February 2000
DHHS, Administration for Children and Families (ACF)
This report contains the proceedings of a meeting held November 18-19, 1999 on the Administration for Children and Families' (ACF) Employment Retention and Advancement grant program. Attending the meeting were representatives from the ACF, 12 of the 13 states that received grants for the Employment Retention and Advancement project, The Lewin Group, the Manpower Demonstration Research Corporation along with other staff from the Department of Health and Human Services, researchers, and members of the welfare community. The purpose of the meeting was to share information on each state's demonstration plans and to engage in working sessions that would help each state further define these plans.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
February 2000
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
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
January 2000
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Clifford Goodman
This report provides an introductory analysis of state legislative actions related to organ and tissue donor registries. The analysis focuses on describing the current state legislation on donor registries, comparing legislation among the various states, and how such policies may enhance or hinder efforts to develop, modify, and link statewide donor registries.
Client Area: Federal Government
January 2000
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
This report contains the results of a study to identify, document, and assess the factors that affect access to and utilization of new generation antidepressant and antipsychotic medications. Three primary questions guided the assessment:
What are the formal policies and procedures implemented by health care payers that affect consumer access to and utilization of psychiatric medications? Are these policies and procedures different for psychiatric medications than for other medication classes?
How does the implementation of these policies and procedures affect access to and utilization of these medications?
Do policies, procedures, and modes of implementation (regardless of whether they differ for mental health) create barriers to adequate mental health care?
Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse
December 1999
DHHS, Administration for Children and Families
The Program Design Manual is the one of a series of products developed by The Lewin Group, under contract to the Administration for Children and Families, to assist states to design program strategies for promoting the employment retention and advancement of TANF recipients. The manual provides states with a step-by-step process for thinking through goals, target populations, and strategies they might include in their program plans. The manual also provides helpful guidance with regard to issues related to the evaluation of these programs. ACF has a major initiative underway to identify sites for an experimental evaluation of employment retention and advancement programs. States interested in participating in that evaluation will find the manual helpful in thinking through their plans. States who are not interested in the evaluation but are planning initiatives in this area should find the manual helpful in thinking through their design options as well.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
November 1999
Institute of Medicine
The Lewin Group was commissioned by the Institute of Medicine (IOM) Committee on Medicare Coverage Extensions to prepare cost estimates for selected expanded Medicare benefits. Congress in the Balanced Budget Act of 1997 mandated that the IOM examine Medicare coverage for certain preventive benefits. The Lewin Group prepared cost estimates for the following services:
Skin cancer screening
Medically necessary dental services (in connection with treatment of specific diagnoses)
Elimination of the three-year limit on immunosuppressive therapy. The purpose of these cost estimates is to support the Committee's analysis of their efficacy based upon the clinical evidence available. The following sections summarize our cost estimates for these services, the data sources used for these estimates, and the key assumptions that underlie these estimates. Congressional Budget Office (CBO) type budget-neutral procedures ("pay as you go") apply to each of these extended benefits. Under these congressional budget scoring rules, additional Medicare benefits must be estimated to at least break even over a five-year time period, or funding must be reappropriated from an existing budgetary source.
Our analytic process required estimations of both gross and net costs to Medicare for the five- year period of 2000 through 2004. Gross costs are the direct costs to Medicare of the services, and net costs are the gross costs minus the potential cost offsets Medicare would realize as a result of covering these services. We also reduced our cost estimates to account for cost sharing offsets of 20% and premium offsets of 25% per CBO standards. Cost offsets are derived from the Committee's analysis of the research evidence available and expert judgement.
Projections of the Medicare Part B population for the years 2000 through 2004, as well as other sources of Medicare Part A and Part B population statistics (such as race and sex) were provided by the HCFA Office of the Actuary.
Client Area: Federal Government
Expertise Area: Medicare
September 1999
DHHS, Office of the Assistant Secretaryfor Planning and Evaluation (ASPE)
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
September 1999
DHHS, Administration for Children and Families (ACF)
This report contains the proceedings of a meeting held June 3-4, 1999 on the Administration for Children and Families' (ACF) Employment Retention and Advancement grant program. Attending the meeting were representatives from the ACF, the 13 states that received grants for the Employment Retention and Advancement project, and The Lewin Group, along with other staff from the Department of Health and Human Services, researchers, and members of the welfare community. The purpose of the meeting was to share information on each state's demonstration plans and to engage in working sessions that would help each state further define these plans.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
August 1999
DHHS, Center for Substance Abuse Treatment
The purpose of this study is to quantify the costs and benefits of alcohol and drug abuse treatment and the resulting economic benefits to society, using data from the National Treatment Improvement Evaluation Study (NTIES). Lewin constructed estimates of treatment costs for each of the modalities and across all modalities. To measure benefits, Lewin used data from NTIES to estimate the crime-related and health care costs associated with substance abusers and the income of substance abusers in the periods before and after treatment. The difference between pre-treatment (baseline) costs and post-treatment (follow-up) costs provides an estimate of the economic impact of substance abuse treatment. This "treatment effect" is viewed as a benefit to the extent that it represents avoided crime-related costs, health-care costs, or welfare payments or increased earnings. In other words, the benefits of treatment are equal to the additional costs that would have been incurred and the additional earnings that would not have been realized in the absence of treatment.
Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse
April 1999
Social Security Administration
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
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