The 1996 federal welfare reform law, which sets time limits on benefits and requires increasing numbers of clients to participate in work-related activities, was designed to encourage families to leave cash assistance for work and thereby reduce the welfare rolls. Aware of the possibility that the new legislation might negatively affect access to Medicaid, policymakers enacted Section 1931 to de-link Medicaid from welfare. Nevertheless, Medicaid enrollment has declined at a rate higher than expected since 1996, leading federal and state policymakers to become concerned that enrollment has indeed been affected by changes in cash assistance programs. Similar concerns have been raised in regard to the dramatic drop in participation in the Food Stamp Program. In response to these concerns, the U.S. Departments of Health and Human Services and Agriculture contracted with Mathematica Policy Research, Inc. (MPR) to identify state policies and procedures that appear to promote enrollment in Medicaid and/or the Food Stamp Program in the post-welfare reform era. We selected Indiana as the site for this study because the state increased Medicaid enrollment by almost 15 percent between 1998 and 1999. This report documents the results of our examination of Indiana's efforts to promote enrollment, primarily for children, in Medicaid and SCHIP and to begin to identify strategies for increasing enrollment
in the Food Stamp Program. (author abstract)

The National Academy for State Health Policy (NASHP) hosted a webinar on February 9, 2012 from 2:30 to 4:00 p.m. Eastern time. The webinar was designed to help States improve enrollment and eligibility systems by providing an overview of State progress towards updating their systems. Speakers included: Alan Weil, Executive Director, National Academy for State Health Policy; Alice Weiss, Co-Director, Maximizing Enrollment; Judith Arnold, Director, Division of Coverage and Enrollment, New York Department of Health; Manu Tandon, Secretariat Chief Information Officer, Massachusetts Health and Human Services; and Tracy Turner, Applications and Operational Support Manager, Oklahoma Health Care Authority.

The National Academy for State Health Policy (NASHP) authored this report, which was developed as part of the National Workgroup on Integrating a Safety Net into Health Care Reform Implementation. As a result of the Workgroup, this report provides ten key issues that policymakers, who are concerned with the safety net, should consider in order to reach the health care reform’s goals for vulnerable populations.

The National Academy for State Health Policy (NASHP) released this report on the role of community health centers in providing health care. This report provides an overview of community health centers and other types of Federally Qualified Health Centers. Authors provide recommendations to help State policymakers to develop strategies to integrate health centers into State delivery systems.

From the National Center for Children in Poverty, this resource provides a comprehensive overview of adolescent substance use, which can hinder adolescent developmental growth into adulthood. Substance use in adolescence can lead to the risk of dependency and addiction, and adverse health outcomes. In 2009, 10 percent of 12 to 17 year olds were illicit drug users, and 26 percent of 16 to 17 year olds reported drinking alcohol. Authors conclude with policy recommendations for prevention and treatment programs for this population.

Although many public assistance recipients suffer from depression, few receive consistent treatment. This report on a telephonic care management program in Rhode Island that tried to encourage depressed parents who were receiving Medicaid to seek treatment from a mental health professional presents results through 18 months –– six months following a one-year intervention. Called “Working toward Wellness,” the program represents one of four strategies being studied in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation to improve employment for low-income parents who face serious barriers to employment. The project is sponsored by the Administration for Children and Families and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, with additional funding from the Department of Labor. In Working toward Wellness, master’s-level clinicians (“care managers”) telephoned the study participants in the program group to encourage them to seek treatment, to make sure that they were complying with treatment, and to provide telephonic counseling. The effects of the program are being studied by examining 499 depressed Medicaid recipients with children, who were randomly assigned to the program group or the control group from November 2004 to October 2006. Participants were given a list of mental health professionals in the community from whom they could receive treatment. (author abstract) 

Although many public assistance recipients suffer from depression, few receive consistent treatment. This report presents results through six months of a one-year telephonic care management program in Rhode Island that tried to encourage depressed parents who were receiving Medicaid to seek treatment from a mental health professional. The program, called “Working toward Wellness,” represents one of four strategies being studied in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation to improve employment for low-income parents who face serious barriers to employment. The project is sponsored by the Administration for Children and Families and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, with additional funding from the Department of Labor. In Working toward Wellness, master’s-level clinicians (“care managers”) called the study participants in the program group to encourage them to seek treatment, to make sure that they were complying with treatment, and to provide telephonic counseling. The effects of the program are being studied by examining 499 depressed Medicaid recipients with children, who were randomly assigned to the program group or the control group from November 2004 to October 2006. Participants were given a list of mental health professionals in the community from whom they could receive treatment. (author abstract)

This study, conducted by Mathematica Policy Research, Inc. and its subcontractors, American Management Systems, Inc. and the George Washington University Center for Health Services Research and Policy, was commissioned by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture to identify strategies states and local welfare offices are using to promote participation in food stamps, Medicaid and SCHIP and the ongoing challenges they face in providing support to working families. (author abstract)

This economic analysis of the Nurse Family Partnership (NFP) addresses three randomized trials carried out to examine long-term effects of the NFP on maternal, child, and family functioning. The analysis presented in this report provides information on both the persistence of home visitation program effects on government expenditures and on their ability to be reproduced in different settings. The authors analyzed government expenditures incurred by both comparison and treatment groups for three sites. Because of the differential timing of the intervention in the three sites, government expenditure data was analyzed for different periods in the lives of the study families. For Elmira families, government expenditures were analyzed for the period from the birth of the study child until the family was interviewed during the child’s 15th year. For Memphis, expenditures were analyzed for the period from the study child’s birth until the family was interviewed when the child was 4 ½. For Denver, the period analyzed was birth to 4 years. The study conducted is a net-cost analysis from the standpoint of government spending. (author abstract)

The emphasis on placing TANF recipients into paid employment quickly is consistent with employment assistance approaches employed by several recent demonstration projects (outside of TANF) for youth and adults living with a disability. However, because TANF recipients living with a disability may have other deficits such as low education levels and limited work experience that further limit their employment prospects, they may not be successful at finding paid competitive employment within the time allotted. When this occurs, TANF agencies may choose to create work opportunities outside of the competitive labor market as a first step towards permanent unsubsidized employment. In this practice brief, we profile three programs that use different approaches (unpaid work experience, subsidized employment, and unsubsidized transitional employment) to create work opportunities for TANF recipients who are living with a disability and have not been successful in finding competitive employment. (author abstract)