HHS/ASPE. U. S. Department of Health and Human Services.Background

ASPE ISSUE BRIEF

Drug Testing Welfare Recipients:
Recent Proposals and Continuing Controversies

October 2011

This Issue Brief is available on the Internet at:
http://aspe.hhs.gov/hsp/11/DrugTesting/ib.shtml

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About This Issue Brief
This ASPE Issue Brief examines recent State and federal legislative proposals to require drug tests as a condition of TANF program eligibility.  During 2010 and the first half of 2011, 82 bills on this subject were proposed in 31 State legislatures and the U.S. Congress.  This brief, which was prepared by Laura Radel, Kristen Joyce, and Carli Wulff of ASPE’s Office of Human Services Policy, describes potential uses and limitations of drug tests in the context of welfare programs.

Contents

Appendices

  1. 2010 and 2011 Federal and State Legislative Proposals on TANF Drug Testing
  2. Tribal TANF Drug Testing Policies
  3. Estimated Costs of Drug Testing Proposals

References

Background

In the years since welfare reform transformed federal cash assistance for the poor into to the time-limited, work-focused Temporary Assistance for Needy Families (TANF) Program, the issue of substance abuse among welfare recipients has arisen periodically as a policy and programmatic concern.[1]  In recent years there have been vigorous policy debates focused on welfare policy with respect to persons with drug felony convictions[2],[3] as well as proposals to require drug tests as a condition of eligibility.[4]

This paper discusses the prevalence of substance abuse among TANF recipients, how States typically address substance abuse in their welfare programs, the variety of drug testing proposals now under discussion in States, and legal and practical issues raised by drug testing proposals.

How prevalent is substance use, abuse, or dependence among TANF recipients?

Studies of the prevalence of substance abuse among welfare recipients have varied widely in their findings, with rates of between 4 and 37 percent reported.  Much of the difference in prevalence rates found in these studies is due to different data sources, definitions and measurement methods, particularly the different thresholds used to define substance abuse.  Another key difference is whether alcohol abuse and/or the abuse of prescription drugs are included in the estimate.  In addition, drug use and abuse is higher among single men in States’ General Assistance (GA) caseloads than among single (largely female) parents on TANF.  So studies that define welfare to include GA beneficiaries often find higher rates.  Typically, lower end estimates of around 5 percent or less focus on indications of diagnosable abuse of or dependence on illicit drugs among TANF or (for early estimates) Aid to Families with Dependent Children (AFDC) Program clients.  Higher rates, in the 10 percent range, tend to include any past month use of illicit drugs. Rates in the highest ranges (15 percent or more) usually define substance abuse to include alcohol abuse and include any past year (rather than past month) use of illicit drugs.  The highest rate noted to date in any study, 37 percent,[5] included female welfare recipients reporting having used any illicit drug at least once in the past year and/or two or more binge drinking episodes in the past month (with binge drinking defined as having had 5 or more drinks on the same occasion or within a couple of hours).

Most studies of TANF recipients and persons receiving other types of means-tested government assistance find rates of substance abuse that are somewhat higher than those in the general population not on assistance, though not greatly so. Typical among these is a 2002 analysis of substance abuse among persons in families receiving government assistance conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).[6]  That analysis found that past month illicit drug use was reported by 9.6 percent of persons age 12-64 in families receiving government assistance (including Medicaid, SSI, cash assistance, non cash assistance, and Food Stamps), compared to 6.8 percent of persons in families not receiving assistance.  Of public assistance recipients treated for substance abuse in 2008, the most common primary substance of abuse was alcohol (37 percent of those treated).  Other common primary substances of abuse were heroin (19 percent), cocaine (18 percent), and marijuana (14 percent).  Approximately 4 in 10 public assistance recipients who were admitted to treatment in 2008 had a co-occurring psychiatric disorder in addition to their alcohol or drug problem.[7]

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What does federal TANF law currently say
about substance abuse among program recipients?

