Caseload Growth Research Articles

Examining SNAP and TANF caseload trends, responsiveness, and policies during the COVID‐19 pandemic

AbstractTemporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) cases increased by 3.3 million between March and June 2020, their largest quarterly increase ever. During the pandemic, many states adopted a wide set of policies and procedures to facilitate program enrollment, retention, and eligibility. I track these policies and create a pandemic policy index measuring state generosity. States that adopted more generous policies experienced larger TANF and SNAP caseload growth, especially eligibility policies such as exempting TANF work requirements or SNAP P‐EBT availability. Analyzing the caseload relationship to labor markets, caseloads were less responsive to unemployment rate changes during the pandemic relative to the pre‐pandemic period.

AGGFORCLUS: A hybrid methodology integrating forecasting with clustering to assess mitigation plans and contagion risk in pandemic outbreaks: the COVID-19 Case Study

ABSTRACT The COVID-19 pandemic showed governments’ unpreparedness as decision-makers hastily created restrictions and policies to contain its spread. Identifying prospective areas with a higher contagion risk can reduce mitigation planning uncertainty. This research proposes a risk assessment metric called AGGFORCLUS that integrates time-series forecasting and clustering to convey joint information on predicted caseload growth and variability, thereby providing an educated yet visually simple view of the risk status. In AGGFORCLUS, the development is sectioned into three phases. Phase I forecasts confirmed cases using a mixture of five different forecasting methods. Phase II develops the identified best model forecasts for an extended ten-day horizon, including their prediction intervals. In Phase III, we calculate average growth metrics for predictions and use them to cluster series by their multidimensional average growth. We present the results for various countries framed into a nine-quadrant risk-grouped associated measure linked to the expected cumulative caseload progress and uncertainty.

Elective surgery growth at Florida hospitals accrues mostly from surgeons averaging 2 or fewer cases per week: A retrospective cohort study

Study objectiveHospital administrators often seek to increase operating room (OR) elective caseload. Previous studies from Iowa demonstrated that surgical growth is mostly from low-caseload surgeons (ie, ≤2 cases per week). We repeated that study using data from Florida, a much more populous state, to confirm the generalizability of the findings. DesignRetrospective cohort study. SettingAll hospitals in the state of Florida. PatientsAll patients undergoing elective surgery during 2018 and 2019. MeasurementsWe determined growth between 2018 and 2019 in regular-workday elective surgical caseload and intraoperative work relative value units (wRVU) at hospitals. Using the two-sided, one group Student t-test, we compared the fractions of those increases attributable to low-caseload surgeons vs. 50% to assess if they accounted for most surgical growth. We used the exact binomial test to compare the fraction of hospitals where most growth (>50%) occurred from low-caseload surgeons to half (50%). Main resultsWe studied the 1,629,879 elective cases from 202 hospitals. Surgeons averaging ≤2.0 cases per week accounted for 73.3% (P < 0.0001 compared to 50%) of caseload growth and 68.7% (P < 0.0001 compared to 50%) of wRVU growth. The corresponding overall pooled growth estimates among hospitals were 70.8% for caseload and 65.0% for wRVU. There were 76.2% of the N = 202 hospitals with more than half their growth in cases from surgeons performing, on average, ≤2.0 cases per week (P < 0.0001 compared to 50% of hospitals). The vast majority of surgical growth at hospitals accrued from the contributions of low-caseload surgeons. ConclusionsSurgical growth in elective surgery at Florida hospitals accrued mostly from the increased activity of low-caseload surgeons averaging ≤2.0 cases per week during the preceding year, confirming the generalizability of the previous Iowa study. If growth in caseload is desired, surgical governance committees should ensure that low-caseload surgeons have access to the OR schedule.

Similarities Between Pediatric and General Hospitals Based on Fundamental Attributes of Surgery Including Cases Per Surgeon Per Workday.

