State and Local Finances

This report summarizes the roundtable "Infants and Toddlers in State and Federal Budgets: Yesterday's Choices, Today's Decisions, Tomorrow's Options" conducted by the Urban Institute, with support from the A.L. Mailman Family Foundation, on March 30, 2009. The roundtable's focus grew out of the widely perceived mismatch between sharply limited public investments on infants and toddlers and an accumulated body of research demonstrating the significance of the earliest years of life. We describe the group's diverse perspectives and wide-ranging discussion of strategies to address this mismatch.

In this commentary for The Press-Enterprise (Riverside, Calif.), Olivia Golden and Sheila Zedlewski advise states to grab the federal dollars offered by the economic stimulus package to help pay for recession-driven increases in the demand for welfare.

Medicaid physician fees increased 15.1 percent, on average, between 2003 and 2008. This was below the general rate of inflation, resulting in a reduction in real fees. Only primary care fees grew at the rate of inflation--20 percent between 2003 and 2008. However, because of slow growth in Medicare fees, Medicaid fees closed a small portion of their ongoing gap relative to Medicare--growing from 69 percent to 72 percent of Medicare. The increase in Medicaid fees relative to Medicare fees resulted from relative increases for primary care and obstetrical services, but not for other services.

This speech, given at the University of Chicago's School of Social Service Administration, discusses how the stimulus package addresses the policy needs of low-income working families. It focuses on three questions: how it might reduce poverty in the short term; how it might help position service providers for addressing poverty in the long term; and what researchers can do to inform future policies in this area. Efforts are compared to the following goals: increasing wages, promoting job stability and upward mobility, and providing income supports when needed.

In 2005, Missouri adopted sweeping Medicaid cutbacks. More than 100,000 people lost coverage, and many more faced reduced benefits and higher cost-sharing. Using a range of data sources, we show that the cutbacks were followed by a major increase in the numbers of uninsured people, greater uncompensated care burden on hospitals, and revenue shortfalls that forced community health centers to obtain larger state grants and charge patients more. Competing demands on state budgets and the need to balance budgets even during recessions could result in policies that disadvantage those with great needs as well as the providers who serve them.