Urban Institute

About: Urban Institute is a nonprofit organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Medicaid & Population. The organization has 927 authors who have published 2330 publications receiving 86426 citations.

Determinants and Costs of Medicare Post-Acute Care Provided by SNFs and HHAs

Abstract: Provisions in the 1997 Balanced Budget Act affecting Medicare skilled nursing facility (SNF) and home health agency (HHA) services heighten the importance of knowing more about beneficiary, market, and policy factors that impact use of post-acute care and the costs of such services. This study used data from the Medicare Current Beneficiary Survey and other sources to address these issues. Findings shed light on responses that need to be monitored in light of the recently mandated policies and other SNF and HHA options that are being considered. (Inquiry 1998 Spring; 35(1): 49-61).

Listening to Parents: Overcoming Barriers to the Adoption of Children from Foster Care

Abstract: The Adoption and Safe Families Act of 1997 (ASFA) codified the right of children in foster care to achieve a safe and permanent home. Since its passage, there has been a 79 percent increase in the number of children adopted from foster care. Surprisingly, the vast majority of post-ASFA adoptions were by foster parents or relatives of the children in care. Why so few children are adopted by general applicants is an important question, particularly for the 131,000 waiting for permanent homes. We examined this question using federal data (AFCARS), a state survey, and case record reviews and interviews with parents and agency staff in three sites. We found a steep attrition rate as prospective families go from initial call to adoption, and identified two particularly crucial points in the process. The first is the prospective parents' initial call to an agency. This information call can be an intensely emotional experience for the prospective adoptive parent, but agencies, faced with the challenge of balancing recruitment with screening, do not handle it as well as they might. The second is the placement process. In part this is a result of the inherent conflict between parents looking for the "right child" to complete their family and agencies looking for the "right home" for each child. But we also found great confusion about how the placement decision is made and what role the prospective adoptive parents should play in it. Among our recommendations are an early focus on recruitment rather than screening; documentation of the adoption process and qualifications for adopting; and, a separation of screening from training wherever possible. We also recommend changing the way initial calls are handled and development of a buddy system paring prospective adoptive parents with experienced adoptive parents, and establishment of a process for soliciting, and incorporating feedback from prospective parents. If we want to find homes for waiting children, it is absolutely critical that child welfare agencies develop ways of listening to prospective parents throughout the adoption process and responding to their needs and concerns.

ACA Medicaid Expansion and Insurance Coverage Among New Mothers Living in Poverty.

Abstract: BACKGROUND: Medicaid plays a critical role during the perinatal period, but pregnancy-related Medicaid eligibility only extends for 60 days post partum. In 2014, the Affordable Care Act’s (ACA’s) Medicaid expansions increased adult Medicaid eligibility to 138% of the federal poverty level in participating states, allowing eligible new mothers to remain covered after pregnancy-related coverage expires. We investigate the impact of ACA Medicaid expansions on insurance coverage among new mothers living in poverty. METHODS: We define new mothers living in poverty as women ages 19 to 44 with incomes below the federal poverty level who report giving birth in the past 12 months. We use 2010–2017 American Community Survey data and a difference-in-differences approach using parental Medicaid-eligibility thresholds to estimate the effect of ACA Medicaid expansions on insurance coverage among poor new mothers. RESULTS: A 100-percentage-point increase in parental Medicaid-eligibility is associated with an 8.8-percentage-point decrease (P CONCLUSIONS: ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers. Opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.

The production of criminological experiments.

Abstract: The article examines the production of crime and justice field experiments during the 1990s. Data were collected on the characteristics of criminological experiments funded by the National Institute of Justice (NIJ), the principal research agency of the U.S. Department of Justice, during the 10-year period from 1991 through 2000. The analyses find that, whereas the funds available for research and evaluation at the NIJ increased during this period, the number of projects and the amount of funds awarded supporting field experiments declined. The article describes the characteristics of the experiments funded and assesses the extent to which the reduced support can be attributed to the characteristics of NIJ research funding, research topics, researchers, or criminal justice operational agencies.

When There Is No Welfare: The Income Packaging Strategies of Mothers Without Earnings or Cash Assistance Following an Economic Downturn

Abstract: The 1996 welfare reform law sought to reformulate single mothers’ income package, replacing cash welfare checks with paychecks. However, many single mothers have not been able to do that and have neither earnings nor cash assistance. Among a sample of single mothers in Los Angeles and southeast Michigan, we find that when single mothers lose jobs and do not receive cash assistance, they package income from a variety of sources (such as other public assistance programs and informal child support), find others in their social networks to pay their bills, or move in with others. However, their income packaging strategies are fraught with challenges. Benefits from certain public programs are difficult to secure; financial assistance from friends and family members can quickly vanish, particularly if a partner is deported or jailed; and doubling up with others often leads to living in crowded and unsafe conditions.