IntroductionOperating room (OR) management decision-making at both pediatric and adult hospitals is determined, in large part, by the same fundamental attributes of surgery and other considerations related to case duration prediction. These include the non-preemptive nature of surgeries, wide prediction limits for case duration, and constraints to moving or resequencing cases on the day of surgery. Another attribute fundamentally affecting OR management is the median number of cases a surgeon performs on their OR days. Most adult surgeons have short lists of cases (i.e., one or two cases per day). Similarly, at adult hospitals, growth in caseloads is mostly due to the subset of those surgeons who also operate just once or twice per week. It is unknown if these characteristics of surgery apply to pediatric surgeons and pediatric hospitals as well.MethodsOur retrospective cohort study included all elective surgical cases performed at the six pediatric hospitals in Florida during 2018 and 2019 (n = 71,340 cases). We calculated the percentages of combinations of surgeon, date, and hospital (lists) comprising one or two cases, or just one case, and determined if the values were statistically >50% (i.e., indicative of “most”). We determined if most of the growth in caseload and intraoperative work relative value units (wRVUs) at the pediatric hospitals between 2018 and 2019 accrued from low-caseload surgeons. Results are reported as mean ± standard error of the mean.ResultsAveraging among the six pediatric hospitals, the non-holiday weekday lists of most surgeons at each facility had just one or two elective cases, inpatient and/or ambulatory (68.1%; p = 0.016 vs. 50%, n = 27,557 lists). Growth in surgical caseloads from 2018 to 2019 was mostly attributable to surgeons who in 2018 averaged ≤2.0 cases per week (76.3% ± 5.4%, p = 0.0085 vs. 50%). Similarly, growth in wRVUs was mostly attributable to these low-caseload surgeons (73.8% ± 5.4%, p = 0.017 vs. 50%).ConclusionsLike adult hospitals, most pediatric surgeons’ lists of cases consist of only one or two cases per day, with many lists containing a single case. Similarly, growth at pediatric hospitals accrued from low-caseload surgeons who performed one or two cases per week in the preceding year. These findings indicate that hospitals desiring to increase their surgical caseload should ensure that low-caseload surgeons are provided access to the OR schedule. Additionally, since percent-adjusted utilization and raw utilization cannot be accurately measured for low-caseload surgeons, neither metric should be used to allocate OR time to individual surgeons. Since most adult and pediatric surgeons have low caseloads, this is a fundamental attribute of surgery.

The Downs and Ups of the SNAP Caseload: What Matters?

AbstractBeginning in the 1990s, states have received unprecedented flexibility to determine Supplemental Nutrition Assistance Program (SNAP) eligibility and program administration. We find state SNAP policies accounted for nearly half of the 2000–2016 caseload increase. State economic conditions also play an important role in caseload changes, accounting for almost half of the 2007 through 2013 increase. Within distinct periods of our 1990–2016 data, policy and the economy make different contributions to caseload changes. Policy simulations indicate that mandating states to maintain their 2000 SNAP policies, prior to the greatest expansion in latitude, would have lowered 2000–2016 caseload growth by 38%.

Spatial Analyses of Temporary Assistance for Needy Families: Its Responsiveness to Labor Market Performance and Policies during the 2008 Recession

The major economic downturn of the Great Recession led many families with children to depend on cash assistance from the Temporary Assistance for Needy Families (TANF) program. In order to capture TANF caseload growth rates relative to their labor market performance, we developed a responsiveness index which revealed that many of the western and midwestern states were quite responsive to the recession. Using Exploratory Spatial Data Analysis (ESDA) tools, we found the presence of strong spatial clusters in unemployment rate and in TANF maximum aid. Several states in the western region were surrounded by neighboring states with higher growth in unemployment rate changes than the national average based on ‘Rook Contiguity’ weight matrix. The presence of High-High clusters of the level of TANF benefits was found in Northeastern states whereas the presence of Low-Low spatial clusters was found primarily in Southern states. The present study’s findings have confirmed the idea that spatial analyses can be useful for policy research. In the era of evidence-based policy making, the role of spatial analyses is bound to expand.

