Creating Employment Incentives

“Enrollment Patterns and Medical Expenditures for Medicaid Buy-In Participants in Five States.” Su Liu, Henry T. Ireys, Justin S. White, and William Black, October 2004. The Medicaid Buy-In option promotes employment and economic self-sufficiency for individuals with disabilities. This study used information from federal Medicaid and Medicare databases to examine policy questions about enrollment in the Medicaid Buy-In program in five states and participants' medical expenditures. Using 2001 data, researchers determined the federal databases can be used to generate descriptive information about program participation that states cannot easily provide directly. In addition, information on enrollment patterns and medical expenditures gleaned from the federal databases may be useful to CMS in monitoring the Medicaid Buy-In program and to state Medicaid staff developing or refining Buy-In programs.

Affordable and Accessible Insurance for All?

"The Role of Reinsurance in State Efforts to Expand Coverage." Deborah Chollet, October 2004. Recently, some states have revisited the concept of reinsurance to spread risk in insurance markets, improve the predictability of claims, and reduce the markup of premiums that insurers charge as a buffer against unanticipated claims. This brief examines efforts in Arizona, Connecticut, Idaho, Massachusetts, New Mexico, and New York and proposes lessons for states considering reinsurance programs to expand small group or individual coverage. The author concludes that, while it is unlikely that a state-level reinsurance program will solve the complex problem of making coverage affordable and accessible to all, it can be an efficient strategy for stabilizing coverage and perhaps expanding it.

Assessing Family Functioning

"Indicators of Child, Family, and Community Connections." Various authors, 2004. Family indicators, which typically include measures such as family structure, benefit receipt, and employment and poverty status, do not fully portray how families function as a unit and as part of society. This chartbook begins to address this gap by presenting examples of how available data can be used to generate indicators of the social context of families. It also assesses the need for additional data and measures in several domains. A selection of important areas for further development are discussed. Companion volume of related papers.

Welfare Reform in Indian Country

"Overcoming Challenges to Business and Economic Development in Indian Country." Walter Hillabrant, Judy Earp, Mack Rhoades, and Nancy Pindus, August 2004. American Indian tribes and Alaska Native villages have embraced the goals, objectives, and programs associated with welfare reform, but lack of jobs limits the success of tribal programs such as Temporary Assistance for Needy Families (TANF) and Welfare-to-Work (WtW). Recognizing the scope and importance of the jobs problem, the federal government has promoted business and economic development in Indian country. This report presents findings from a study, done under Mathematica's WtW evaluation, of economic development initiatives in eight tribes—Cheyenne River Sioux, Citizen Potawatomi, Colville Confederated Tribes, Gila River, Mississippi Choctaw, Navajo Nation, Three Affiliated Tribes, and Turtle Mountain Chippewa—and two Alaska Native corporations—Bristol Bay Native Corporation and Doyon Limited.

Engaging Welfare Recipients in Work

"A Study of Work Participation and Full Engagement Strategies." Jacqueline Kauff, Michelle K. Derr, and LaDonna Pavetti, September 2004. Dramatic changes in the welfare system have drawn attention to the need to engage a broader group of welfare recipients in activities that build their capacity to work. Some state and local programs currently strive to engage all or most TANF recipients in work-related pursuits, but little is known about strategies they use. This study examined seven programs to document their operations and effectiveness, and to identify lessons that could help other programs with similar goals. The study findings are particularly timely, as the proposed reauthorization of the TANF legislation will likely require states to engage a greater percentage of their caseload in work activities.

Working World: Low-Wage Realities

"Characteristics of Low-Wage Workers and Their Labor Market Experiences: Evidence from the Mid- to Late 1990s." Peter Schochet and Anu Rangarajan, April 2004. Examines the post-PRWORA labor market experiences of low-wage workers, using the Survey of Income and Program Participation (SIPP).

Upcoming Presentations

The 2004 annual meeting of the American Public Health Association takes place November 6 to 10 in Washington, DC. Be sure to check out our presenters at this year's meeting, which will focus on the role of public health in addressing environmental issues; sustaining healthy environments; and enhancing research, public awareness, prevention, and treatment of disease caused or exacerbated by environmental factors.