Publications & Insights

A Resource Guide for State Officials: Implementing and Financing Assertive Community Treatment Programs

The Lewin Group prepared a field-tested and practice-proven Resource Guide for decision makers in state governments. It provides practical, experience-based information about strategies for implementing ACT programs to assist individuals who have severe and persistent mental illness. Additionally, the Resource Guide presents a broad overview of ACT program concepts and issues, including:

• Factors that help or hurt program implementation, such as financing structures, consumer issues, and common concerns
• A Budget Simulation Model that provides a cost forecasting method to enable states to project costs based on specific population and program design scenarios 
• A companion literature review offers detail regarding assertions about ACT model requirements, and about the evidence-base of research supporting the ACT program

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

Aging and Disability Resource Center for AoA

Since 2003, The Lewin Group has provided expert technical assistance (TA) to assist states and community-based organizations in the design and implementation of the Aging and Disability Resource Center grants awarded jointly by the Administration on Aging (AoA) and CMS’ Real Choice Systems Change Grants. Activities have included identifying TA needs and developing “user-driven” plans; maintaining grantee profiles; providing TA through a variety of remote and on-site mechanisms (topic-focused calls, national meetings, site visits); establishing a system for grantee feedback and exchange; designing a formative evaluation; integrating all activities into a single website; and developing an online TA Tracking Tool to assist in and streamline the TA activity. In addition, The Lewin Group also supports policy development initiatives undertaken by AoA, particularly new additions to the Older Americans Act of 2006.

Client Area: Federal Government
Expertise Area: Aging and Disability

Analysis of Cost Efficiency of Hospitals

For a state hospital association, The Lewin Group analyzed the cost efficiency of acute care and critical access hospitals and identified the extent of hospital cost shifting from public to private payers.

The purpose of the study was to educate health care stakeholders about the following issues:

• Financial health of the state’s hospitals
• The extent that public payers reimburse hospitals below cost for services provided to public employees, the elderly, and historically vulnerable populations
•  Implications of these findings

Client Area: Associations

Case Study: Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP) Pilot Exercise

The Lewin Group evaluated a pilot exercise of federal-state communications protocols to mobilize volunteer health professionals in an emergency.

The study included development of a communications assessment checklist, on-site observers in four states and in the HHS Emergency Operations Center, an After-Action Report, and presentations at two national conferences.

• The exercise started with four emails to state coordinators and ended 36 hours later with almost 400 volunteers ready to deploy
• State spam filters trapped time-sensitive information
• We identified the need to train federal and state personnel in informatics skills, including competencies with software such as spreadsheets and health alerting systems

Client Area: Federal Government
Expertise Area: Emergency Preparedness and Response

CMS Comprehensive Error Rate Testing (CERT) Program

The Lewin Group helped CMS develop the program by which it determines the accuracy of Medicare payments made to providers. CERT is based on sampling Medicare claims as they enter the processing systems, reviewing them, and calculating an error rate. The Lewin Group serves as the statistical contractor for this program, developing the algorithms for sampling claims, and calculating the payment error rate. An overall payment error rate is reported. In addition, error rates for different components of Medicare and for different services are calculated. This rate satisfies the requirements of the Improper Payments Information Act of 2002, and is reported by CMS to OMB and Congress.

Client Area: Federal Government
Expertise Area: Medicare

Community Hospital Strategic Plan

The Lewin Group assisted a community hospital in developing a strategic plan to address service line growth opportunities, physician alignment concepts, financial performance, and organizational governance and leadership.

 The plan entailed the following phases:

• Fact-based analysis of the service area market
• Implications of maintaining the status quo and key strategic alternatives
• Development of a strategic vision for the market and its facilities
• Objectives and action steps in support of these objectives

Client Area: Hospitals, Health Systems, and Providers

Comparing the Cost and Coverage Impacts of the House and Senate Leadership Health Reform Bills: Long Term Costs for Governments, Employers, Families and Providers

In our most recent report, prepared for The Peter G. Peterson Foundation, we compared the effects of two major proposals to reform the U.S. health care system. These include the Senate Leadership “Patient Protection and Affordable Care Act” under consideration in December, and the “Affordable Health Care for America Act” passed by the House of Representatives in November 2009. In this study we provide estimates of the program’s impact on coverage and spending for the federal government, state and local governments, private employers, consumers and providers. We estimated the impact of both bills on federal spending over a 20 year period from 2010 through 2029. The Congress uses 10-year forecasts for budgeting purposes, which is currently 2010 through 2019. To better understand the long-term budget implications of the bill, we present spending estimates for both the 2010 through 2019 budget window and the 2020 through 2029 period.

Expertise Area: Health Reform

Cost Impact Analysis of the “Health Care For America” Proposal (Economic Policy Institute)

The Lewin Group developed detailed analyses of the Health Care for America Proposal. Under the proposal, employers would be required to provide coverage or pay a payroll tax to have their workers covered under a newly created national health insurance pool called Health Care for America (HCA). Modeled on Medicare, Health Care for America would offer a single Medicare-like fee-for-service option (public HCA plan) and a selection of Health Maintenance Organizations (HMOs) or other private managed care plans (private HCA plans).

In our report, we estimated the impact on costs and coverage for each major stakeholder. This included a detailed analysis of changes in spending for the federal government and state and local governments. These included the cost of subsidies, offsets to existing government safety-net programs, and changes in tax revenues resulting from these proposals. Estimates were provided assuming full implementation in 2007, and included estimates of health spending over a ten-year period, including a phase-in of coverage under the proposal.

Expertise Area: Health Reform

Delaware Children's Health Chartbook

For Nemours Health and Prevention Services (NHPS), The Lewin Group produced a Chartbook on Children’s Health in Delaware, a comprehensive resource covering a broad range of children’s health issues.

Lewin conducted an extensive review of the children’s health data available from a variety of sources, performed a comprehensive analysis of these data, and worked closely with NHPS to present the findings in a visually appealing, user-friendly, and easy-to-interpret Chartbook. The Lewin Group:

• Highlighted current issues in children’s health
• Noted differences between Delaware and other states
• Identified disparities among racial and ethnic groups
• Informed policymakers
• Set research and funding priorities

Client Area: Foundations
Expertise Area: Community Health Needs Assessment

Demographic and Service Need Projections for the Aging Population: 2020–2030 – A Projection Model for the Baby Boomers of San Mateo County

The Lewin Group developed a model for the Health Department in San Mateo County, California, that projects the socio-demographic characteristics, as well as the health, housing, and transportation service needs for its aging “baby boomer” population.

With 40 percent of the county’s baby boomers born in another country*, and uncertainty regarding migration patterns, future income, and disability rates, our micro simulation model allows the County to vary key assumptions as well as the information included in the output tables. The Lewin Group created core output reports providing information about:

• Socio-demographic characteristics, including vulnerable populations
• Housing cost burdens for renters and owners
• Disability status
• Health care provider and nursing home bed supply needs
  

*From The Lewin Group tabulations of the 2005 American Community Survey conducted by the U.S. Census Bureau.