Gatekeeping disability income support: A conceptual model

AbstractIn most developed countries, disability income support caseloads are on the rise. Little empirical knowledge exists, however, about how policy‐makers design these programmes, contributing to caseload growth. This article specifically explores how the boundary between who is eligible and who is not for disability income support is drawn in Australia and Canada. Forty‐five interviews were conducted between March 2012 and September 2013 with informants who were or are currently involved in designing disability income support in these jurisdictions. Analysis followed the fundamental steps of grounded theory. Findings revealed that the informants describe this process as “gatekeeping,” which can be subdivided into two stages: (a) establishing the gate (definition of disability) and (b) operating the gate (who interprets the definition and how). I present the results using a conceptual model I developed, deconstructing each stage of the process of gatekeeping into discrete units of analysis. The model is useful for future comparative studies, providing a historical perspective and allows policy researchers to concentrate on specific aspects of the process in detail, which could lead to finding solutions to the challenges related to disability income support.

The Downs and Ups of the SNAP Caseload: What Matters?

Since the 1990s, states have received unprecedented flexibility to determine Supplemental Nutrition Assistance Program (SNAP) eligibility and program administration. We investigate the role of state flexibility in explaining SNAP caseloads and find that state SNAP policies accounted for nearly 40 percent of the predicted caseload decline between 1993 and 2000 – primarily through the eligibility restrictions on noncitizens – and nearly one quarter of the 2000-2011 caseload increase. State economic conditions, measured by the unemployment rate, also play a strong role in caseload changes, accounting for more than half of the predicted caseload decline between 1993 and 2000 and almost two-thirds of the increase between 2007 and 2011. We then conduct a number of policy simulations, including simulations of the size of the SNAP caseload if states had not acquired flexibility over program rules between 2000 and 2011. We estimate that, if all required states to adopt policies that would be expected to restrict caseload growth, the caseload would be between 44 percent lower while if all states were required to adopt policies that would be expected to increase the caseload the caseload would be 18 percent higher.

Child Participation in Supplemental Security Income: Cross- and Within-State Determinants of Caseload Growth

Researchers have struggled to explain the substantial growth over recent years in Supplemental Security Income (SSI) receipt among children younger than the age of 18. Although existing studies hav...

A Spatial Analysis of Mental Healthcare in Texas

This paper discusses competing-destinations formulation of the gravity model for the flows of patients from their residential areas to health supplier regions. This approach explicitly acknowledges the interdependence of the patient between a set of alternative health supplier regions. This competing-destinations-based approach may be implemented as a probabilistic demand function or conditional logit model, with a Poisson outcome. A Texas-based case study of residential areas and State Mental Hospitals (SMHs) is presented. The results of the estimation do not lend support to the presence of scale effects in SMHs due to the size of population. This result, combined with the negative effect of average length of stay and with the positive effect of the provision of forensic services on patient flows, highlights the problem of caseload growth in SMHs.

Policymaking under Constraint: Decision Modes in the U.S. Courts of Appeals

The caseload of the U.S. Courts of Appeals has increased dramatically while the volume of cases decided by the United States Supreme Court has declined precipitously. Thus, the Courts of Appeals have increasingly assumed an important policymaking role as the final arbiter of federal law, while simultaneously confronted with increased demand to monitor the decisions of the U.S. District Courts for error. In the present study, we exploit this dilemma to examine how courts with mandatory jurisdiction respond to the challenge to increase their policymaking role under the increasing resource constraints posed by caseload growth. We focus on shifts in the use of two important policymaking institutions of the Courts of Appeals—disposition with oral argument and by en banc rehearing. We find that as caseload stress has become particularly acute, the Courts of Appeals have prioritized disposition by oral argument over the use of en banc rehearing. Given the decline in the docket of the Supreme Court, an implication of this finding is that the constraint produced by rising caseloads has diminished oversight and increased autonomy for policymaking by three-judge panels in the Courts of Appeals.