Federal law currently includes two provisions specifically related to TANF recipients’ substance use, both added by the 1996 welfare reform law, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA, P.L. 104-193).  Both refer only to the use and abuse of illicit drugs.  First, there is a provision that says States may require drug tests for welfare recipients and may penalize those who fail such tests (21 U.S.C. 862b).  In addition, the law includes a lifetime ban on TANF and Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) benefits for persons convicted of a drug-related felony, though States have the option of modifying or opting out of the ban (21 U.S.C. 862a), and many have done so.  Some States also use a provision allowing the use of Individual Responsibility Plans to require substance abuse treatment for beneficiaries who need it, and to sanction for noncompliance with that plan (42 U.S.C. 608(b)).

It should be noted that while proposals to introduce drug testing in State TANF programs have proliferated in recent years, action with respect to the drug felon ban has moved in the opposite direction.  An increasing number of States have opted out of the drug felon ban in recent years because the unavailability of benefits was found to hinder the successful social and economic re-entry of persons released from prison.  As of 2009, 11 states imposed the TANF ban on all drug felons, 26 states and the District of Columbia had modified the ban to impose it only under certain conditions, and 13 states had opted out entirely. Common modifications to the ban include to apply it only to persons whose drug felonies involve drug manufacture, distribution, or trafficking; to place time limits on the ban; or to exempt individuals who complete substance abuse treatment.  While some states opted out or modified the drug felon ban early, other state modifications are relatively recent.  Seven states enacted legislation to modify or eliminate the TANF drug felon ban between 2004 and 2009.[8]

How do States typically address substance abuse in their TANF programs?

States have struggled to decide whether substance abuse in the context of the TANF program should be addressed as a public health issue, a criminal issue, a social issue, or a moral issue.  Prior to welfare reform, few States made efforts to identify whether clients had alcohol or other drug abuse problems.  That changed under welfare reform as employment and self sufficiency became primary program goals.  In a survey at the time TANF was first implemented, States identified screening for substance abuse as one of their top challenges related to assessing the job readiness of TANF clients.[9]  In the TANF era, a variety of States have identified substance abuse as a barrier to employment and have established mechanisms to encourage substance abuse treatment for those who need it.[10],[11]

Many states already conduct substance abuse screening and assessment either as part of their TANF intake processes or at some point later, such as after an unsuccessful job search or if a beneficiary quickly loses an initial job. These efforts are intended to determine whether substance abuse presents a barrier to employment.  States use various screening and assessment approaches within their TANF programs and vary in their efforts to link program participants who have substance abuse disorders with substance abuse treatment.  The most commonly used screening approaches are question and answer instruments which are designed to detect evidence of alcohol and illicit drug abuse and dependence, such as the Substance Abuse Subtle Screening Inventory (SASSI), which has been shown to be reasonably accurate in detecting problem substance use, including alcohol abuse, in a variety of populations.[12]  Other more specialized approaches to substance abuse screening have also been tested, with some success.[13]  Clients who screen as potentially having a substance abuse problem are then referred to substance abuse specialists for a fuller assessment of their substance use, functioning, and treatment needs.  However, TANF programs typically identify and refer far fewer clients to treatment than would be expected based on prevalence rates.[14]

In recent years more than half the States have considered legislation that would require their welfare agencies to administer drug tests to TANF applicants and/or recipients, though few have enacted laws on the topic (see Appendix A for details).  These proposals vary in their content on many dimensions.  Of those actually enacted, a broad, suspicionless drug testing program in Michigan had operated briefly in 1999 before being suspended by the courts.  (“Suspicionless” testing refers to programs that test either everyone or a random subset without having reason to believe that the individuals tested have used illicit drugs.)  Arizona has been testing TANF recipients for whom they have reason to suspect substance abuse (i.e. “for cause”) since 2009.[15]  Missouri and Florida each passed drug testing legislation in 2011.  Missouri will be testing current beneficiaries for cause,[16] while the Florida program requires suspicionless testing of all applicants.[17]  During the initial weeks since Florida’s program began operations, 2 percent of TANF applicants there have tested positive.[18]  In addition, more than 20 Indian Tribes also use drug testing in their Tribal TANF Programs, primarily to identify individuals in need of further assessment and treatment as part of their job readiness activities (details appear in Appendix B).[19]

Legislative proposals on drug testing vary widely.  Some focus on punishment and cost savings and would deny benefits to individuals who test positive without efforts to provide substance abuse treatment, without opportunities for benefits to continue for children, and without procedural safeguards to ensure the reliability of positive results.  Proposals in this category include bills introduced in Kentucky and Oregon (see Appendix A for details).  Others are oriented toward identifying clients who need substance abuse treatment in order to achieve employment and self sufficiency goals.  Such proposals, including bills in Connecticut, Illinois and New York, would require substance abuse evaluation and treatment as a consequence of testing positive.  Still others include provisions related to child well-being, requiring that children’s benefits be paid to a third party who will ensure benefits are spent to meet the children’s needs.  Proposals in Maryland, Rhode Island, and South Carolina, among others, include this feature.