Client Area: State and Local Governments
Expertise Area: Aging and Disability

Design of Community Hospital’s Medical Staff Development Plan

The Lewin Group designed a medical staff development and recruitment plan for a community hospital that quantified the supply of and demand for physicians, by specialty, in accordance with Stark II guidance.

The detailed medical staff development plan included the following steps:

• Conduct a community needs study to reflect current and future physician needs
• Prioritize a list of key specialties that were at risk, and potential solutions for ensuring access
• Analyze internal quantitative and qualitative medical staff needs

Client Area: Hospitals, Health Systems, and Providers
Expertise Area: Health Professionals Workforce

Development of a Community Hospital’s Managed Care Contracting Strategy

The Lewin Group assisted a community hospital in establishing an overall managed care strategy based on its patient volume, market share, rate structure, internal self-assessment, and market dynamics.

Topics addressed in the managed care contracting strategy included:

• Criteria for evaluating a specific managed care contract opportunity
• Issues to evaluate in previous and current contracts
• Contract renewals
• Negotiating strategies

Client Area: Hospitals, Health Systems, and Providers

Economic Costs of Diabetes in the U.S. in 2007

Diabetes mellitus is the fifth leading cause of death in the United States. Diabetes also contributes to higher rates of morbidity–people with diabetes are at higher risk for heart disease, blindness, kidney failure, extremity amputations, and other chronic conditions.

The American Diabetes Association (ADA) hired The Lewin Group to study the economic toll of diabetes. As an update to our 2003 study, The Lewin Group estimated the national economic burden of diabetes at $174 billion in 2007. This consists of approximately $116 billion in additional health care expenditures attributed to diabetes, and $58 billion in lost productivity from absenteeism, reduced productivity, permanent disability, and premature mortality. Highlights include:

• Diabetes cost calculator that provides prevalence and cost estimates
• Assessment of continued growth in diabetes prevalence
• Analysis of changing practices, technology, and cost to treat people with diabetes
• Improvements in data sources and methods to estimate economic and social burden

Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness

Evaluation of a Major Foundation Sponsored Safety Net Ambulatory Care Redesign Collaborative

The Lewin Group examined an Ambulatory Care Redesign Collaborative designed to improve primary care providers’ productivity, patient flow, and provider and patient satisfaction at five public safety net hospital systems.

The evaluation featured two primary objectives:

• Assess Collaborative’s effectiveness in improving access and quality of clinic-based ambulatory care services 
• Identify factors for sustainability

Client Area: Foundations

Evaluation of Refugee Social Services and Targeted Assistance Programs

The Lewin Group, with its subcontractors, performed a study for DHHS Office of Refugee Resettlement (ORR). This comprehensive evaluation examined the effectiveness of ORR employability services through the Refugee Social Services and Targeted Assistance Formula Grant programs. The study involved an implementation study, an outcome study, and a plan for continuous evaluation. The Lewin Group:

• Fielded a survey of more than 900 refugees
• Collected program and state administrative data
• Conducted focus groups of refugees
• Conducted site visits to understand how services are delivered and document outcomes achieved over time

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Evidence-Based Practice Centers Coordinating Center for AHRQ

The Lewin Group serves as the Evidence-based Practice Centers (EPC) Coordinating Center, part of the Effective Health Care Program of the Agency for Healthcare Research and Quality. Our responsibilities have included scientific and technical support for AHRQ and the 14 Evidence-based Practice Centers in the United States and Canada, including critical analyses of the nature and quality of the evidence base relevant to a variety of clinical topics nominated to AHRQ by outside organizations.

The Lewin Group’s analyses have helped to inform AHRQ’s decisions regarding which nominated topics to select for extensive evidence reports and technology assessments produced through the EPCs. These reports are used for informing and developing coverage decisions, quality measures, educational materials and tools, guidelines, and research agendas. Some reports are used to inform Medicare coverage decisions or to inform recommendations of the U.S. Preventive Services Task Force. The Lewin Group has conducted more than one hundred 15–25 page analyses of the nature and quality of evidence related to clinical topics nominated to AHRQ. The Lewin Group also planned and coordinated four national conferences on Translating Research into Practice and Policy under this effort.

Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA

Facility Planning Support for a Community Hospital

The Lewin Group supported a community hospital’s master facility plan by projecting service line volumes, their resulting capacity needs, and the financial impact of environmental changes and growth initiatives.

The following core components of The Lewin Group’s prospective financial and demand model informed the master facility plan:

• Projected income statements, cash flow, and balance sheets
• Corresponding financial ratios relevant to future financing options
• Prospective volume and occupancy by service type

Client Area: Hospitals, Health Systems, and Providers

Hospital District Merger Assessment

The Lewin Group reviewed the strategic and financial position of two hospital districts and advised the system on the ramifications of a merger between the two entities.

The Lewin Group illustrated various merger scenarios and their financial impacts, based on the following key issues:

• Service or facility consolidation
• Payer mix changes
• Debt capacity
• Impact analysis of tax subsidy and other legislative agenda items

Client Area: Hospitals, Health Systems, and Providers

Implant System for Low Back Pain: Evidence Review and Strategy

For a major orthopedic implants company, The Lewin Group reviewed the scope and quality of available evidence on the use of a novel implant system for treating low back pain. Based on the findings of this review and analysis of emerging evidence from available and continuing clinical trials, The Lewin Group identified strategic considerations for pursuing Medicare and other public and private reimbursement.

We reviewed unpublished and published peer-reviewed and other substantive literature for this class of implants, including alternative pedicle screw-based and interspinous systems. In addition to journal articles, our literature review included technology assessments, guidelines, coverage policies, and regulations in the United States and abroad. The Lewin Group evaluated the strength of evidence for the implant system and how payers would interpret and use this evidence in coverage policies, and provided recommendations for the design of further research to strengthen the case for coverage.

Client Area: Pharma / Bio / Device
Expertise Area: Evidence-Based Medicine / HTA

Medicaid Pharmacy Cost and Utilization: Fee-for-Service vs. Managed Care

This Lewin Group report brought hard data to bear on the many policymaking efforts underway in the Medicaid pharmacy arena.

Our report, Comparison of Medicaid Pharmacy Costs and Usage between the Fee-for-Service and Capitated Setting, was funded by the Center for Health Care Strategies and prepared in collaboration with the Association for Community Affiliated Health Plans. The Lewin Group:

• Presented quantified data findings
• Described differences in drug spending and usage patterns between Medicaid fee-for-service and capitated managed care programs
• Provided state Medicaid agencies and health plans with approaches to assess their programs’ success
• Identified cost-saving opportunities for Medicaid programs and health plans to consider

Client Area: Associations
Expertise Area: Medicaid and CHIP

NHLBI Pediatric Cardiovascular Risk Reduction Initiative

The National Heart, Lung, and Blood Institute (NHLBI) contracted with The Lewin Group to assist in an ongoing initiative.