Aid to Jobless Workers in Florida in the Face of the Great Recession: The Interaction of Unemployment Insurance and the Supplemental Nutritional Assistance Program

Although many programs redistribute resources in the U.S., two program were central in providing a safety net for those facing hardship during the Great Recession: the Supplemental Nutrition Assistance Program (SNAP), which grew to 47.7 million people in January 2013 – or 15.1 percent of all Americans – and the Unemployment Insurance Program (UI), which more than doubled with the onset of the recession, reaching a seasonally adjusted maximum of 6.5 million recipients in June 2009. We examine state administrative data from Florida for SNAP and UI from late 2005 through early 2010. We focus on two research questions: 1. In the face of caseload growth and compositional change in both programs, how has joint participation in UI among SNAP recipients changed? How much of the increase in joint participation is driven by changes in the characteristics of individuals participating in SNAP? How much is driven by the changing economic and policy conditions? 2. How has the role of UI changed for SNAP participants, and in particular how have patterns of combined usage evolved during this period? We find that the number of families relying on both SNAP and UI together ballooned with the Great Recession, and that the patterns changed as expected, with UI growing dramatically in relative importance. At the same time, only a minority of those swelling the ranks of SNAP obtained benefits from the UI program, suggesting that the current safety net has important limitations in times of serious economic distress.

Welfare reform's impact on caseload decline in the United States: An application of latent trajectory model

This paper examines the effect of welfare reform policies on caseload changes during 1992–2005. Using state-level panel data we estimate latent trajectory models to determine if welfare reform has contributed to changes in the trajectories of caseload growth (decline) beyond what would have naturally occurred through the passage of time. Our results show that (a) states vary considerably in both their mean initial level as well as linear trajectories of caseload changes; (b) welfare reform was responsible for the major share of the decline in caseloads; (c) the economy played a minor role in hastening caseload declines; and (d) other income support policies like EITC and minimum wage also had a role to play.

The effect of the original introduction of Medicaid on welfare participation and female labor supply

This paper uses the fact that states introduced Medicaid programs at different times between 1966 and 1972 to estimate Medicaid’s effect on Aid to Families with Dependent Children (AFDC) participation. Using state-level data, we find that the introduction of Medicaid accounted for approximately 10% of growth in AFDC caseloads from 1964 to 1974, a time period during which there was thought to be significant unexplained growth in caseloads. Analysis of individual-level data indicates that Medicaid’s effect on AFDC participation occurred through its effect in increasing the number of eligibles who participated in the program, and not because of increases in eligibility or reductions in workforce participation.