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What does drug testing reveal and what limitations are inherent?

Positive drug tests are intended to identify whether an individual has used specific substances recently.  The most common tests detect five specific drugs (amphetamines, cocaine, marijuana, opiates and phencyclidine (PCP)); tests for additional drugs are also available at additional expense.  They function by detecting in the tested individual’s bodily fluids or tissues (e.g. urine, blood, saliva, or hair) the substance itself and/or metabolites produced as the body breaks down the substance.  How long a substance may be detected depends on how quickly the body fully metabolizes the substance.  Urine drug tests, which are the least expensive and most frequently used form of drug test, can generally detect marijuana use within the past week; cocaine, heroin and other “hard” drugs used within the past two days; and alcohol use within the past several hours (though alcohol is not often included in drug screens).  Drug tests cannot measure frequency of use, nor do they indicate the severity of impairment or whether an individual has a substance use disorder that requires treatment.  In addition, without medical review and confirmation testing on initial positive results,[20] urine screens also cannot distinguish between the illicit use of street drugs and the legitimate use of certain prescription and over-the-counter drugs.  For instance, a drug test cannot distinguish between prescribed Tylenol with codeine and illicit opiates.  Improper testing procedures and mishandling of samples can also produce inaccurate results.[21], [22], [23]

Drug testing has significant limitations in its ability to identify welfare recipients with substance abuse problems.  One study concluded that drug tests would misclassify, either positively or negatively, more cash assistance recipients than it would accurately identify as having a substance abuse problem in need of intervention.  Estimates for false negatives included those who abuse alcohol or other substances not detected by the most commonly used drug tests and those whose most recent use was not within the short window within which metabolites are detectable by urine screens.  False positive results included users whose legitimate prescription drug use would be detected, persons with medical conditions (e.g. kidney disease) that can cause inaccurate results, as well as occasional users detected by the screen but who are not in need of treatment.[24]

Testing of hair rather than urine is often promoted because it is less invasive and can detect drug use over longer time periods.  Hair tests cannot detect very recent drug use but do detect use that has occurred between (approximately) 10 and 90 days prior to the test (depending on the length of the hair).  In addition to being more expensive than urine testing, however, hair testing raises several important concerns.  As compared with urine drug tests, hair testing may more frequently result in positive results because of external (i.e. passive) exposure to drugs or chemicals.  Hair treatments, such as coloring or straightening, can also affect the results of hair tests, making it more difficult to detect drug use.  In addition, hair testing is not used in some Federal criminal justice proceedings because there is some evidence that naturally dark hair (e.g. that of African Americans and Asians) is more likely to test positive than lighter hair, leading to concerns of racial bias in the effects of testing programs.[25]

One study has examined the specific limitations of drug testing welfare recipients.  A pilot test of a drug testing regime for welfare recipients in Florida concluded in 2003 that drug testing “did not produce reliable estimates of the level of drug use among TANF recipients.”[26]  In particular, many recipients determined through a validated screening tool as likely to have a substance abuse problem nonetheless tested negative in urine drug screens.  Studies have also found recipients’ drug use is largely unrelated to welfare exits,[27] long welfare stays, repeat welfare use or the length of time spent on welfare, [28] and is of only minor relevance in predicting employment success among welfare recipients.[29]  However, one study did find that welfare reform led to declines in drug use and increased substance abuse treatment utilization among women at risk for relying on welfare.[30]  The study concluded that there is evidence that the effects operated through both sanctions and work incentives. That is, drug users were discouraged from participating in the TANF program and those who found employment reduced their recreational use of illicit drugs.  It should be noted, however, that the research base is weak and the few existing studies have not used rigorous methodologies.

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What are the similarities and differences among TANF drug testing proposals
being considered by the states?

