenting skills, however these effects exist within the context of many more null findings. Impacts are inconsistent across program models on other important child and family outcomes, including birth outcomes,7,8 child maltreatment,9,10 and child health.11,12 Given the lack of robust evidence for non-parenting outcomes, our evidence review focuses only on the impact of home visiting on parenting outcomes.
More Research Is Needed to Understand the Potential of Home Visiting Programs to Reduce Racial and Ethnic Disparities
Most of the research on parenting outcomes in home visiting programs either does not examine impacts by race and ethnicity, or no significant differences emerge in subgroup analyses. Research does suggest that matching clients and home visitors on race and/or ethnicity can have better effects on birth outcomes, but this finding does not hold for parenting outcomes.13 Future studies should examine differential impacts of evidence-based home visiting programs based on race and ethnicity.
For more information on what we know and what we still need to learn about evidence-based home visiting programs, see the evidence review on evidence-based home visiting programs.
WHAT IS THE KEY POLICY LEVER TO INCREASE ACCESS TO EVIDENCE-BASED HOME VISITING PROGRAMS?
The current evidence base does not identify a specific policy lever that states should adopt to ensure access to home visiting programs to all families who need the services.
We identified one key policy lever that states can implement to increase access to home visiting programs:
- Use Medicaid to fund evidence-based home visiting programs that promote parenting skills.
Key Policy Lever: Use Medicaid to Fund Evidence-Based Home Visiting Programs that Promote Parenting Skills
Although there are multiple avenues for states to support home visiting, components of home visiting programs may be covered by Medicaid funding. Additionally, because coverage of home visiting program services under Medicaid must be outlined in a state’s Section 1115 waiver or state plan amendment, there are consistent data sources to determine which states use Medicaid. Other funding options for evidence-based home visiting programs lack consistently available data on use by states.
States use their Medicaid dollars in a variety of ways to support home visiting. Home visiting is not a service that by itself is reimbursed by Medicaid, but components of the programs and services provided in the home visit can be covered by Medicaid. The targeted case management (TCM) benefit, through a state plan amendment, is one of the most common ways states have funded a part of home visiting through Medicaid. Other states use waivers—such as the Section 1115 or 1915(b) waivers—to pilot approaches for specific children or specific communities, or to integrate home visiting into Medicaid managed care arrangements.
As of September 2026, 19 states (including the District of Columbia) use Medicaid as a source of funding for evidence-based home visiting programs that are proven to impact parenting and two states (the District of Columbia and Nebraska) are taking steps to do so.
Changes to Medicaid funding at the federal level may impact Medicaid coverage and services of evidence-based programs such as home visiting. Work to determine the full impact of federal Medicaid changes on state offerings is ongoing.
States Can Use a Variety of Funding Mechanisms to Improve Access to Home Visiting Programs
Beyond Medicaid, states use a variety of funding mechanisms, including both federal and state funds, to fund their home visiting programs. The primary federal mechanism is the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. States receive a base funding allotment determined by the number of children in the state, if they appropriate at least the same level of state funding to home visiting as they did in either Fiscal Year (FY) 2019 or 2021.
Beginning in FY2024, states and jurisdictions are also eligible for MIECHV matching funds on top of their base allotment. In FY2025, every state, except for Mississippi and North Dakota, provided funds to draw down at least a portion of federal funds.
States may also use other federal funding streams to support home visiting, including Medicaid, Title V Maternal and Child Health Services Block Grant, Temporary Assistance for Needy Families (TANF), Child Welfare, Children’s Health Insurance Program (CHIP), Title IV-E of the Social Security Act, and Head Start funds. These federal funds generally require state matching funds.
State funding streams include state general revenue, Children’s Trust Funds, tobacco settlements and taxes, and money from states’ cannabis accounts. By allocating additional resources beyond federal MIECHV funds, states can support programs and expand the reach of services.
Data on total funding levels for home visiting are not available across all states. States can leverage multiple funding sources and direct them to various state initiatives (e.g., prevention services, maternal health), which makes this information difficult to track.
For more information on the state policy levers that may help improve parenting through evidence-based home visiting programs see our State Policy Lever Checklists.
HOW DOES ACCESS TO EVIDENCE-BASED HOME VISITING VARY ACROSS STATES?
States vary considerably in the amount and type of investments they make in home visiting programs, which leads to variation in the percentage of children under age 3 who are served. The National Home Visiting Resource Center (NHVRC) collects data from most evidence-based program models to describe the models that are implemented in each state and the number of children under age 3 that are served by each program model.14 These data are published in the NHVRC’s 2025 Home Visiting Yearbook, which includes participation data from 2024.