Assessing the Impact of Welfare Reform on Single Mothers

THE PERSONAL RESPONSIBILITY and Work Opportunity Reconciliation Act (PRWORA), signed into law in 1996, transformed the U.S. welfare system. PRWORA replaced the Aid to Families with Dependent Children (AFDC) program with Temporary Assistance for Needy Families (TANF). Since its inception in 1935 as part of the Social Security Act, AFDC had been the main welfare program providing assistance to low-income single mothers. But a number of factors, particularly the rapid growth in the never-married single-mother population and a resumption of growth in caseloads in the early 1990s (following the surge of the late 1960s and early 1970s; figure 1), rendered the program unpopular. (1) Under the new TANF program, welfare participation among single mothers has dropped dramatically, from 25 percent in 1996 to 9 percent today. At the same time, the fraction of single mothers who work has increased from 74 percent in 1996 to 79 percent today. The goal of this paper is to ascertain what features of welfare reform, if any, have been most responsible for this decline in welfare participation and increase in work among single mothers. [FIGURE 1 OMITTED] Two factors complicate our task. First, a key feature of PRWORA was that it reduced federal authority over welfare policy, giving the states much greater leeway in the design of their own individual TANF programs. A great deal of program heterogeneity has emerged across states, making it difficult to develop a set of variables that comprehensively characterize the different state TANF programs. Second, a number of other recent developments may also have contributed to the changes in welfare and work participation since 1996. These factors, such as the strong U.S. economy of 1996-2000 and the significant expansion of the earned income tax credit (EITC) after 1993, must be controlled for in order to isolate the impact of particular elements of state TANF policies. One important fact lends credence to the idea that factors other than PRWORA may account for the lion's share of recent caseload declines: the dramatic drop in welfare participation (and the dramatic increase in work) among single mothers actually began in 1993-94, before PRWORA's enactment (figure 2). From 1993 to 1996 AFDC participation fell from 32 percent to 25 percent. On the other hand, beginning around 1993, many states began to obtain federal waivers allowing them to adopt TANF-like reforms of their AFDC programs. Such reforms included work requirements, time limits on benefits, sanctions for failure to meet work requirements, and family caps. These changes may have contributed substantially to caseload declines even before PRWORA. [FIGURE 2 OMITTED] At the same time that PRWORA delegated greater control of welfare policy to the states, it also mandated nationwide many of the popular features introduced under state waivers, such as time limits and work requirements. To understand the sense in which the federal law mandates certain features of state TANF programs, one must understand how federal TANF funds are distributed to the states. Under AFDC, states received federal matching funds based on their AFDC expenditures. PRWORA converted these matching funds to block grants. The block grant for a state was fixed at a level related to federal funding of AFDC benefits and other related programs in the year when that funding had been highest in that state. States were given substantial leeway in how the block grant funds could be used: for example, they may use it to support child care (an important postreform development to which we will return). However, to avoid fiscal penalties on the federal block grant, states must adhere to a maintenance of effort (MOE) rule: states must maintain their spending on assistance for needy families at no less than 75 to 80 percent of their pre-1996 level. (2) PRWORA requires that state TANF programs set a five-year lifetime limit for any individual receiving federally funded aid, although states may exempt up to 20 percent of their caseload from the limit. …

The Welfare Implications of Increasing DI Benefit Generosity

The empirical literature on DI has primarily focused on the impact of program parameters on caseload growth or reduced labor force attachment. The focus on the efficiency costs of DI provides a misleading view of the social desirability of the program itself and of the adequacy of benefit levels. In order to provide a more comprehensive view, we develop a framework that allows us to simulate the benefits as well as the costs associated with a marginal increase in benefit generosity using a representative crosssectional sample of the population. Using the 1991 March CPS, we estimate the total cost of providing an additional $1 of income to current DI recipients to be $1.42. While the load factor due to moral hazard is fairly high, we demonstrate that it is moderate enough that representative workers should be willing to buy additional insurance through reduced take-home pay at this price. The reform looks less attractive, however, once the financial benefits and costs are distributed across individuals in the sample. Fist, the average implicit price of an additional dollar of insurance is actually much higher than $1.42 for all but the least educated category of workers due to the redistribute nature of the program. We predict that the reform leads to a net welfare loss for these more highly educated groups, regardless of the level of risk aversion. Second, despite an average implicit price of less than $1, the expected utility gain also turns negative for high school dropouts under high levels of risk aversion. Second, despite an average implicit price of less than $1, the expected utility gain also turns negative for high school dropouts under high levels of risk aversion. This counterintuitive finding arises since the utility calculation weighs low income individuals more heavily as risk aversion increases and individuals with income below the floor provided to current DI recipients help to finance the benefit increase.