During 2010 and the first half of 2011, legislators in 31 states have proposed 82 bills that would require drug tests of TANF applicants and/or recipients.[31]  There was also one proposal each in the U.S. House of Representatives and Senate.  The many current legislative proposals differ on their features and are summarized in Appendix A.  Features that differ widely among the bills include the following:

The legislative proposals identified differ in the populations that would be subject to drug testing.  Of the bills, 50 State bills plus the two congressional bills would require that applicants be tested, 35 State bills would require suspicionless testing of current recipients, and an additional 26 would test current recipients for cause.  In addition, while nearly all bills focus on testing adult applicants or recipients, a small minority of State bills would require youth aged 13 or older be tested and proposed legislation in one State would require that all benefit recipients, including children under 12, be tested.

Consequences for a positive test vary.  Most commonly, 55 bills would automatically deny benefits to those testing positive (for varying lengths of time from 90 days to several years), while 24 either require substance abuse evaluation and treatment or provide referral to services.  For States providing treatment or referral services, some bills allow benefits to continue during treatment and many allow for earlier reapplication upon completion of treatment.  About one-third of State bills provide for children and other family members to continue to receive the benefit (usually paid to a third party) if

the adult is either in treatment or is ineligible for benefits as a result of a positive test.  In addition, while not mentioned in the statutory language, news reports regarding the implementation of Florida’s new TANF drug testing law indicate that parents testing positive will be reported to the State’s child abuse hotline.[32]

Fewer of the legislative proposals include procedural safeguards to protect against false positive results or the use of drug testing data for purposes unrelated to the TANF program:  24 allow for retesting, 13 note that results may not be used for criminal prosecution, and 12 would allow for administrative hearings or appeals.  Eleven bills would require recipients to pay for the costs of testing, although some States would reimburse those who test negative.

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On what basis have recent TANF drug testing programs been challenged in court?

Drug testing is a common pre-employment condition among private employers.  Testing by the government has resulted in Constitutional challenges — the most recent one involves a challenge to Florida state law.  Courts have upheld the legality of drug testing by government agencies for individuals in sensitive positions and when public safety is involved, as well as for persons involved in accidents on the job and for certain public school students.  Testing when there are specific reasons to suspect drug use is also allowed.  However, courts have struck down suspicionless drug testing requirements when they have determined there is no real public safety issue.[33]

Michigan’s 1999 program of suspicionless drug testing of TANF recipients was suspended by the courts after operating only a few weeks, and Florida’s recently implemented policy of testing applicants is the subject of a pending challenge.  The primary issue in the Florida challenge is whether such testing violates the Constitution’s Fourth Amendment prohibition against unreasonable searches and seizures, which prevents the indiscriminate searching of individuals.  Plaintiffs argue that since suspicionless testing involves no reasonable cause to suspect the individuals tested and courts have definitively ruled that drug tests constitute searches, suspicionless testing should not be allowed under the Fourth Amendment.  Also at issue in some disputes in this area is the adequacy of due process protections provided to persons for whom a positive drug test results in the suspension of benefits.  The Fifth and Fourteenth Amendments require that the government make available safeguards to prevent an individual from being deprived of property through arbitrary processes or results.  In the context of drug testing, due process typically includes assuring that drug tests are processed by reputable, certified labs that conform to federal specifications, conducting more accurate confirmatory tests when initial results are positive, and having positive results reviewed by a Medical Review Officer who can determine whether the results may be due to legally obtained prescription drugs or medical conditions that may influence test results.

Drug testing by government agencies as a condition of eligibility for public benefits is an area of active litigation.[34]  Governmental entities interested in conducting drug tests should examine relevant statutory and case law before implementing such requirements.

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How much does it cost to implement drug testing in TANF programs?

The estimated cost of drug testing TANF applicants and recipients varies by State and proposed law, depending on the proposed number of individuals who would be tested and the range of activities for which costs were estimated.  Aggregate cost estimates of proposed welfare drug testing legislation were identified for twelve States (see Appendix C for details).  The estimated costs in these States ranged from $92,487, for drug testing 20% of recipients and treating 2% of those tested in Louisiana, to $20 million, for just the testing of all public assistance applicants and recipients in New York.  Other estimates include the cost of increasing staff to monitor or administer the tests, as in Maryland and Missouri.  Idaho’s estimate includes the cost of making programming changes to the State’s information system. Florida’s law and Alabama’s proposal require the applicant or recipient to pay for the up-front costs of the drug test, though both would reimburse those who test negative.  Most estimates do not incorporate costs relating to increased substance abuse treatment utilization or to increased child welfare interventions.

