Overview
Counties administer housing, health, human services and early childhood programs, positioning them to connect families with housing assistance before crises and coordinate PN-3 systems to improve outcomes. Stable, affordable housing supports healthy outcomes from the prenatal period through age three (PN-3). Nationally, one in six children has experienced housing instability; families with eviction histories face greater risks of homelessness and other housing challenges.1 Severe housing insecurity during pregnancy is associated with low birth weight, preterm birth and longer newborn hospital stays.2 Housing instability among young families is associated with over $100 billion in avoidable healthcare and special education costs over a decade.
County Role in PN-3 Housing Stability
- Administer vouchers, rental assistance and eviction prevention for pregnant people and families with young children
- Fund and operate home visiting, early intervention, and maternal and child health programs reaching vulnerable families
- Coordinate housing authorities, child welfare, health departments and community organizations to align referrals
- Share local data to identify housing-unstable families before eviction or homelessness occurs
- Target outreach and resources toward historically underinvested communities
Key Strategies for Counties
- Embed housing navigators or community health workers in home visiting, WIC and prenatal programs
- Establish cross-sector coalitions of housing authorities, health systems, home visiting providers and philanthropy
- Expand dedicated vouchers and flexible rental assistance for pregnant and parenting families at risk
- Braid Medicaid, housing and early childhood funding to sustain initiatives beyond grants
- Build landlord partnerships and mediation services to keep young families stably housed
County Examples
Spartanburg County, S.C.
Spartanburg County, S.C. joined Hello Family in October 2021 in partnership with four local nonprofits: Family Connects, BirthMatters, Triple P and Quality Counts. The initiative pairs evidence-based newborn nurse home visits, doula support and parenting programs with a hotline for child development questions and service and resource referrals. Evidence of improved outcomes from a city-level pilot prompted countywide expansion, supported by a federal Social Impact Partnership to Pay for Results Act project.3
San Joaquin County, Calif.
San Joaquin County’s housing authority received a HUD Family Unification Program award. Housing Choice Vouchers assist families whose inadequate housing is a primary factor in imminent child placement in out-of-home care or delayed return from care. Under HUD’s model, the child welfare agency certifies eligibility; the housing authority issues vouchers. Families can also receive rental assistance and supportive services before and after moving in. This approach speeds family reunification and case closure.4
Pitt County, N.C.
Pitt County, N.C. was among 33 North Carolina counties covered by the Healthy Opportunities Pilots under the state’s CMS-approved Section 1115 Medicaid waiver. Access East, Inc., the regional network lead, coordinated Pitt and eight other counties. Medicaid health plan care managers screened enrollees for unmet non-medical needs; community-based human service organizations provided eligible enrollees food and housing support. The General Assembly funded the pilots, but legislative budget bills left them unfunded, pausing services July 1, 2025. The state budget later allocated $25 million in non-recurring restart funds. The pilot illustrates intergovernmental coordination to reach high-need Medicaid enrollees and the need for sustained, coordinated financing.5
This content is intended for educational purposes only. The National Association of Counties (NACo) supports policies and programs that equip county governments with the resources and flexibility needed to serve residents. NACo does not endorse any particular strategy or approach shared in this resource over another. For official NACo positions, please refer to the American County Platform.
[1] Children’s HealthWatch, “Housing.” https://childrenshealthwatch.org/housing/.
[2] Leifheit, K., et al., “Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes,” International Journal of Environmental Research and Public Health, 2020. https://pubmed.ncbi.nlm.nih.gov/33233450/.
[3] Spartanburg County, S.C., “Hello Family.” https://www.hellofamilyspartanburg.org/.
[4] Housing Authority of the County of San Joaquin, “Family Unification Program,” https://hacsj.org/portfolio-item/family-unification-program/; Urban Institute, “HUD’s Family Unification Program Works—But How Communities Implement the Program Matters,” 2025. https://www.urban.org/urban-wire/huds-family-unification-program-works-how-communities-implement-program-matters.
[5] North Carolina Department of Health and Human Services, “Healthy Opportunities Pilots,” https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots; North Carolina Health News, “Healthy Opportunities Pilot told to prepare for program to shutter,” 2025. https://www.northcarolinahealthnews.org/2025/06/03/funding-cut-for-healthy-opportunities/.
Source: www.naco.org
