Early childhood home visiting is a strategy for delivering services to improve health, well-being, and education outcomes for vulnerable families with young children. Nurses, social workers, and other professionals visit the homes of families who participate on a voluntary basis. The federal government has long supported early childhood programs in which home visiting is a major component or is otherwise permitted. The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is the primary federal program that focuses exclusively on home visiting. The program was implemented in March 2010, following the Obama Administration's budget request for a national home visiting program and a home visitation pilot program carried out in 15 states that had been initiated by the George W. Bush Administration. Congress considered proposals to establish home visiting programs as part of health care reform in 2010 and in prior years. HHS provides MIECHV funding to states, territories, and tribal entities for home visiting services in at-risk communities, as identified by these jurisdictions. MIECHV prioritizes certain populations, including low-income families, young mothers, or individuals who have a history of substance abuse, among other risk factors. 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. Jurisdictions that carry out home visiting programs under the program must adhere to specific requirements. For example, they must use most of their program funding to implement one or more home visiting models that have been identified by HHS to be effective. Separately, HHS provides training and technical assistance to jurisdictions and is carrying out research activities to evaluate the impacts of the program on participants' outcomes. This report begins with an overview of the MIECHV program and home visiting generally, and discusses federal efforts to increase and support home visiting services. It goes on to describe the program, including information about its administration, coordination, and funding. Following this is an outline of MIECHV requirements for states and other jurisdictions, including information on the types of home visiting models that have been implemented across jurisdictions. The report concludes with information about efforts to research, evaluate, and provide technical assistance within the MIECHV program. Appendix A includes federal legislative history on home visiting; Appendix B includes funding levels by state for the MIECHV program in selected years; Appendix C includes a timeline of relevant dates for the program; and Appendix D provides information about home visiting models adopted by jurisdictions, and features of selected home visiting models that meet HHS criteria for being effective. Home visiting is a holistic strategy that involves social, health, and/or educational services for parents and their children from birth to entry into kindergarten. 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). For some home visiting models, the number of visits becomes more infrequent over time. Depending on the program model, visits may be conducted by nurses, mental health clinicians, social workers, or paraprofessionals who have received specialized training. These visitors provide services such as parenting education and they refer families to other services in the community. To a large extent, parents shape their children's earliest experiences. Home visiting programs seek to help parents better understand the development of their children. For example, home visitors can help parents facilitate learning opportunities through playing games, talking to their children frequently, and reading to them. Home visitors can also provide information to parents about child health, such as the value of well-child visits, car seat safety, and brushing teeth. Home visiting can directly help parents identify outside supports, such as referrals for health insurance and substance abuse resources. The programs can help achieve positive benefits for children, parents, and possibly their communities. For many years, greater attention has been focused on early childhood home visitation as a way to improve child and family outcomes. In recent decades, this trend appears to be driven in some part by newer research on how the human brain develops and, specifically, the significance of prenatal and early childhood environments to later life. At least since the 1960s, a variety of early childhood home visiting models have undergone many assessments and evaluations intended to test how effectively they achieve their goals. Looking at findings across multiple home visiting studies, researchers conclude that home visiting can provide benefits to children and their parents, including preventing potential child abuse and neglect, enhancing cognitive development, improving parenting attitudes and parenting behaviors (e.g., discipline strategies), and increasing maternal education. They caution, however, that while visiting programs can lead to improvements, the difference is small between observed outcomes for families that received home visits versus those who did not. Further, while one or more individual studies may have shown positive effects with regard to the desired outcomes, those effects have not necessarily been studied and/or achieved across more than one study or program site. Nonetheless, some models or aspects of models have been shown to be particularly effective. Overall, while researchers have cautioned that home visiting is not a panacea, they have generally encouraged its implementation as part of a range of strategies intended to enhance and improve early childhood development. 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. (See Appendix A for a history of federal home visiting efforts.) 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. States, territories, and Indian tribes determine which communities are at risk by conducting needs assessments. The MIECHV law requires that jurisdictions administer programs that are evidence-based. Specifically, jurisdictions must use no less than 75% of their program funds to implement home visiting models that HHS has determined as effective, ensure that services are carried out with fidelity to these program models, and demonstrate improvements in outcomes for participating families. MIECHV funding is mandatory, meaning that the authorizing law funds the program directly (as opposed to the funding provided through appropriations law). Annual funding levels have been between $100 million and $400 million. The most recent reauthorization of the program, the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123 ) extended funding through FY2022. With limited exceptions, jurisdictions have two full fiscal years to expend these funds. The law includes several requirements related to eligible families, funding program administration, and research and evaluation. Figure 1 summarizes the major components of the program. Under the MIECHV program, jurisdictions provide home visiting services to eligible families who volunteer to participate. An eligible family includes (1) a woman who is pregnant, and the father-to-be, if available; (2) a parent or primary caregiver of a child, including grandparents or other relatives of the child, and foster parents, who is serving as the child's primary caregiver from birth to entry into kindergarten; and (3) a noncustodial parent who has an ongoing relationship with, and at times provides physical care for, the child from birth to entry into kindergarten. 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. Funding for the MIECHV program has increased over time from $100 million to $400 million annually. 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. MIECHV funding may be expended by the jurisdiction through the end of the second succeeding fiscal year after the award. 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. Formula funding is available annually for home visiting in the 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Northern Mariana Islands, and American Samoa. The factors for allocating funds under the formula component have changed, effective with funding awarded with the FY2016 appropriation. HHS has noted that the funds are intended to both address the need for services and to reward jurisdictions for improved outcomes. Table 1 uses funding for FY2018 as an example of how formula funds are to be awarded. Funds are allocated, in part, based on a "need funding" factor that accounts for the relative share of children in poverty, with certain adjustments. Most of the funds will be allocated based on a "base funding" factor that accounts for the amount of competitive funding each jurisdiction receives.