Using data from NHVRC, it is possible to estimate how many children under age 3 each state is serving in its home visiting programs, as a percentage of the total population that is under age 3 in families with incomes less than 150% of the federal poverty level (FPL).15
According to data from NHVRC, the reach of home visiting varies considerably across the US. Except for a handful of states, the reach is relatively small. The percentage of families with young children served by evidence-based home visiting programs in 2024 ranged from more than 25% of children in Maine and Wyoming to less than 5% in Georgia, Mississippi, Nevada, and Texas. The median state served 11.7% of young children. Looking at the US as a whole, the average was 9.5% served.
WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO INCREASE ACCESS TO EVIDENCE-BASED HOME VISITING PROGRAMS?
States have substantial latitude in how they fund and implement their home visiting programs. Over the last year, progress to support evidence-based home visiting programs was slow.
2 States Remain in the Process of Covering Evidence-Based Home Visiting Services Under Medicaid
Two states are in the process of providing coverage for evidence-based home visiting services under Medicaid, although progress remains slow. Nebraska enacted legislation in 2025 to cover evidence-based home visiting programs under the Medicaid targeted case management benefit, which requires the state to submit a Medicaid state plan amendment before implementation. The bill stipulates that the state match for Medicaid reimbursement must be covered with funds returned to the state from managed care organizations that exceed their medical loss ratio. As of September 2026, Nebraska had not yet submitted a state plan amendment for federal review.
Lawmakers in the District of Columbia successfully enacted legislation in 2024 to require the health care programs run by the District—including Medicaid, the DC HealthCare Alliance Program, and the Immigrant Children’s Program—to cover and reimburse services provided by home visiting programs. The legislation requires that services be offered through an evidence-based program as defined by HomVEE. As of September 2026, the District had not yet submitted its state plan amendment for federal review, a step required for implementation.
1 State Enacted Legislation to Establish an Evidence-Based Home Visiting Program
Legislators in Tennessee enacted legislation that requires the establishment of an evidence-based early childhood mental health home visiting program for children from birth to age 5. The state is authorized to seek federal funds, state appropriations, grants, and private donations, and to enter into agreements with the state’s Medicaid managed care organizations to fund home visiting services. The specific funding source for the program and the evidence requirements for program models have not yet been determined.
Arizona considered legislation that would have established an evidence-based nurse home visiting program, but the bill did not pass this session.
1 State Enacted Legislation to Require Private Health Plans to Cover Home Visiting Services
Legislators in New Hampshire enacted a biennial budget in 2025 that requires coverage of perinatal home visiting services by private health insurance plans, effective January 2026. Home visiting services covered include evidence-based, voluntary home, or community-based services for caregivers with newborns aimed at improving maternal and child health.
4 States Increased or Leveraged Funding for Home Visiting Services
At least four states (Colorado, Georgia, Iowa, and Rhode Island) enacted legislation or budget provisions to increase state funding for home visiting services or maximize available federal funding.
- Colorado reallocated $5.1 million in general fund appropriations from child maltreatment prevention services to home visiting services, allowing the state to draw down an additional $1.1 million in federal funds for the SafeCare program.
- Georgia increased funding for its pilot program to provide additional home visiting services in at-risk and underserved communities to $3.7 million.
- Iowa enacted legislation to allow Early Childhood Iowa area boards to voluntarily transfer their home visiting contracts to the state’s Department of Health and Human Services for oversight, allowing the state to draw down federal funding through Title IV-E of the Social Security Act. Spending of the additional funds, however, would not be limited to the area that transferred oversight.
- Rhode Island increased its state allocation for home visiting to secure the maximum federal award available through the MIECHV program.
Three additional states introduced legislation related to home visiting funding, but none of the bills passed. Mississippi’s bill would have required the state department to expand funding opportunities for evidence-based home visiting services, prioritizing areas with high infant mortality rates and underserved populations. Legislation in Rhode Island would have created a joint commission to study ways to maximize revenue for child welfare and children’s behavioral health services, including home visiting. North Carolina proposed a recurring general fund appropriation to expand evidence-based maternal and infant health programs and services, including home visiting.
2 States Enacted Changes to Improve Access and Outreach to Home Visiting Services
Enacted in October 2025, California’s legislation allows families who are enrolled in home visiting programs through their participation in CalWORKS, the state’s TANF program, to continue with services even if they lose CalWORKS eligibility due to income changes. New York added home visiting programs to the Health Care and Wellness Education and Outreach Program, which allows for additional and improved outreach to families who may be eligible for services.
An additional proposal in Wisconsin would have addressed access challenges by requiring hospitals to provide a home visit for parents with a newborn that request it. This bill did not pass.
Federal Impact on Home Visiting Services
Last year, the federal government passed the One Big Beautiful Bill Act making cuts to federal funding for Medicaid.16 Work to understand the implications of federal policy changes on state budgets is ongoing, though changes are anticipated to have a detrimental effect on state support for evidence-based policies and strategies such as home visiting.
