Why It Matters
The Healthy Start program's statutory authorization extended only through fiscal 2025, and appropriations laws have kept the program funded, most recently through Dec. 11. Presidential budget requests for fiscal 2026 and fiscal 2027 under the Trump administration proposed eliminating it.
A new Congressional Research Service (CRS) report says Congress could reauthorize the program at the same, increased or decreased funding levels. It could also alter program requirements or take no action to continue the program.
The Big Picture
Healthy Start began in 1991 as a pilot at 15 community sites. It now funds local organizations in areas with high infant mortality rates to provide health and social services to women, their partners, infants and children up to 18 months.
Congress codified the program in 2000 and reauthorized it in 2007 and again in the Coronavirus Aid, Relief, and Economic Security Act. Appropriations rose from $125.5 million in fiscal 2020 to $145.3 million in fiscal 2026, based on CRS's review of appropriations laws.
The evidence on results is mixed. A 2017 national evaluation found participants were more likely than nonparticipants to receive early prenatal care and implement safe sleep practices. Many participants did not reach targets for breastfeeding and intimate partner violence screening.
The national infant mortality rate was 5.6 per 1,000 births in 2019 and 5.5 in 2024. The Healthy Start rate fell from 8.0 in 2019 to 5.6 in 2023. The Health Resources and Services Administration (HRSA) says higher rates among participants likely reflect the high-risk populations the program targets.
A 2024 Government Accountability Office report recommended that HRSA document how it reviews evaluation data and coordinates with other programs. According to the office, the Department of Health and Human Services (HHS) has partially addressed both recommendations. CRS says the effect of the HHS restructuring plan on the program is unclear.
Appropriations proposals divide on the program. House reports H.Rept. 118-585 and H.Rept. 119-271 sought to eliminate its funding, while Senate reports S.Rept. 118-207 and S.Rept. 119-55 sought to continue or expand it. Some observers say Healthy Start duplicates the Maternal, Infant, and Early Childhood Home Visiting program, while others say the two are distinct.
Two bills would reauthorize it:
- H.R. 3302, sponsored by Rep. Alexandria Ocasio-Cortez (D-NY), would authorize $145 million annually for fiscal 2026 through fiscal 2030.
- S. 3799, sponsored by Sen. Roger Marshall (R-KS), would authorize the same amount annually for fiscal 2027 through fiscal 2031.
The Bottom Line
HRSA's national evaluation, begun in 2021, is expected in late 2026. Its results are one input Congress could weigh alongside infant mortality trends.
H.R. 3302 was placed on the Union Calendar on Oct. 3, 2025. S. 3799 was reported with an amendment on June 22 and placed on the Senate Legislative Calendar. Neither bill has received floor action to date.
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