Examples of costs used in State cost estimates include:

None of the State cost estimates identified for this paper showed net savings resulting from proposed drug testing programs, though these are all legislative cost estimates rather than rigorous cost-benefit analyses.  Also, none of the State cost estimates identified described anticipated unit costs of drug testing programs.  However, an article from a magazine published by The Society for Human Resources Management reported in 2005 that, “testing an applicant or employee ranges from $25 to $44 for urinalysis… [while] hair follicle testing costs $75 to $150 per test.”[35]  News reports regarding the implementation of Florida’s new drug testing policy have cited an estimate of $30 per TANF recipient for the drug tests being required of applicants,[36] though the State’s drug testing pilot program in the early 2000s cost $90 per test once staff costs and other program costs were included.[37]  Testing costs among the Indian Tribes that currently administer drug tests in their TANF programs ranges from $15 per client to $89 per client, with most reporting unit costs in the range of $30 to $50.[38]

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What impact does drug testing of TANF applicants and recipients have on objectives,
such as cost savings, child well-being, and increased employment?

Cost Savings.  As noted above, some States anticipate drug testing TANF applicants and recipients will save money. Those who would fail the test, do not comply with the test, or are deterred from applying knowing they would be tested would help decrease the public assistance rolls.  These savings, particularly savings from deterrence, are difficult to measure.  However, none of the legislative costs estimates we identified estimated net savings as a result of the proposed drug testing programs.  For instance, an analysis of Idaho’s public assistance programs estimated savings from removing or deterring people with substance abuse issues at $1.12 million.  The cost of drug testing and treating all approved applicants was estimated to cost between $1.2 and $1.3 million.[39]  In Louisiana, as noted above, drug testing for 20% of TANF recipients and treatment for those (2%) who test positive has been estimated to cost $92,487, while savings were expected to be $31,248 for those who do not comply and have their benefits terminated.  The net cost for Louisiana’s proposal was estimated to be $61,239.[40]  The newly enacted Florida law would allow TANF applicants who failed the drug screen to designate a payee for their children to continue to be able to receive benefits.  This provision would decrease the potential savings of drug screening in that State since only savings from the adults’ benefits would be realized.[41]  Savings would also be reduced if substance abuse treatment and child welfare costs that are likely to be incurred outside the TANF program were included.

Child Well-Being.  Few proposals suggest child well-being improvements as a result of drug testing, though provisions for protective payees for children’s benefits are intended to ensure funds are spent on children’s needs.  Proposals that sanction families by definition reduce the income available to the family and may therefore decrease child well-being.  Sanctions and benefit decreases have been shown to increase the risk that children will be hospitalized and face food insecurity.[42]  An Idaho analysis also suggests that children may be harmed unintentionally by drug testing programs because parents may refuse to apply for benefits knowing they will face drug testing or may refuse to complete treatment.[43]  On the other hand, deterrent effects of drug testing may lead welfare applicants to reduce drug use, with potential positive effects for children.  These potential effects, both positive and negative, are speculative.  No rigorous research has investigated the impacts of TANF drug testing requirements.

Increased Employability.  Some proponents of drug testing for TANF applicants and recipients support the practice because they believe testing will deter and/or detect and remediate substance abuse, which is seen as a barrier to employment.  Little evidence is available to evaluate this proposition.  An evaluation of a Florida drug testing pilot found that those welfare recipients who tested positive for drugs had similar employment outcomes as others on TANF.  Florida’s drug screening and testing pilot for TANF was implemented from January 1999 to May 2001.  A total of 8,797 applicants and recipients were tested and 335, or 3.8%, tested positive for a controlled substance.  Florida State University conducted an evaluation of the pilot and found that there was very little difference in employment and earnings between those who tested positive versus those who tested negative and concluded that the cost of the program did not justify the outcomes achieved and the program did not warrant full implementation.[44], [45]  The study’s a review of the research evidence concluded that drug use is not a major barrier to employment for welfare recipients.[46]  The authors of the Florida study caution that a disproportionate emphasis on drug use as a barrier to employment could be ineffective if other major barriers, such as physical and mental health problems, lack of job skills, and lack of transportation, are ignored.  It should be noted that few drug testing proposals include substance abuse treatment components, making deterrence the primary mechanism through which decreased drug use or increased employment could result.