The Lewin Group is providing comprehensive technical expertise and logistical support for the planning and development of evidence-based clinical practice guidelines to address cardiovascular risk reduction in children seen in primary care settings. The Lewin Group has:

• Developed and conducted a systematic literature search
• Abstracted information from in-scope studies into detailed evidence tables
• Devised a grading system for assessing the quality and methodological rigor of studies
• Facilitated communication among national expert panel members

Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA

Payment Error Rate Measurement (PERM) Program

The Centers for Medicare & Medicaid Services (CMS) selected The Lewin Group as the statistical contractor for the FY2007 PERM program.

The Lewin Group gained expertise in the PERM program through our work with CMS and many state Medicaid and State Children’s Health Insurance Program (SCHIP) programs since 2001. We pilot-tested various methodologies to measure payment error, and also implemented the FY2006 PERM measurement in Medicaid fee-for-service (FFS) in 17 states. The Lewin Group:

• Reviewed each state’s eligibility sampling plan to achieve an approvable plan
• Collected and analyzed Medicaid and SCHIP fee-for-service and managed care payment data
• Sampled fee-for-service line items and managed care capitation payments on a quarterly basis
• Calculated each state’s Medicaid and SCHIP program error rates

Client Area: Federal Government
Expertise Area: Medicaid and CHIP, Program Integrity

Performance Measurement Development for Hawai'i Teen Pregnancy Prevention and Positive Youth Development Programs

The Lewin Group was hired to provide the Hawai’i Department of Human Services (DHS) with objective criteria for measuring the performance of its TANF-funded Teen Pregnancy Prevention (TPP) and Positive Youth Development (PYD) programs, and to assess the degree to which DHS’ TPP/PYD initiative is grounded in the literature on TPP and PYD. The Lewin Group:

• Conducted a literature review on predictors of teen pregnancy and the effectiveness of TPP and PYD programs
• Developed program performance measures and a quarterly report format for DHS to use with its contractors to report on performance
• Produced a report and briefing of findings, and trained providers in using the performance measures

Client Area: State and Local Governments
Expertise Area: Children, Youth, and Family Policy

Physician Supply and Demand: Projections to 2020

The Lewin Group projected physician supply and requirements for 18 specialties for the Health Resources and Services Administration (HRSA).

Regular assessment of future health workforce supply and demand is key to setting policies as the nation’s health care needs change. Accurate projections can help the United States achieve its goal of ensuring access to high-quality, cost-effective health care. The Lewin Group:

• Researched implications of changing demographics
• Analyzed impact of changing government policies
• Forecasted trends that may affect future adequacy of physician supply
• Simulated potential affect of new technologies on short- and long-term requirements for physicians

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

Review of County-wide Indigent Health Care System

The Lewin Group assisted with the development of a strategic plan to strengthen the service delivery and financing systems for a County’s safety net patients.

The final plan was designed to achieve the following goals:

• Enhance access to care for uninsured and indigent populations
• Articulate the role(s) for policymakers, hospitals, medical schools, public clinics, foundations, public health entities, and others to implement the strategic plan
• Encourage or design an effective governance and oversight approach
• Incorporate best practices for service delivery and financing

Client Area: Hospitals, Health Systems, and Providers

Supporting Children’s Hospitals and Children’s Health: The Role of the Federal “CHGME” Program

The Children’s Hospitals Graduate Medical Education Program (CHGME) allows independent children’s teaching hospitals to continue and expand their services dedicated to children’s unique health care needs.

A report by The Lewin Group highlighted the benefits of the CHGME Program across the following key hospital missions:

• Graduate medical education and training
• Complex, high-quality clinical care for all children
• Cutting-edge pediatric research
• Community benefits and rural outreach

Client Area: Associations
Expertise Area: Health Professionals Workforce

The Colorado Works Program Evaluation

The Colorado Department of Human Services (DHS) hired The Lewin Group to perform an in-depth study of Colorado’s Temporary Assistance for Needy Families (TANF) program, Colorado Works.

The study provides administrators with information about program strategies and the approaches counties might find useful for improving program implementation, performance, and outcomes. The five-year study, which began January 2005, was designed in active consultation with DHS and an Advisory Committee that included representatives of the counties and Colorado’s advocacy community. The Lewin Group is:

• Creating annual evaluation reports to summarize findings from activities
• Performing TANF work participation analyses that examine trends in rates over time, characteristics associated with compliance, and the effect of strategies being pursued by counties on rates
• Conducting caseload modeling to estimate the effects of changes in the population, economy, and program on the TANF caseload
• Conducting a study of Colorado Works “leavers” to examine how clients fare after exiting TANF

Client Area: State and Local Governments
Expertise Area: Income Security

The Lewin Group Home and Community-Based Services (HCBS) Population Tool

The Lewin HCBS Population Tool provides estimates of the potential demand for HCBS in the United States for between 2000 and 2020.  The Lewin Group generated these estimates by combining national-level data on specific disabilities and conditions with state-level Census data on age, income, and broad measures of disability. The Tool allows the user to generate state-specific estimates of the number of potential HCBS users controlling for calendar year, age, and income (relative to poverty).  Specifically, the model provides counts of persons in the community with MR/DD and with functional limitations [Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs)]. The user can select from among four different definitions of functional disability in addition to MR/DD conditions and functional limitations.

Lewin has used this tool to provide estimates of potential demand for HCBS at county-level for states including Vermont, Maine, Louisiana and Pennsylvania. The estimates at County level can be broken down by small age groups and income levels. State governments can use the estimate for Medicaid program planning, cost allocation, rate setting and other planning purposes.

Please click here to link to the tool.

Client Area: State and Local Governments
Expertise Area: Aging and Disability

Wisdom at Work: Retaining Experienced Nurses®

With the United States facing a growing shortage of hospital nurses, the Robert Wood Johnson Foundation (RWJF) created Wisdom at Work: Retaining Experienced Nurses (WAW) to build an evidence base to identify strategies to help hospitals retain experienced nurses.

