Category Archives: Human Services

Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan

Source: Helen Levy, John Z. Ayanian, Thomas C. Buchmueller, Donald R. Grimes, Gabriel Ehrlich, Journal of Health Politics, Policy and Law, Vol. 45 no. 1, February 2020
(subscription required)

From the abstract:

Context: Medicaid expansion has costs and benefits for states. The net impact on a state’s budget is a central concern for policy makers debating implementing this provision of the Affordable Care Act. How large is the state-level fiscal impact of expanding Medicaid, and how should it be estimated?

Methods: We use Michigan as a case study for evaluating the state-level fiscal impact of Medicaid expansion, with particular attention to the importance of macroeconomic feedback effects relative to the more straightforward fiscal effects typically estimated by state budget agencies. We combine projections from the state of Michigan’s House Fiscal Agency with estimates from a proprietary macroeconomic model to project the state fiscal impact of Michigan’s Medicaid expansion through 2021.

Findings: We find that Medicaid expansion in Michigan yields clear fiscal benefits for the state, in the form of savings on other non-Medicaid health programs and increases in revenue from provider taxes and broad-based sales and income taxes through at least 2021. These benefits exceed the state’s costs in every year.

Conclusions: While these results are specific to Michigan’s budget and economy, our methods could in principle be applied in any state where policy makers seek rigorous evidence on the fiscal impact of Medicaid expansion.

States can improve supports for infants and toddlers who are in or at risk of entering foster care

Source: Megan Fischer, Kristina Rosinsky, Elizabeth Jordan, Maggie Haas, Deborah Seok, Child Trends, February 2020

From the summary:
To understand what policies and services are already in place for infants and toddlers in care and at risk of entering care, as well as where the child welfare field can leverage the opportunities provided by the Family First Act, Child Trends fielded the 2019 Survey of Child Welfare Agency Policies and Practices for Infants and Toddlers in, or who are Candidates for, Foster Care. The survey, supported by ZERO TO THREE (ZTT) and the Health and Human Services Administration (HRSA), aimed to understand the current array of policies and practices intended to serve this population, and how this array may have shifted since the initial fielding of the survey in 2013. The goal of the survey and report were to identify and share innovations in policy and practice and highlight key challenges that child welfare agencies face in meeting the needs of very young children who have experienced maltreatment. By collecting and sharing such information, we hope to support agencies in strengthening their approaches to serving this population.

With the Family First Act, states have a new opportunity to use federal funds to support children who are at risk of entering foster care (also known as candidates for foster care) and their families. Healthy early development requires stable, nurturing relationships with caregivers (Center on the Developing Child, 2007). For young children who are safe and supported, staying with their families rather than entering foster care is particularly beneficial.

Although the 2019 survey was fielded early in the implementation of the Family First Act, its findings show where states have existing strengths and infrastructure to provide prevention services to families with infants and toddlers. Findings also shed light on where states need to increase their capacity to provide a robust array of services for infants and toddlers who are candidates for foster care, as well as their families.

Does Administrative Burden Influence Public Support for Government Programs? Evidence from a Survey Experiment

Source: Lael R. Keiser, Susan M. Miller, Public Administration Review, Volume 80 Issue 1, January/February 2020
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From the abstract:
Research indicates that administrative burden influences the behaviors and views of clients and potential clients of government programs. However, administrative burden may also shape mass attitudes toward government programs. Taking a behavioral public administration approach, the authors consider whether and how exposure to information about administrative burden embedded within eligibility‐based programs influences citizen favorability toward those programs. It is hypothesized that if information about the existing screening mechanisms is highlighted and made salient, this will lead to greater approval of eligibility‐based programs. This expectation is evaluated using a survey experiment that explores administrative burden in the Temporary Assistance for Needy Families (TANF) program. The evidence shows that being exposed to information about administrative burden increases favorability toward TANF and its recipients, though these effects are conditional on party identification. The results provide insight into a potential consequence of administrative burden, showing the way in which information regarding burden can shape citizens’ support for eligibility‐based programs.

Evidence for Practice
– Public managers in social welfare programs face challenges in gaining public support because of the stigma associated with these programs.
– The evidence suggests that giving the public information about program screening improves views toward welfare programs.
– Increasing awareness about program screening processes may be beneficial. However, public officials should consider potential trade‐offs, such as discouraging applications.

Administrative Easing: Rule Reduction and Medicaid Enrollment

Source: Ashley M. Fox, Edmund C. Stazyk, Wenhui Feng, Public Administration Review, Volume 80 Issue 1, January/February 2020
(subscription required)

From the abstract:
Administrative burden is widely recognized as a barrier to program enrollment, denying legal entitlements to many potentially eligible individuals. Building on recent research in behavioral public administration, this article examines the effect of voluntary state reductions in administrative burden (administrative easing) on Medicaid enrollment rates using differential implementation of the Affordable Care Act. Using a novel data set that includes state‐level data on simplified enrollment and renewal procedures for Medicaid from 2008 to 2017, the authors examine how change in Medicaid enrollment is conditioned by the adoption of rule‐reduction procedures. Findings show that reductions in the administrative burden required to sign up for Medicaid were associated with increased enrollments. Real‐time eligibility and reductions in enrollment burden were particularly impactful at increasing enrollment for both children and adults separate from increases in Medicaid income eligibility thresholds. The results suggest that efforts to ease the cognitive burden of enrolling in entitlement programs can improve take‐up.