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Summary

Most estimates find that 5 to 10 percent of welfare recipients have substance abuse problems, rates that are a few percentage points higher than those found in the general population.  These rates generally include only illicit drugs. However, as in the general population, alcohol abuse is the most prevalent substance abuse problem among welfare recipients.  Drug tests detect recent drug use, but provide no information about frequency of use, impairment, or treatment needs.

The majority of states have active legislative proposals regarding drug testing of TANF applicants or recipients, though only a few have approved legislation and currently only Florida is conducting suspicionless testing of TANF applicants and participants.  The Florida drug testing program is currently under legal challenge.  Bills being considered in state legislatures vary significantly on many features, including who is tested and under what circumstances, whether substance abuse assessments and/or treatment are made available to those who test positive, and whether the proposals include features intended to prohibit the misuse of information obtained and/or to protect the well-being of the children in households denied benefits.

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Appendix A:
2010 and 2011 Federal and State Legislative Proposals on TANF Drug Testing
State Bill Number (and year) Status
(as of 6/15/2011)
Target Population Testing Method Substance(s) Included Procedural Safeguards Consequences of a Positive Test Is Substance Abuse Treatment or Child Well-Being Addressed? Other/Comments
US Congress S. 83 and H.R. 1769(2011) Referred to committee Requires states to certify that TANF applicants have been drug tested and states may include continued (random or set) testing of recipients Not specified Controlled substance as defined in section 102 of the Controlled Substance Act. Not specified Ineligible for benefits for positive test for two years (or for drug related crime after bill is in effect). No benefit at any time for three positive tests or three convictions. States determine rehabilitation and treatment programs.  Recipients may continue receiving benefits and must have clean drug test 6 months after entering treatment for continued receipt.  
Alabama Senate Bill 496 (2011) Pending Committee Action Any person applying for temporary cash payments (dependent children under 18 are excluded) Chemical, biological or physical instrumental analysis Drug which are prohibited by law and include, but not limited to:  amphetamine, tetrahydrocannabinol, oxycodone, cocaine, phencyclidine, opiate, barbiturate, benzodiazepine, methamphetamine, proposxyphene, tricyclic antidepressant, without a valid prescription May retake the test one or more times Ineligible for benefit for one year Reapplication allowed after 6 months for documented treatment completion; If parent is ineligible, child remains eligible and payment is made to designated payee Cost of test is responsibility of person being tested, but if person passes test, the amount of the test is added to first TANF benefit paid
  House Bill 157 (2011) Pending Committee Action Random testing of adult applicants plus required testing for someone who appears or acts in way that suggests they may be under the influence Blood or urine Schedule I, Schedules II-IV without valid Rx Results not admissible in criminal proceeding without consent of person tested Ineligible for benefits    
 