RWJF engaged The Lewin Group to provide evaluation and technical assistance services for this continuing initiative. WAW, launched in early 2007, provided grants to 13 hospitals and health systems nationwide to evaluate the impact and outcomes of existing strategies aimed at retaining experienced nurses in hospitals. As part of its evaluation, The Lewin Group built an evidence base of effective nurse retention strategies. The Lewin Group:

• Provided evaluation coordination and technical assistance support to the grantees
• Facilitated the activities of a technical expert panel of nurse leaders
• Conducted research to identify strategies organizations are using to address the issue of knowledge management
• Prepared case studies describing successful best practices used by employers to retain experienced workers and their skills and knowledge

Client Area: Foundations
Expertise Area: Health Professionals Workforce
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Colorado Works Evaluation 2009 Annual Report

October 2009

This annual report presents the findings from the Colorado Works Evaluation from activities conducted during State Fiscal Year 2009. In 2005, the Colorado Department of Human Services contracted with The Lewin Group and its partners, the University of Colorado’s Health Sciences Center, the Johns Hopkins University’s Institute for Policy Studies, and Capital Research Corporation, to perform an in-depth study of the state’s Temporary Assistance for Needy Families program. This report examines caseload trends, work participation, employment outcomes of program participants and leavers, and service delivery variation across Colorado counties. It reviews TANF trends and outcomes in light of the recession.

Client Area: State and Local Governments
Expertise Area: Income Security

Welfare Leavers in Colorado

July 2009

This report explores why former welfare recipients in Colorado left the Colorado Works program and how they fare after exiting. It is part of a multi-year, in-depth study The Lewin Group conducted for the Colorado Department of Human Services (CDHS). The analysis in this report relies primarily on data from a survey of 494 individuals who had been on single-parent Colorado Works cases and left the program during the first three months of 2007. Survey Research Management conducted the survey for Lewin. The survey occurred in August through November of 2008, which was between 17 and 23 months after the individuals surveyed had left Colorado Works. The paper covers characteristics of this sample of welfare leavers; their reasons for leaving the program; the extent to which they have returned to TANF in Colorado or elsewhere; employment outcomes of the group; characteristics of the jobs held by those who are working; sources of income, including earnings of spouses, partners, or other household members, and benefits from other government programs; and indicators of well being, such as food security, mental health, and health insurance coverage. The paper gives particular attention to the outcomes of Colorado Works leavers who were neither working nor receiving TANF benefits at the time of the survey.

Client Area: State and Local Governments
Expertise Area: Income Security

Research Brief: Broader Uses of the TANF Block Grant

July 2009

Colorado counties have used the TANF block grant in a number of ways to reach a population beyond those served by basic cash assistance This issue brief outlines ways in which counties may use their TANF funds to assist needy families in their communities and highlights promising practices and strategies from across the state.

The brief is a part of a five-year evaluation of Colorado Works, the state's TANF program, that The Lewin Group and its partners, University of Colorado's Health Sciences Center, The Johns Hopkins University's Institute for Policy Studies, and Capital Research Corporation, are conducting for the Colorado Department of Human Services.

Client Area: State and Local Governments
Expertise Area: Income Security

Research Brief: Employment Experiences of Colorado Works Recipients as Measured Using Administrative Data

April 2009

This issue brief provides analysis of employment and earnings outcomes of individuals who received welfare in Colorado since 2005, based on wage records from Colorado’s Unemployment Insurance Program. The brief is a part of a five-year evaluation of Colorado Works, the state's TANF program, that The Lewin Group and its partners, University of Colorado's Health Sciences Center, The Johns Hopkins University's Institute for Policy Studies, and Capital Research Corporation, are conducting for the Colorado Department of Human Services. The brief shows that between 2005 and 2008, about a third of Colorado Works participants worked while on welfare, and had relatively low earnings during that period. Those who left welfare worked at higher rates, but the consistency of their employment varied. Earnings increased overall in the two years following exit, though remained low. About 10 percent earned $20,000 or more in the first and second years after leaving Colorado Works. Among certain subgroups, including those with fewer months of welfare and those with older children, larger shares of individuals earned $20,000 or more.

Client Area: State and Local Governments
Expertise Area: Income Security

Research Brief: Disconnected Welfare Leavers in Colorado

March 2009

Colorado's TANF program's caseload has fallen sharply since federal welfare reform legislation was enacted in 1996 that gave states considerable authority in setting welfare policy. While employment gains among low-income families contributed to the decline, many families in Colorado are leaving TANF without employment. This issue brief is a part of a five-year evaluation of Colorado Works, the state's TANF program, that The Lewin Group and its partners, University of Colorado's Health Sciences Center, The Johns Hopkins University's Institute for Policy Studies, and Capital Research Corporation, are conducting for the Colorado Department of Human Services. The brief defines a sample of welfare recipients in Colorado who left welfare but were not working in 2008 as "disconnected" and provides an in-depth analysis using survey and Unemployment Insurance data. It examines the characteristics and outcomes of the disconnected adults, including why they left TANF, how they differ from other TANF leavers, their sources of income, their employment history, and their overall well-being.

Expertise Area: Income Security

Colorado Works Program Evaluation 2008 Annual Report

December 2008

This report summarizes the findings from the past year’s work on the Colorado Works Program Evaluation. It presents and updates analysis of longitudinal data on TANF caseload trends, work activity participation rates, and employment and earnings outcomes of welfare participants; presents findings on county policies, strategies, and activities from a survey of county TANF directors; and analyzes client interactions with other social service agencies including the Child Support Enforcement Division and Child Welfare.

Client Area: State and Local Governments
Expertise Area: Income Security

A Statistical Analysis of the Colorado Works Caseload Trend

December 2008

This report summarizes statistical models The Lewin Group developed to explain the determinants of caseload trends in the Colorado Works program from July 1998 through December 2007. Using regression analysis, equations were developed to estimate the size of the Colorado Works monthly caseload based on the Colorado economy, Colorado Works program characteristics, and other factors. Separate models of caseload size were developed for one-parent families, two-parent families, and child-only cases. In addition, models were also developed of monthly entries and exits for one-parent cases, and county-level models of the one-parent caseload for the five largest counties. Models were estimated using data from July 1999 through December 2007. Among the findings: Unemployment rate is the key factor affecting the size of the one-parent and two-parent caseloads. The caseload in a month is affected by the unemployment rate up to 24 months earlier. Several Colorado Works and federal policy variables also had a statistically significant effect on the size of the caseload.

Client Area: State and Local Governments
Expertise Area: Income Security

Welfare Time Limits: An Update on State Policies, Implementation, and Effects on Families

April 2008

One of the most controversial features of the 1990s welfare reforms was the imposition of time limits on benefit receipt. The law prohibits states from using federal TANF funds to assist most families for more than 60 months. Under contract to the Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services, Lewin and MDRC conducted a comprehensive review of what has been learned about time limits. The review, which updates a 2002 study, includes analysis of administrative data reported by states to ACF, visits to several states, and a literature review. Key findings include the following: time-limit policies vary dramatically from state to state; nationally, at least a quarter million TANF cases have been closed due to reaching a time limit since 1996, although about one-third of these closures have occurred in New York, which continues to provide assistance through a state and locally funded program; and many of the families whose TANF cases were closed due to time limits are struggling financially and report being worse off than they were while on welfare.