Evidence for Practice
– The administrative burden associated with enrolling in social safety net programs in the United States imposes high costs on applicants. As a consequence, many eligible individuals do not receive the benefits that they are lawfully entitled to.
– Insights from behavioral economics, including streamlining of the enrollment process and automated benefit determinations, can be effectively employed—in some cases—to reduce the cognitive burden associated with program enrollment processes and increase take‐up of benefits.
– States that have implemented simple changes to enrollment processes, including administrative verification of income and real‐time decision‐making, have seen greater increases in Medicaid enrollments than those that did not implement such changes.

What New Orleans Can Teach Other Cities About Reducing Homelessness

Source: Teresa Wiltz, Stateline, October 15, 2019

….After Katrina, homelessness skyrocketed, from about 2,000 people experiencing homelessness in 2005 to nearly 12,000 in 2007, according to Unity of Greater New Orleans (Unity GNO), a nonprofit designated by the federal government to lead the city’s efforts to provide housing and services to the homeless.

But in 2011, the city launched an all-out offensive on homelessness, slashing the number of homeless residents by more than 80%, from close to 6,700 in 2011 to fewer than 1,200 in 2018. Factoring in the city’s efforts to reduce homelessness since 2007, the overall number has been slashed 90%…..

….City officials did it by fighting homelessness on a variety of fronts: They adopted a “housing first” policy: providing homes and services to New Orleans’ neediest, without requiring that they resolve mental health or substance abuse issues first. They expanded a health care clinic for the homeless and started conducting weekly check-ins to connect more people to counseling and other services.

They designated 200 housing vouchers for veterans and set aside 55 units for them in a converted convent. They successfully lobbied Congress for 3,000 extra housing vouchers in 2008. And last year, the city opened a 100-bed, “low-barrier” shelter where people don’t have to be sober to be admitted.

In tackling the problem, the city relied almost exclusively on federal funds, according to Andreanecia Morris, executive director of HousingNOLA, a partnership of city officials, homeless advocates and dozens of nonprofits and public and private organizations…..

State of the Workforce Report 2019

Source: National Association of State Workforce Agencies (NASWA), September 2019

From the press release:
The National Association of State Workforce Agencies (NASWA) released the first-ever, annual State of the Workforce Report, which includes national workforce data and a state profile of each of the 50 states, plus the District of Columbia.

“There is now a place for you to easily find key labor market information for each state and how their workforce agency is structured,” said Jon Pierpont, NASWA Board President and Executive Director, Utah Department of Workforce Services. “Though every state is different, we all work towards supporting citizens with every opportunity to become self-sustaining. This report shows our uniqueness and amplifies the impact workforce agencies are having throughout the country.”

The 50 state profiles include labor market and unemployment insurance information, an overview of the state’s workforce structure, and individuals served. The report also highlights the uniqueness of every state by promoting the innovations taking place across the country in serving America’s workforce.

Lawmakers Target Anti-Poverty Programs After Paid Trips to Disney

Source: Jared Bennett, Center for Public Integrity, September 4, 2019  
This story was published in partnership with Vox.

A conservative think tank is pushing policies limiting food aid and other anti-poverty measures. After being wined and dined, Republican lawmakers are coming on board.

In December, the Foundation for Government Accountability hosted public officials from across the country in Orlando. The scene: Walt Disney World’s Swan and Dolphin Resort, an ocean-themed oasis with palatial fountains next to a lake lined with palm trees.

The FGA, a right-leaning think tank based in Naples, Florida, paid travel and lodging expenses for many of the conservative leaders in attendance, including Kentucky Gov. Matt Bevin and three White House aides.

Guests heard presentations such as “Stop the Scam: The Reality of Food Stamp Fraud.” Between sessions, the foundation treated attendees to catered desserts and a fireworks display from a terrace featuring a faux Eiffel Tower overlooking the Epcot World Showcase Lagoon, according to invitations obtained by the Center for Public Integrity through open-records requests.

The FGA aimed to send decision-makers back to their respective states, or the nation’s capital, with fresh zeal to restrict access to public assistance programs designed for low-income people, including Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, formerly known as the Food Stamp Program. The association even provided road maps for achieving this goal in the form of model legislation — suggested wording for laws and regulations that could serve as a template for like-minded policymakers…..

….The FGA and its 501(c)(4) nonprofit lobbying wing, the Opportunity Solutions Project, advocate for a variety of policy proposals, from reforming licensing requirements for workers set by state and local governments, to installing work requirements for Medicaid and blocking that program’s expansion under the Affordable Care Act, also known as Obamacare…..

Stay or Exit: Why Do Nonprofits Maintain Collaborations With Government?

Source: Shuyang Peng, Yuguo Liao, Jiahuan Lu, The American Review of Public Administration, OnlineFirst, Published August 13, 2019
(subscription required)

From the abstract:
Although the public-management literature has demonstrated a growing interest in public–nonprofit collaborations, it pays little attention to the sustainability of collaborations. This study proposes that nonprofits’ intentions to maintain collaborations with government are influenced by both instrumental and relational factors. Using a national sample of human service nonprofits, this study demonstrates that both nonprofits’ continuance commitment and affective commitment play a role in shaping their intentions to maintain collaborative relationships with government. Specifically, continuance commitment is driven by the presence of a formal agreement and the dependence on government funding, and affective commitment is shaped by distributive and procedural justice. The findings have implications for public managers to effectively manage their collaborations with nonprofits.

The CHIP Dip

Source: Federal Funds Information for States, Issue Brief 19-20, July 1, 2019
(subscription required)

From the summary:
Beginning in fiscal year (FY) 2020, states will face increased costs for the Children’s Health Insurance Program (CHIP). The 23-percentage point increase in the federal CHIP matching rate—included in the Affordable Care Act (ACA)—will be reduced in FY 2020 and fully phased out in FY 2021. FFIS estimates that state costs could increase by approximately $4.3 billion (302%) to maintain total spending, although several factors remain uncertain.