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Friday, March 29, 2019

Oregon Bill Calls for “Universal In-Home Visits” to Families with Newborns

Oregon Bill Calls for “Universal In-Home Visits” to Families with Newborns

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Story Highlights
  • A new bill (SB 526) has been introduced in the Oregon legislature directing the Oregon Health Authority to study and recommend legislation for a nurse home visiting program that offers up to three home visits by a licensed health care provider for parents and families with newborns.
  • The Governor of Oregon plans to develop a “universal in-home program” that provides in-home nurse visits for all new parents regardless of insurance status and requires insurance companies to reimburse the costs.
  • There are many unanswered questions whether this policy will be mandatory for all families with newborns.
Oregon Governor Kate Brown recently submitted a bipartisan budget proposal for the years 2019-2021 that includes a focus on behavioral health (addictions and mental health). A focus of the budget is investment in child health and Oregon’s Coordinated Care Organizations, which is the state’s approach to blending a wide range of health services under one program.1
The bill directs the Oregon Health Authority (OHA) to study and recommend a program that offers up to three post-birth home nurse visits by a licensed health care provider for families with newborns beginning when the babies are three weeks old.2
There are many unanswered questions about the proposed home nurse visit program, including whether it will be an “opt-in” program or become mandatory for all parents of newborns in the state.
On March 18, 2019, the Oregon Senate Committee on Health Care discussed the key elements of the OHA’s role in this study, which is “to design, implement and maintain a voluntary statewide program to provide universal newborn nurse home visiting services to all families with newborns residing in this state. Requires OHA to consult, coordinate and collaborate with health benefit plan insurers, hospitals, local public health authorities, the Early Learning Division, existing early childhood home visiting programs, community-based organizations, and social service providers in designing program. Establishes standards for nurse home visiting services. Requires OHA to collect and analyze data to assess the effectiveness of the program. Requires health benefit plans to reimburse for the cost of universal newborn home visiting services.”3

Similar In-Home Newborn Visit Programs Include Providing Vaccines

Other similar in-home newborn education and medical care programs operated by Duke University and Lincoln County Public Health “Babies First” programs are cited as examples. Those programs include:
  • Home visits to new families and children with special needs;
  • Intensive home visits with assessments of learning opportunities and safety in the home;
  • Education and information on child development, including monitoring and child growth;
  • Developmental testing; hearing, vision and dental screenings;
  • Support to families and education on health topics;
  • Provides immunizations;
  • Assistance with the Special Supplemental Nutrition Program for Women, Infants, and Children (WC);
  • Referrals for medical care and social services as needed;
  • Case management

An “Emergency” Measure To Protect “Public Peace, Health and Safety”

Currently, the bill has 18 sponsors and has language in it declaring SB 526 as an emergency measure needing resolution by the end of the year.4 According to the bill, what this means is that the sponsors of the bill claim that, This 2019 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2019 Act takes effect on its passage.”4
Oregon is not the only state to push for in-home visits for families with newborn children. Governor Jay Inslee of Washington tweeted, My budget would also offer universal home visits. This gives every new parent the opportunity to get a visit from a nurse during the first few weeks back home with their newborn to share important information and build confidence.”5

“This Is Stuff All Kids Need”

According to Patrick Allen, the Director of Oregon Health Authority, the governor’s plan involves a six year program to develop a universal nurse home visit program for parents with newborn babies regardless of insurance status.1 6 The program would also include parents who adopt newborns. The family would receive two or three home visits that would provide basic health screenings for babies, connecting parents with primary care physicians and other services, and coordinating the scheduling of the many government recommended childhood vaccines for babies.1
Currently, the state offers in-home visits to some families through programs that have eligibility requirements, but they are limited to families that qualify for Medicaid or those who are considered “at-risk”.6 Allen stated in reference to the new proposed program, “This isn’t something for people in trouble. This is stuff all kids need. Stuff my kids needed.”1
Allen also pointed out that the program has been piloted in Lincoln County, Oregon. He added that no other state offers universal in-home visits for new parents, although North Carolina is focusing efforts on moving toward such a program as well.1
State Sen. Elizabeth Steiner Hayward (D-Beaverton), one of the bill’s co-sponsors told Oregon Public Broadcasting, “We’re still working out the details of how it’s going to happen and how it’s going to get paid for, but many of them are recognizing that the value in reducing emergency department visits, in identifying postpartum depression and anxiety very early and intervening, in connecting moms with services to help them bond successfully and get their baby in for the right visits.”6
Cate Wilcox, the manager of the Maternal and Child Health Section at the Public Health Division of the Oregon Health Authority provided some examples of issues that a nurse could address during a in- home visit:
Is the baby gaining weight? How is breastfeeding going? How are you feeling? Those are some of the health aspects. Then there would be some social aspects: Do you have childcare? Are you attaching well? How has your child played? Is the home safe?6

Will It Be Mandatory?

Although Senator Steiner Hayward told Oregon Public Broadcasting that the in-home nurse visit program would be optional for those families who want it,6 the bill does not make crystal clear whether the program would remain “opt-in” or become mandatory for all families with newborn babies. The term “universal in-home visits” is vague and does not provide any clarification to determine whether in-home visits would be optional.
The strong language regarding the declaration of emergency in the bill also suggests that this may indeed be a mandatory program for all parents with newborns:
This 2019 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2019 Act takes effect on its passage.4
The assumption behind these kinds of state-operated health surveillance programs is that parents cannot be trusted to properly care for their own infants and children and that state employees are the only qualified agents to ensure that children are cared for in the way the state deems appropriate. If this becomes a mandatory program, the Parental Rights Foundation has made it clear that home visits, even by licensed medical personnel, would constitute a violation of family privacy if the visit is unwanted. Licensed medical practitioners are by law mandatory reporters; once they are inside your home they are a de facto investigative agent of the State.”7
The proposed newborn in-home nursing visit program hinges on the definition of the term “universal” which has yet to be made clear to the public.


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