Client Area: Federal Government
Expertise Area: Income Security

Key Features of Colorado Works in Comparison to Other State TANF Programs

April 2008

The enactment of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) provided states with considerable flexibility to design their own welfare programs.  The result was an increase in the variation between states’ welfare programs.  In an effort to understand how Colorado’s TANF program compares to other programs across the country, the Colorado Department of Human Services (CDHS) commissioned The Lewin Group and its partners—the University of Colorado’s Health Sciences Center (UCHSC), the Johns Hopkins University’s Institute for Policy Studies (JHU), and Capital Research Corporation (CRC)—to perform an in-depth study of Colorado’s TANF program (Colorado Works) on a variety of different dimensions.  This report examines how Colorado compares with other states on dimensions such as caseload changes, program expenditures, eligibility requirements and benefits, work requirements, financial incentives to work, sanctions, work participation rates, employment outcomes, and diversion policies.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Local Implementation of TANF in Five Sites: Changes Related to the Deficit Reduction Act

March 2008

This study follows up on a study conducted by the Lewin Group and its subcontractor, the Nelson A. Rockefeller Institute of Government, which assessed and reported on recent adaptations made by local offices in managing Temporary Assistance for Needy Families (TANF) programs.  The assessment sought to clarify recent changes implemented by local program managers in five study sites to improve performance, several years after the initial wave of change brought about by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA).  This study revisited the original five study sites to determine the nature of changes brought about by the Deficit Reduction Act (DRA) of 2005, which reauthorized the TANF program.

Client Area: Federal Government
Expertise Area: Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Houston Case Study

March 2008

One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Houston, Texas. The study focused on refugees who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Houston, which settled a large, diverse, and frequently changing refugee population. Themes emerging from this case study include Houston’s emphasis on rapid employment, driven in part by the relatively low TANF benefits offered in the state, the necessity of understanding newly arriving refugees’ cultural experiences when providing services to a changing population, and the special challenges facing refugees from Somalia and Liberia, who arrived with very low educational attainment. The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Miami Case Study

March 2008

One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Miami, Florida. The study focused on refugees, asylees, and related populations who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Miami, including primarily Cubans, Colombians, and Haitians. Themes emerging from this case study include the role of Miami’s extensive network of experienced service providers and community support for arrivals; the strong focus on employment in refugee services; the relatively high education level of refugees served in Miami; the importance of bi-lingual Spanish and English skills; and special challenges facing the Haitian population The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Sacramento Case Study

March 2008

One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Sacramento, California. The study focused on refugees who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Sacramento, including primarily refugees from countries in the former Soviet Union and Hmong arriving in 2004. Themes emerging from this case study include Sacramento’s strong emphasis on English language training as a component of employability services; the use of on-the-job training by several service providers as a tool for moving refugees into permanent employment; and the importance of the welfare system in understanding the context in which the refugee employability programs operate. The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Synthesis of Findings from Three Sites

March 2008

This report summarizes findings from The Lewin Group’s evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) programs. The Office of Refugee Resettlement (ORR) administers these programs and sponsored an evaluation to assess how program services are delivered and how refugees who receive them fare over time. RSS and TAG services aim at helping refugees overcome barriers to employment and integration into the United States. The study focuses on refugees in three sites—Houston, Miami, and Sacramento—who entered the country between 2000 and 2004. It relies on administrative and programmatic data, a survey of refugees, and information collected through interviews with service providers and focus groups with program participants. The study documents differences across the sites with regard to which refugee groups they served, the approaches taken for delivering services, and the emphasis placed on ESL instruction versus rapid employment. The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

Colorado Works Program Expenditure Trends and Patterns at the County Level

December 2007

Federal TANF funds can be used for a range of cash and non-cash services to needy low-income families with children, including cash benefits, employment services, child care, and other support services, and services intended to prevent families from requiring monthly cash benefits.  In Colorado, the federal TANF block grant and the related supplemental funds are used, along with state and county funds, to operate the Colorado Works program.  This report describes the general trends in Colorado Works spending between 2000 and 2006 as well as county expenditures of Colorado Works funds, including basic cash assistance, non-cash assistance, and reserve amounts.

Client Area: State and Local Governments
Expertise Area: Income Security

Understanding Program Participation: Findings from the Colorado Works Evaluation

December 2007

The Deficit Reduction Act of 2005 (DRA) reauthorized the TANF program and made policy changes that increased the effective work participation rates that states must meet to avoid a financial penalty. In Colorado, counties have been reassessing strategies to meet federal requirements while still providing services and benefits to clients that best help them to meet their immediate needs and overcome barriers to longer-term self-sufficiency. This report examines three related topics affecting participation and engagement in Colorado’s TANF program. They are: (1) Work participation activities and strategies; (2) Diversion policies among Colorado’s counties; and (3) Sanctioning practices in Colorado.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Colorado Works Evaluation: 2007 Annual Report

October 2007

This report summarizes the findings from the past year’s work on the Colorado Works Program Evaluation.  It presents and updates longitudinal data analysis of the TANF receipt and employment outcomes among welfare recipients.  It also analyzes client interactions with other social service agencies including child support services and child care services.  It also summarizes special topic reports examining program participation and fiscal trends, which were conducted throughout the year.

Client Area: State and Local Governments
Expertise Area: Income Security

Findings from Focus Groups Conducted with Colorado Works Applicants and Participants

September 2007

This report presents findings from focus groups that were conducted with 78 current and past TANF recipients in four Colorado counties.  The focus groups provide the clients’ perspective about their experiences on welfare and how participation in various services may have contributed to their long-term self-sufficiency.  The report focuses on seven key topic areas: (1) Reasons for TANF application, (2) Application and eligibility determination process, (3) Views on diversion, (4) Views on services provided by staff, (5) Views on services received through TANF offices and Workforce Centers, (6) Work participation requirements and time limits, and (7) Long-term self-sufficiency.

Client Area: State and Local Governments
Expertise Area: Income Security

Entry-Level Employers in Colorado: Results from a Survey of 25 Employers

August 2007

The purpose of this study is to examine Colorado employers’ experiences with welfare recipients they have hired for low-skill, entry-level jobs. The research gathers information on the characteristics of employers and the low-skill workforce, employer hiring practices, staffing needs, overall employer satisfaction, and employer feedback on county Colorado Works offices and workforce centers operated under local Workforce Investment Boards.  The survey provides information about the extent to which the Colorado Works program and the clients are able to meet employer needs.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Anticipated Effects of the Deficit Reduction Act Provisions on Child Support Program Financing and Performance: Summary of Data Analysis and IV-D Director Calls

July 2007

For the National Council of Child Support Directors, The Lewin Group and its subcontractor, EcoNorthwest, explored the potential implications of changes to federal financing of child support enforcement programs contained in the Deficit Reduction Act of 2005 (DRA). The project involved two tasks the first being Data Analysis. Using child support administrative data and economic and demographic information from the Census Bureau and other sources, the project team explored the potential effects of the DRA provision on use of incentives for state match on state performance in two areas: support order establishment and collections made on current support due.The second task was a survey of IV-D Directors. The project team had conversations with 28 state CSE directors about a number of DRA provisions, including the treatment of incentives for match purposes, adoption of (or increase in) the pass-through of collections to current assistance cases, and the mandatory fee for non-assistance cases that generate $500 or more in collections per year. The directors described the extent to which they expect to make up the funding shortfalls and the potential implications of any loss in funding.