In addition to changes affecting Medicaid, federal action on MIECHV will shape states’ ability to sustain home visiting services. The program is currently authorized through FY2027 and requires congressional reauthorization by the end of the fiscal year for funds to be appropriated to states in future years. In June 2026, the Work & Welfare Subcommittee of the U.S. House Ways and Means Committee began holding hearings for reauthorization. The hearings demonstrated bipartisan agreement on the importance of the MIECHV program and the need for reauthorization. As of September 2026, the program has not yet been reauthorized.
For more information on each state’s progress on evidence-based home visiting programs, find our individual state summaries under Additional Resources below (and here).
ADDITIONAL RESOURCES
View our Policy Impact Calculator, which illustrates how policies, such as state minimum wage, paid family and medical leave, out-of-pocket child care expenses, taxes and tax credits, as well as federal nutrition benefits, interact to impact overall household resources.
NOTES AND SOURCES
- Sandstrom, H. (2019). Early childhood home visiting programs and health. Health Affairs. https://www.healthaffairs.org/do/10.1377/hpb20190321.382895/full/
- Bronfenbrenner, U. (1992). The ecology of human development. In R. Vasta (Ed.) Six Theories of Child Development (pp. 187–249). London: Kingsley Publishers
- Sweet, M. A. & Appelbaum, M. I. (2004). Is home-visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development, 75(5), 1435–1456. https://doi.org/10.1111/j.1467-8624.2004.00750.x
- National Scientific Council on the Developing Child. (2015). Supportive relationships and active skill-building strengthen the foundations of resilience [Working paper no.13]. https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/The-Science-of-Resilience2.pdf
- Nievar, M. A., Van Egeren, L. A., & Pollard, S. (2010). A meta-analysis of home visiting programs: Moderators of improvements in maternal behavior. Infant Mental Health Journal, 31, 499–520. https://doi.org/10.1002/imhj.20269 [Evidence-Based Home Visiting Evidence Review Study D]
- Sweet, M. A. & Appelbaum, M. I. (2004). Is home-visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development, 75(5), 1435–1456. https://doi.org/10.1111/j.1467-8624.2004.00750.x
- Casillas, K. L., Fauchier, A., Derkash, B. T., & Garrido, E. F. (2016). Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse and Neglect, 53, 64–80. https://doi.org/10.1016/j.chiabu.2015.10.009 [Evidence-Based Home Visiting Evidence Review Study A]
- Lee, H., Crowne, S. S., Estarziau, M., Kranker, K., Michalopoulos, C., Warren, A., Mijanovich, T., Filene, J., Duggan, A., & Knox, V. (2019). The effects of home visiting on prenatal health, birth outcomes, and health care use in the first year of life: Final implementation and impact findings from the Mother and Infant Home Visiting Program Evaluation – Strong Start (OPRE Report #2019-08). Office of Planning, Research & Evaluation. https://www.acf.hhs.gov/opre/resource/effects-home-visiting-prenatal-health-birth-outcomes-health-care-first-year-final-implementation-impact-findings-strong-start
- Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components associated with home visiting program outcomes: A meta-analysis. Pediatrics, 132 Suppl 2 (0 2), S100–S109. https://doi.org/10.1542/peds.2013-1021H [Evidence-Based Home Visiting Evidence Review Study C]
- Sweet, M. A. & Appelbaum, M. I. (2004). Is home-visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development, 75(5), 1435–1456. https://doi.org/10.1111/j.1467-8624.2004.00750.x
- Casillas, K. L., Fauchier, A., Derkash, B. T., & Garrido, E. F. (2016). Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse and Neglect, 53, 64–80. https://doi.org/10.1016/j.chiabu.2015.10.009 [Evidence-Based Home Visiting Evidence Review Study A]
- Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components associated with home visiting program outcomes: A meta-analysis. Pediatrics, 132 Suppl 2 (0 2), S100–S109. https://doi.org/10.1542/peds.2013-1021H [Evidence-Based Home Visiting Evidence Review Study C]
- Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components associated with home visiting program outcomes: A meta-analysis. Pediatrics, 132 Suppl 2 (0 2), S100–S109. https://doi.org/10.1542/peds.2013-1021H [Evidence-Based Home Visiting Evidence Review Study C]
- NHVRC does not include service data from the following evidence-based programs that impact parenting: Family-Check Up, Healthy Beginnings, Healthy Steps, Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT), Oklahoma’s Community-Based Family Resource and Support Program, and Promoting First Relationships.
- We estimate the percentage served out of the eligible children under age 3, using the NHVRC service data (number of served children under age 3) from 2024 as the numerator, and the Census Bureau’s 2023-2024 American Community Survey data (number of children under age 3 in families with incomes of less than 150% of the FPL) as the denominator. The family income of less than 150% of the FPL was used as a proxy for the high-priority eligibility criteria typically used across home visiting programs (e.g., pregnant women, mothers under 21, single/never married mothers, parents with less than a high school education, and families with incomes below 100% of the FPL).
- KFF. (2025). Health Provisions in the 2025 Federal Budget Reconciliation Bill. KFF. https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/
