How evidence-based home visiting delivers measurable savings to state government
(highest-risk families)
ER visits
child abuse/neglect
Medicaid costs
The Opportunity
The Nurse-Family Partnership (NFP) pairs specially trained registered nurses with low-income, first-time mothers from early pregnancy through the child’s second birthday. Founded on three randomized controlled trials—including a landmark study conducted in Memphis, Tennessee1—NFP is among the most rigorously tested social programs in the country. Tennessee ranks in the lowest quartile nationally for overall child health.2 NFP is already operating in the state through sites at Le Bonheur Children’s Hospital and East Tennessee State University, funded by the Tennessee Department of Health,3 but current capacity reaches only a fraction of eligible families.
Near-Term Fiscal Returns: Where Dollars Are Saved
The strongest and most immediate fiscal returns come from reduced utilization of costly acute-care and public assistance programs—savings that appear in state budgets within the first years of program operation:
| Outcome | Evidence & Fiscal Impact |
|---|---|
| Emergency Room Visits | 56% reduction in ER visits for accidents and poisonings among children in nurse-visited families.1 At an average cost of $1,200–$2,500 per pediatric ER visit, this translates to immediate, measurable savings for TennCare. |
| Medicaid & SNAP Enrollment | NFP families achieved greater economic self-sufficiency, producing an 8.5% reduction in Medicaid costs from birth to age 18 and a 9.6% reduction in SNAP costs over 12 years following birth.2 |
| Preterm Birth & NICU | 88% of NFP babies are born at term.3 Preventing even one NICU admission (average cost: $76,000+) can offset the cost of serving multiple NFP families for the full program duration. |
| Child Welfare System | 48% reduction in substantiated child abuse and neglect.4 Each child removal costs Tennessee an estimated $25,000–$35,000 per year in foster care, court, and casework costs. |
| Criminal Justice (long-term) | 59% reduction in arrests among children of nurse-visited families5 and 72% fewer criminal convictions among participating mothers.4 |
| Overall ROI | RAND Corporation found a net societal benefit of $34,148 per higher-risk family served, equating to $5.70 returned for every $1 invested. Communities recovered program costs by child age four.6 |
Longer-Term Societal Returns
Beyond near-term budget savings, NFP’s RCTs documented outcomes that reduce costs across multiple state systems over time: a 59% reduction in arrests among children of nurse-visited families8 and 72% fewer criminal convictions among participating mothers.7 The RAND Corporation estimated a net societal benefit of $34,148 per higher-risk family served (in 2003 dollars), with communities recovering total program costs by the time children reached age four.9 Nobel laureate James Heckman’s independent analysis of the Memphis trial confirmed improvements in children’s cognitive development, maternal mental health, and boys’ educational outcomes.10
A Proven Financing Model Exists
Multiple states already fund NFP through Medicaid. Alabama provides a direct peer-state model: in 2022, it received CMS approval for a Medicaid State Plan Amendment covering NFP as a targeted case management benefit, reimbursing providers $765 per family per month.11 Since implementation, Alabama NFP has expanded to 33 counties—roughly half the state.11 Other states use Medicaid managed care contracts, TANF, Title V, and MIECHV federal home visiting grants.12 Tennessee has the flexibility to pursue any combination of these mechanisms to sustain and scale NFP.
Sources
1. Kitzman, H., Olds, D.L. et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes. JAMA, 278(8). https://pubmed.ncbi.nlm.nih.gov/9272896/
2. Changent/NFP National Service Office. Tennessee State Profile (2025). https://www.nursefamilypartnership.org/locations/tennessee/
3. East Tennessee State University Nurse-Family Partnership Program. https://www.etsu.edu/nursing/etsunfp/
4. Olds, D.L. et al. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78(1). https://pubmed.ncbi.nlm.nih.gov/2425334/
5. Miller, T.R. (2015). Projected Outcomes of NFP Home Visitation During 1996–2013, USA. Prevention Science, 16(6), 765–777. https://pubmed.ncbi.nlm.nih.gov/25900397/
6. Changent/NFP National Service Office. NFP Benefits and Costs Fact Sheet (April 2025). https://changent.org/why-it-works/resources/fact-sheet-nfp-benefits-costs/
7. Olds, D.L. et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. JAMA, 278(8). https://pubmed.ncbi.nlm.nih.gov/9272895/
8. Olds, D.L. et al. (1998). Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up. JAMA, 280(14). https://pubmed.ncbi.nlm.nih.gov/9786373/
9. Karoly, L., Kilburn, M.R., & Cannon, J. (2005). Proven Results, Future Promise. RAND Corporation. https://www.rand.org/pubs/monographs/MG341.html
10. Heckman, J.J. et al. (2017). An Analysis of the Memphis Nurse-Family Partnership Program. NBER Working Paper 23610. https://www.nber.org/papers/w23610
11. NASHP (2026). Strengthening Public Insurance Financing of Home Visiting Services: Alabama Case Study. https://nashp.org/strengthening-public-insurance-financing-of-home-visiting-services-alabama-case-study
12. Blueprints for Healthy Youth Development. Nurse-Family Partnership: Program Financing. https://www.blueprintsprograms.org/programs/35999999/nurse-family-partnership/