Client Area: Associations
Expertise Area: Income Security

Evaluation of the District of Columbia’s Child Support Co-Location Demonstration : Final Report

February 2007

In 2004, the District of Columbia’s Child Support Services Division (CSSD) launched a demonstration to improve collaboration between the child support agency and the Temporary Assistance for Needy Families (TANF) agency and reduce the number of TANF clients who failed to attend scheduled child support intake appointments, the first step to establishing a child support order. To accomplish this goal, child support intake workers were co-located at the TANF office in the Anacostia neighborhood. CSSD contracted with The Lewin Group to develop the demonstration and conduct the evaluation. To measure the effect of the intervention, individuals applying for TANF or visiting the office for recertification were randomly assigned to a treatment or control group. Treatment group members received child support services at the TANF office, while control group members followed the standard procedure for child support intake, which involved an in-person interview at the CSSD headquarters. The impact study found that the demonstration produced a significant increase in paternities and orders established; impacts on child support payments began to emerge after 12 months.

Client Area: State and Local Governments
Expertise Area: Income Security

Local Implementation of TANF in Five Sites

January 2007

The devolution of responsibility for the nation’s primary welfare program from the federal government to state and local agencies was one of the most important institutional changes in federal welfare policy during the 1990s.  The Personal Responsibility and Work Reconciliation Act (PRWORA) of 1996 created the Temporary Assistance for Needy Families (TANF) block grant, which gave states considerable latitude to allocate funds across program functions and move functions outside of traditional welfare agencies to other public agencies and private organizations.  This study, conducted by the Lewin Group and the Nelson A. Rockefeller Institute of Government, determined how local management of TANF programs has evolved to address changing needs and improve program results.  Rather than viewing TANF implementation as a single event followed by a stable administrative structure and a static array of services and requirements, the project viewed implementation in dynamic terms.  It sought to understand how local welfare offices in five areas modify their programs and adopt more effective approaches in response to changing circumstances.

Client Area: Federal Government
Expertise Area: Income Security

Colorado Works Evaluation: 2006 Annual Report

September 2006

his report summarizes the findings from the past year’s work on the Colorado Works Program Evaluation.  It provides policy analysis of the Colorado Works program as well as descriptions of the local socioeconomic trends.  It presents longitudinal data analysis of the TANF receipt and interactions among welfare recipients.  It also summarizes special topic reports examining service delivery strategies and practices, which were conducted throughout the year.  These include program coordination and collaboration, employment services and employer interactions, preventative services, and serving the hard-to-employ.

Client Area: State and Local Governments
Expertise Area: Income Security

Employment Services and Employer Interaction in Colorado Works Programs

June 2006

This report describes employment services in local Colorado Works programs, particularly strategies that involve interaction with employers and industries, highlighting promising practices for other programs. It finds that the most common employment-specific activities in Colorado counties are (1) job readiness workshops that generally include some guided job search activity, and (2) work experience activities.  It also finds that counties generally tailor their employment services to local labor market trends, working with both public and nonprofit agencies as well as private sector business when possible.  Finally, several county programs are found to have developed large and formal networks of employers for such employment activities which may serve as a model for other counties.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Family and Preventative Services in Colorado

June 2006

In Colorado, county human service and social service departments provide a range of programs for adults, youth and relative caretakers to help stabilize families, increase self-sufficiency, and prevent the intergenerational transmission of welfare dependency.  This report provides an overview of services offered in Colorado.  The report also highlights three broad areas of innovative family-related and prevention services, including collaborations with child welfare and other efforts to prevent out-of-home placements, programs designed to increase child well-being through parental involvement and access to quality child care, and a broad array of youth programs including non-marital pregnancy prevention programs, summer employment and training initiatives, and in-school services for high-risk youth.

Client Area: State and Local Governments
Expertise Area: Children, Youth, and Family Policy, Income Security

Program Coordination and Collaboration in the Colorado Works Program

June 2006

This report examines the variety of cross-agency collaboration and coordination strategies used by county Colorado Works/TANF programs across the state. Based primarily upon information collected during site visits to 18 Colorado Works county programs, this report focuses on collaborative arrangements in two major areas: (1) partnerships with local Workforce Centers and other community organizations to obtain employment, education, and training services; and (2) collaboration with other public agencies and private organizations to obtain a wide array of support services.  The report finds that program coordination is extensive and that there is wide variation in the network of collaboration across Colorado counties.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Serving the Hard-To-Employ in Colorado

June 2006

This report examines strategies Colorado counties were using to serve the hard-to-employ TANF population in 2005, highlighting promising approaches that counties might choose to adopt and providing  the state with useful information that can help guide future policy choices. While there are a wide range of issues that affect welfare recipients’ ability to succeed in the job market, this report focuses on seven barriers: 1) Physical disabilities; 2) Limited education and learning disabilities; 3) Mental health; 4) Substance abuse; 5) Domestic violence; 6) Limited English skills; and 7) Homelessness.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Colorado Works Program Evaluation: Findings from County Survey

October 2005

The State of Colorado’s Department of Human Services funded The Lewin Group to perform an in-depth study of Colorado’s TANF program, Colorado Works. The objective is to provide administrators with information about program strategies and approaches being used in various counties that others might find useful for improving program implementation, performance, and outcomes. This report summarizes findings from a survey of county Colorado Works directors conducted in 2005. It documents the diversity of the policies, organization and staffing approaches, and activities and services found across the state.

Client Area: State and Local Governments
Expertise Area: Income Security

The Interaction of Child Support and TANF

January 2005

Child support is an important income source for many low-income families, and the receipt of support may be most critical for women as they transition off welfare. In the post-welfare reform era emphasizing work and self-sufficiency, many policymakers now consider child support as a key income support. In the effort to support self-sufficiency, for example, it is important that custodial parents, primarily mothers, know the rules of child support, establish orders, begin to receive child support while on welfare and receive child support payments on a regular basis after leaving welfare. To examine the interaction of child support and welfare receipt, researchers from MDRC, The Lewin Group, and The University of Wisconsin-Madison analyzed several data sources to address questions concerning child support receipt of current and former welfare recipients. This report is the second and final in a series for this project. The first report, produced by The Lewin Group, provided an extensive literature review.