Pre‐1997 Trends in Welfare and Food Assistance in a National Sample of Families

Both the Food Stamp Program (FSP) and Aid to Families with Dependent Children (AFDC) saw unprecedented caseload growth from the late 1980s until 1994, followed by caseload declines in the following years. These rapid caseload declines are attributed to changing macroeconomic conditions and to substantial changes in program design. First, in the early 1990s, state applied for waivers from federal welfare program regulations, which allowed them more freedom to experiment with welfare reforms. Then, in 1996, Congress redesigned the federal safety net for low-income Americans through the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). This paper uses data from the Panel Study of Income Dynamics (PSID) to investigate participation transitions from year to year during the 'waiver period,' from 1989 to 1996. The distinctive feature of the approach here is that it considers all possible transitions at the individual level among three participation states - AFDC (with or without FSP), FSP Only, and Neither-rather than treating each program separately. This investigation provides a baseline for future work using PSID data to study the impact of the 1996 welfare reforms.

The growth in noncitizen SSI caseloads 1979-1996: aging versus new immigrant effects.

The goal of this research is to assess the degree to which the recent growth in the rate of Supplemental Security Income (SSI) usage is concentrated among recently arrived elderly immigrants or among earlier arriving immigrants who have "aged in place" and thus become eligible for benefits. We use 1980 and 1990 Census data and 1997 Current Population Survey (CPS) data to examine whether the growth in the elderly noncitizen caseload during the 1980s and 1990s may be attributed to increases in rates of receipt among newly arrived elderly immigrants, to increases in rates of receipt among "settled" immigrants who have aged into categories that allow them to obtain SSI benefits, or to increases in the number of persons in each of these groups. We find that the major contribution to the growth in the noncitizen elderly SSI caseload has been the significant increase in the rate of receipt among those who have lived in the United States for more than 10 years (a smaller increase occurred among recent arrivals). This factor accounts for about half of the total growth in the caseload and cannot be explained by increases in poverty among noncitizens. The idea that the availability of SSI for elderly immigrants has acted as a magnet for poor elderly immigrants, thereby accounting for the growth in the elderly immigrant SSI caseloads during the 1980s and 1990s, does not receive much support in the findings of this research.

The federal courts: challenge and reform

federal courts are the world's most powerful judiciary and a vital element of the American political system. In recent decades, these courts have experienced unprecedented growth in caseload and personnel. Many judges and lawyers believe that a crisis in quantity is imperiling the ability of the federal judiciary to perform its historic function of administering justice fairly and expeditiously. In a substantially revised edition of his 1985 book The Federal Courts: Crisis and Reform, Chief Judge Richard A. Posner of the US Court of Appeals for the Seventh Circuit provides a comprehensive evaluation of the federal judiciary and a detailed programme of judicial reform. Drawing on economic and political theory as well as on legal analysis and his own extensive judicial experience, Posner sketches the history of the federal courts, describes the contemporary institution, appraises the concerns that have been expressed with the courts' performance, and presents a variety of proposals for both short-term and fundamental reform. In contrast to some of the direr prophecies of observers of the federal courts, Posner emphasizes the success of these courts in adapting to steep caseload growth with minimum sacrifice in quality. Although the book ranges over a variety of traditional topics in federal jurisdiction, the focus is steady on federal judicial administration conceived of as an interdisciplinary approach emphasizing system rather than doctrine, statistics rather than impressions, and caseload rather than cases.

Managing probation programs with geographic information systems

At a time when funding for probation does not catch up with the growth in caseloads, probation programs need to adopt new technology, such as geographic information systems (GIS), to increase their management efficiency. We discuss our implementation of a GIS to support management of the probation program in Cuyahoga County, Ohio. GIS provides a set of efficient tools for data integration, mapping, and analysis. Furthermore, it allows probation officers to understand their clients and plan their tasks better. As a decision support system, GIS integrates information from various sources and makes them readily available to probation officers. As a data analysis tool, GIS enables probation officers to study the profiles of their clients with only minimal efforts. As a task management assistant, GIS supports a wide variety of alternatives in storing or updating records and planning activities.