Publications on Federalism/Devolution

Since 2001, more than half the states have changed their Medicaid programs, through either Medicaid waivers or provisions included in the Deficit Reduction Act of 2005. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and structure of program financing. With a few important exceptions, the changes have been fairly circumscribed. However, states may exercise this new flexibility if, for example, national health care reforms do not occur or an economic downturn creates state fiscal pressures. If that happens, new policies could lead to profound changes in Medicaid and could be carried out relatively easily.

Using state survey data, researchers examined Medicaid supplemental payments, including disproportionate share hospital and upper payment limit payments in 2005 and changes in these payments between 2001 and 2005. The researchers found that states increased their use of general funds in financing Medicaid DSH payments while expanding the size and scope of other supplemental payments considerably. Although the federal government has made some headway in reforming state Medicaid financing in recent years, the paper concludes that problems persist and more work remains.

This paper describes the strategies and tactics used by the Urban Institute's Assessing the New Federalism (ANF) project to communicate changes in the social safety net in the wake of welfare reform. From 1997 to 2004, the growth of electronic communications revolutionized the way people communicate. This report documents how ANF adapted to these changes and offers lessons for future work. Several themes run through this work: continual evaluation of the dissemination program led to continual evolution; cost, time and outcomes were major measures of effectiveness; and being timely and relevant required new communication strategies.

This paper builds on a series of ANF publications that explored various aspects of social policy federalism since 1996. It explores what ANF's work can tell us about the evolution of federalism within five major social programs during the nine years between 1997 and 2006, focusing on lessons about federal-state relationships. It addresses Temporary Assistance for Needy Families (TANF), Food Stamps, Medicaid, the State Children's Health Insurance Program (SCHIP), and child welfare. The paper is the result of a review and synthesis of over 65 publications addressing state and federal financing and/or programmatic arrangements in the major program areas, informed by interviews with experts who participated in ANF research.

This study, commissioned by the National Adoption Day Coalition, provides a first look at legislation specifically related to the adoption of children from foster care introduced in the 50 state legislatures and the District of Columbia between 2002 and 2006. Using data from various legislative databases, the study found that state legislatures are active in the area of foster care adoption, but that legislation may not adequately address known barriers to adoption. The study also looked at several bills to understand the legislative process surrounding adoption and considered how legislation supports families after they adopt children from foster care.