Client Area: Federal Government
Expertise Area: Income Security

Study of the Implementation of the Performance-Based Incentive System: Final Report

September 2004

This report was prepared for the Department of Health and Human Services, Office of Child Support Enforcement (OCSE) under contract with The Lewin Group. The study reviews the implementation of the performance-based incentive funding system through which the Federal government awards payments to state Child Support Enforcement programs. OCSE implemented the new incentive formula over the fiscal year 2000 to 2002 period. The statute provided a gradual phase-in, in part, so that state officials would havetime to perfect their measurement of performance and identify factors that affect performance. This final report explores state experiences in implementing the new system, including problems, successes, advantages and disadvantages. It also reports changes to the new system that were recommended by child support stakeholders.

Client Area: Federal Government
Expertise Area: Income Security

Spending on Social Welfare Programs in Rich and Poor States

July 2004

This study was conducted for the Assistant Secretary for Planning and Evaluation, DHHS. It addresses how a state’s fiscal capacity affects its spending on social welfare, how states differ in their "packaging" of services for low-income populations, how economic conditions affect state spending on social welfare, and how the poorest states have adjusted to their relative economic austerity. The study also looks at factors in addition to fiscal capacity and federal grants that might influence state spending, including state needs for social welfare spending, as measured by poverty and unemployment rates and political and institutional factors, including state budget processes. .

Client Area: Federal Government
Expertise Area: Income Security

The Relationship of Earnings and Income to Food Stamp Participation: A Longitudinal Analysis

November 2003

This study considers the role that the dynamics of household income plays in determining Food Stamp Program (FSP) participation. In particular, many nonparticipant households have had a short-term drop in income. Other nonparticipants, however, have had long-term low income and are often very disadvantaged. Many households may not participate because the same conditions that limit their incomes, such as low literacy levels or physical or mental disability, also limit their ability to participate in the FSP. Many poor nonparticipants are receiving other benefits, such as Supplemental Security Income or Medicaid, suggesting an avenue by which agencies can reach eligible nonparticipants. The two main objectives of this study are to (1) determine the extent to which nonparticipation can reasonably be attributed to temporary low income, and (2) assess why some households that appear to have long-term low income do not participate.

Client Area: Federal Government
Expertise Area: Income Security

Study of the Implementation of the Performance-Based Incentive System: Interim Report

October 2003

Since 1975, the federal government has paid incentives to state child support enforcement programs to encourage improvement in collections through efficient establishment and enforcement techniques. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) required the Department of Health and Human Services (HHS) to develop a performance-based incentive funding system through which the federal government would award payments to state child support enforcement (CSE) programs. The 1998 Child Support Performance and Incentive Act (CSPIA) created the new structure to reward states that operated effective CSE programs. The federal Office of Child Support Enforcement (OCSE) implemented the new incentive formula over the Fiscal Year (FY) 2000 to 2002 period. Policymakers called for the gradual phase-in so that state officials would have time to perfect their measurement of performance and identify factors that affect the determination of incentives. CSPIA requires HHS to produce interim and final reports that detail the implementation of this new system and offer recommendations for its improvement. This interim Report to Congress describes the development of the new incentive system, components of the system, and initial program results.

Client Area: Federal Government
Expertise Area: Income Security

State Demographic, Economic, and Programmatic Variables and Their Impact on the Performance-Based Child Support Incentive System

August 2003

In 1998, Congress enacted the Child Support Performance and Incentive Act (CSPIA), to revise the incentive structure to reward states for performance on a larger number of their establishment and enforcement practices. In addition to other studies of the new incentive system, CSPIA required a report on how various demographic and economic variables affect state performance.

Client Area: Federal Government
Expertise Area: Income Security

Child Support and TANF Interaction: A Literature Review

April 2003

Welfare and child support programs have long been intertwined. Given the common populations served and the role that child support payments play in self-sufficiency and cost recovery, understanding the interaction between child support and welfare is important. The Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) funded a study to examine this interaction. This literature review is the first report from this important study. A future report will present findings from analyses of several datasets examining the extent of child support receipt among current and former welfare clients and the contribution of payments to self-sufficiency.

Client Area: Federal Government
Expertise Area: Income Security

Administrative and Judicial Processes for Establishing Child Support Orders

July 2002

While the federal government has mandated the use of a number of enforcement techniques, states and localities still have considerable flexibility in designing the processes by which they establish child support. States have discretion in terms of shaping and running their child support programs. In many states, courts play a key role in child support order establishment, as well as other aspects of the program. In others, executive-branch agencies establish orders administratively. Despite the widespread use of the terms "judicial" and administrative," no study has tried to define each process -- or a range of quasi-judicial processes. The 50 states and the District of Columbia each has its own order establishment process and its own set of "players." This study addressed the following questions: What key characteristics define administrative and judicial processes? Is it possible to classify state processes into four or five key categories or types? Are there similarities, as well as differences, between the processes? How do cases progress through each of the process types? Are there differences in the number of people or agenies involved? Do clients perceive the processes as fair and accessible? Do cases appear to move quickly through one process or another? In order to answer the study questions, the project team developed a taxonomy of judicial and administrative processes; reviewed processes in nine states; and conducted site visits in five states.

Client Area: Federal Government
Expertise Area: Income Security

Welfare Time Limits: State Policies, Implementation, and Effects on Families

July 2002

Few features of the 1990s welfare reforms have generated as much attention and controversy as time limits on benefit receipt. Time limits first emerged at the state level and subsequently became a central feature of federal welfare policy in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which imposed a 60-month time limit on federally funded assistance for most families. To inform discussions about the reauthorization of PRWORA, the U.S. Department of Health and Human Services contracted with the Manpower Demonstration Research Corporation (MDRC) to conduct a comprehensive review of what is known about time limits. As part of this project, The Lewin Group conducted a survey of all 50 state welfare agencies.

Client Area: Federal Government
Expertise Area: Income Security

Supports for Working Poor Families: A New Approach

December 2001

With welfare reform, millions of families with children have shifted from reliance on cash assistance from Aid to Families with Dependent Children (AFDC) to reliance on earnings. Increases in programs providing support to low-wage workers and their families have facilitated this shift from welfare to work. Key work support programs include the Earned Income Tax Credit, food stamps, medical insurance under the State Children's Health Insurance Program and Medicaid, and subsidized childcare. By "making work pay," these work support programs have helped families move from welfare to work and have improved family well-being. This paper presents innovative policy options for improving access to the Food Stamp Program (FSP). It presents background on the current programs and the rationale for why a new approach is needed; suggests principles to serve as a guide in designing a new approach; presents options for making the benefits available under the FSP readily accessible to eligible working families; and discusses where to go from here and lays out first steps.

