Recent large federal investments in services for pregnant women and young children will fuel the expansion of home visiting services across the U.S. The authors summarize the history of home visiting and describe trends toward evidence-based and national program models. Moving to an integrated system requires supports for implementation with fidelity to the home visiting model, along with scale up and sustainability of services. Lessons from recent initiatives highlight the factors likely to affect states' efforts to expand and integrate home visiting services in the coming years.