Committee hears amendment to let Medicaid reimburse postnatal home visiting services

Assemblymember Hanadi Nadim presented Assembly Bill 297 to the Assembly Committee on Health and Human Services and said a conceptual amendment (posted on NELIS) would let home visiting providers enroll as Medicaid providers so Medicaid could reimburse visits by qualified home visiting programs. "AB 297 seeks to improve maternity and infant care in Nevada," Nadim said, and her presentation cited Nevada's low ranking in adequate prenatal care and documented racial disparities in maternal and infant outcomes.

Nadim and co-sponsor Assemblymember Cecilia Gonzales described the amendment's two goals: improve access to evidence-based home visiting services during pregnancy and the postpartum period, and expand sustainable Medicaid funding to scale those services statewide. Nadim said the state currently serves about 500 families in the Nevada home visiting program supported by a grant, and the proposal would align Nevada with about 28 other states that cover home visiting services through Medicaid.

Stacy Weeks of Nevada Medicaid explained how the benefit would be optional at the Medicaid enrollment level and that managed-care case managers could notify beneficiaries about the available benefit. She said the amendment as discussed would limit Medicaid coverage to Medicaid beneficiaries and that Division of Public and Behavioral Health (DPBH) would certify entities that Medicaid would cover.

Vicki Ives of the Division of Public and Behavioral Health cited both national and state evidence about outcomes of evidence-based home visiting models, including improved rates of developmental screening, higher school readiness and preventive dental visits, and higher safe-sleep practice adherence. Ives cited research and investment studies (for example, RAND analyses) showing positive returns on investment for evidence-based home visiting models.

Supporters that testified included public health and child advocacy organizations, nurse and home-visiting program representatives, doulas, lactation consultants, and many parents who described how a home visit after birth made a meaningful difference. Matthew Richardson of Nurse-Family Partnership recited randomized-trial outcomes associated with that home-visiting model, including reductions in child abuse and neglect and emergency room visits and improvements in child development and maternal employment.

Opponents and callers raised concerns about whether the program would be optional or mandatory, the fiscal cost, whether registered nurses must perform visits, and whether existing programs are underused. Katzen Kawitz of Stand for Health Freedom urged language changes to make the optional nature explicit in the bill text. Janine Hanson of Nevada Families for Freedom and other callers similarly requested explicit opt-in language and said the fiscal note and scope needed clarification.

In closing remarks, Assemblymember Nadim said the sponsor's amendment makes coverage optional and Medicaid-only and invited Stacy Weeks to confirm details. Weeks told the committee the amendment would make the benefit optional in Medicaid the way other Medicaid benefits are optional and that DPBH would certify covered entities. "The amendment that was hopefully posted online makes this an optional benefit, like any benefit in Medicaid," Weeks said.

The committee did not take a final vote on AB 297. Members asked for more information about certification, which home visiting models would be eligible, how reimbursement rates would be set (including rural add-ons), and the fiscal impact. Witnesses and sponsors said they would work with staff on those specifics and provide data to the committee.