Client Area: Foundations
Expertise Area: Income Security

Automated Cost-of-Living Adjustments of Child Support Orders in Three States

April 2001

In recent years, federal and state governments have taken a number of actions to strengthen the nation's child support system. One chief policy concern is that child support awards, over time, may not keep pace with non-custodial parent earnings or the cost associated with raising a child. Given the cost and complexity of traditional review and adjustment procedures, a number of states are considering, or have implemented, one of the two new approaches authorized in the Personal Responsibilty and Work Opportunity Reconciliation Act (PRWORA) of 1996: Cost-of-living (COLA) adjustments that alter orders periodically without reviews, and An automated method to identify orders eligible for review and to apply the appropriate adjustment. This report focuses primarily on COLA adjustments and reviews the COLA policies in two states: Minnesota, and New York. The study reviewed the processes involved in passing COLA legislation, the stakeholders who were involved, the steps the states took to implement their COLA systems, the fiscal outcomes for both the parents and the states, and assessments of the pros and cons of a COLA system. In addition, the study examined a proposed automated method for reviewing and adjusting orders in Vermont.

Client Area: Federal Government
Expertise Area: Income Security

Evaluation of SSA's Disability Quality Assurance (QA) Processes and Development of QA Options That Will Support the Long-Term Management of the Disability Programs: Final Report

March 2001

This report provides findings from the project team's review of SSA's quality assurance system for disability determinations and options for improvement. The report finds that SSA's QA system reflects the end-of-line inspection type of system that was prominent in the health care industry and other industries when it was developed, and needs to be transformed to a more advanced, state-of-the-art quality management system. This will require a sustained effort over many years. Program leadership will play a critical role. Options are presented for improving leadership, developing a culture of quality, improving pre-effectuation reviews, improving measurement of quality in initial determinations, improving SSA's relationship with the state Disability Determination Services, continuously improving the disability determination process, and improving the quality of appellate decisions.

Client Area: Federal Government
Expertise Area: Income Security

The Potential of the Child Support Enforcement Program to Avoid Costs to Public Programs: A Review and Synthesis of the Literature

April 2000

The U.S. Department of Health and Human Services contracted with The Lewin Group and Johns Hopkins University to synthesize the literature on child support cost avoidance and to identify areas where additional research is required. The major components of this report are a synthesis of the literature on cost avoidance and an annotated bibliography of cost avoidance studies and related studies that contribute to the methodology of measuring cost avoidance -- e.g., studies on compliance, child support review and adjustment efforts, the behavioral implications of child support policies, microsimulation models and their current and future capacity to estimate cost avoidance, and the use of administrative data to measure cost avoidance. The report also contains a summary of additional research that is needed and recommendations about the most promising strategies for expanding our knowledge about cost avoidance.

Client Area: Federal Government
Expertise Area: Income Security

Understanding the TANF Child-Only Caseload: Policies, Composition, and Characteristics in Three States

February 2000

The Lewin Group recently completed a report for HHS, ASPE to document the composition and trends of TANF child-only cases, focusing on three areas: Alameda County, (Oakland) California; Duval County, (Jacksonville) Florida; and Jackson County, (Kansas City) Missouri. The Lewin Group documented the policies and practices in place in the three states, collected data from the state administrative systems, and conducted a case file review in the three counties. Major findings include: The proportion of TANF cases that are child-only has been increasing since 1988 (to 68 percent in Duval County) primarily because non-child only cases are declining dramatically. State policies and county demographics directly affect the composition of child-only caseloads -- about two-thirds of the child-only cases in Jackson and Duval counties are relative caretaker cases; Alameda cases are divided more evenly into sanctioned, SSI, alien, and relative cases. Relative caretakers are more likely to be grandparents who are caring for a child due to desertion, substance abuse, incarceration, child abuse, or neglect by the parent. States are recognizing the importance of assisting cases where relatives are taking care of the children by creating alternative programs that provide services and increased financial assistance without the licensing requirements of foster care.

Client Area: Federal Government
Expertise Area: Income Security

State Financing of Child Support Enforcement Programs: Final Report

September 1999

The purpose of this study was to examine the relationship between the federal Child Support Enforcement program financing structure and the resources allocated to the CSE program. The study addresses the following main topics: What are the various sources of funding for the State and local share of IV-D expenditures? What share of the expenditures does each source represent? How is the State share of retained TANF collections allocated at the State and local level? How are Federal incentive payments allocated at the State and local level?

Client Area: Federal Government
Expertise Area: Income Security

Policy Evaluation of the Overall Effects of Welfare Reform on SSA Programs

April 1999

How will welfare reform affect disability programs? Lewin evaluated the effects of recent welfare reform legislation on the Social Security Disability Insurance (DI) Program and the Supplemental Security Income (SSI) Program. Some of the reforms affect SSA programs directly ("SSA reforms"), while others have an indirect effect through program interactions ("non-SSA reforms"). Evaluation options are developed to estimate the impact of the non-SSA reforms alone, and to estimate the total effect of all recent SSA and non-SSA reforms. To develop these options, we conducted several activities to collect supportive information, including: a major literature review; a review of ongoing and proposed state and other welfare reform evaluation efforts; five state site visits; and an analysis of SSA administrative data, both by itself, and matched to data from the Survey of Income and Program Participation. We present four options that can be implemented independently or in a complementary manner.

Client Area: Federal Government
Expertise Area: Income Security

Deriving State-Level Estimates from Three National Surveys: A Statistical Assessment and State Tabulations

May 1998

This report assesses the statistical issues involved in the production of state-level estimates related to health and welfare issues from three national surveys: the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), and the National Health Interview Survey (NHIS). With the devolution of many welfare programs from the Federal Government to the states, there is a strong interest in being able to track the health and welfare of the population in each state. This would allow for examination of the effect of various state welfare initiatives.

Client Area: Federal Government
Expertise Area: Income Security

An Exploratory Study of Health Care Coverage and Employment of People with Disabilities: Literature Review

October 1997

Summary: Health insurance access is an important factor in decisions to work or participate in public programs for single mothers, older workers and the elderly. Many DI and SSI beneficiaries say they are deterred from working for fear of losing their benefits. Recent legislative proposals are designed to address these issues through expanded eligibility for government provided health insurance programs.

Client Area: Federal Government
Expertise Area: Health Reform, Income Security

Determinants of AFDC Caseload Growth: Final Report

July 1997

This paper is the culmination of research on participation and expenditures in state AFDC programs. The project entailed the construction of separate pooled time-series econometric models for both the Basic and Unemployed Parent (UP) programs as well as a model for the average monthly benefit for the combined programs. These models utilize quarterly state-level data for all 50 states and the District of Columbia from 1979 to 1994. They relate within-state changes in demographics, the economy, and programs to changes in caseloads, participants, child participants, and expenditures per case. In addition to presenting the results of these models at the national level, this paper includes an in-depth discussion of participation patterns in four states: California, Florida, Maryland, and Wisconsin.

Client Area: Federal Government
Expertise Area: Income Security
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