Arizona

House Bill 2011b Senate Bill 1011 (2010) Transmitted to governor and signed All adult recipients receiving TANF with reasonable cause Not specified Controlled substances without Rx   Ineligible for benefits for one year   All bills have identical language
  Senate Bill 1620 (2011) Transmitted to governor and signed All adult recipients receiving TANF with reasonable cause Not specified Controlled substances without Rx   Ineligible for benefits for one year   Same language as 2010 bills
California Senate Bill 384 (2009) and Assembly Bill 730 (2011) Introduced Random testing to determine  ongoing eligibility Unspecified "chemical" test Schedule I, Schedule II (cocaine, opium, phencyclidine, methamphetamine), prescriptions without Rx   Benefits discontinued if treatment is not completed 1 year treatment program to continue receiving benefits 2009 and 2011 language nearly identical
Connecticut Senate Bill 395 (2011) Referred to committee Periodic testing on all recipients over 18 Not specified Illegal drugs   1st positive test: evaluation with either required education or treatment, 2nd positive test; same; 3rd positive test or for those who refuse treatment, benefits terminated Treatment or education required for continued receipt  
Florida House Bill 353 and Senate Bill 556 (2011) Signed into law All applicants (excludes dependent children under 18) Not specified, but consistent with Florida statute 112.0455 (also vague) Not specified Retesting allowed Ineligible for benefit for one year (3 years after 2nd positive test) Treatment information provided; Reapplication allowed after 6 months for documented treatment completion; If parent is ineligible; child remains eligible and payment is made to designated payee Cost of test is responsibility of person being tested, but if person passes test, the amount of the test is added to first TANF benefit paid; reads very similar to AL bill
Georgia House Bill 464 (2011) Introduced Each recipient would be tested randomly once a year Not specified Marijuana or controlled substances without valid Rx Retesting allowed; results not used for other purposes Ineligible for benefit until clean test (2nd failure leads to two years of ineligibility)   Testing cost to be deducted from benefits
Iowa House File 356 and Senate File 90 Both referred to committee Adult applicants (at application) and recipients (annually, assigned random month) Blood or urine (Senate bill has additional specifications) Marijuana or controlled substances without valid Rx Not admissible in court without consent (Senate includes language about confirmatory test for positive test and provision that person tested is able to request 2nd confirmatory test) Ineligible for benefits   Costs deducted from benefits
Illinois House Bill 11 (2011) Referred to committee May be required as condition of eligibility (to begin as pilot program in 3 counties) [not required for individuals over 65] To be reported by Department of Human Services annually To be reported by Department of Human Services annually Mandatory re-test of original sample Ineligible for benefits if not participating in drug treatment program    
Illinois (continued) House Bill 1402 (2011) Referred to committee Random testing of applicants To be reported by Department of Human Services annually To be reported by Department of Human Services annually   Ineligible for benefit for 1 year Treatment must be completed within 60 days to continue to receive benefit (plus clear test after treatment is over); other family members remain eligible Requires testing to file  for nomination for state senator or representative
Indiana House Bills 1452 and 1559 and Senate Bill 568 (all 2011) Referred to committee Universal testing of applicants;  recipients over 18 to be tested based on reasonable suspicion Urinalysis Controlled substances without Rx Appeals available, all positive samples are retested before action is taken Ineligible for benefit for 1 year If completing rehab program, TANF benefits available on day of treatment completion; child remains eligible Includes language about exclusion from Medicaid for positive test; drug testing language similar between all bills
Kentucky House Bill 208 (2011) Referred to committee All applicants and ongoing recipients (recipients tested once each year by random month assignment) Urinalysis or blood test Schedule I, Schedules II-IV without valid Rx Results not admissible in criminal proceeding without consent of person tested Ineligible for benefit    
  House Bill 402 (2011) Referred to committee Applicants and ongoing All complete pencil/paper questionnaire;  blood or urine test required if questionnaire responses indicate a possible issue Schedule I, Schedules II-IV without valid Rx Results not admissible in criminal proceeding without consent of person tested 60 day grace period for positive test followed by re-test (paid for by person being tested); if this test is positive, benefits are terminated Child and other family members remain eligible  
Louisiana House Bill 611 (2010) Referred to committee Expands mandatory drug testing to all adult recipients receiving cash assistance (FITAP) Whatever is most cost effective At minimum: marijuana, hashish, cocaine, opiates, methamphetamines, benzodiazepines, amphetamines, and phencyclidine Follow up tests permitted for those who fail initial screening      
  House Bill 617 (2010) Passed in House, Referred to committee in Senate 20% of applicants and recipients tested (down from 50% in previous legislation) Whatever is most cost effective At minimum: marijuana, hashish, cocaine, opiates, methamphetamines, benzodiazepines, amphetamines, and phencyclidine        
  House Bill 7 (2011) Passed in House, Referred to committee in Senate Possible drug testing Not specified         Nearly identical to HB 617 (2010) added specification on random testing and clarifies funding issues
Massachusetts House Bill 974 (2011) Referred to committee Random testing for those receiving benefits who have prior drug-related conviction Not specified Not specified   May be ineligible to receive benefits if not going through treatment "Remedies" will be provided to those with positive test  
Maryland House Bill 585 (2011) Unfavorable report by appropriations; withdrawn by sponsor Adult recipients receiving benefits Not specified Controlled, dangerous substances Not specified Ineligible unless treatment is undertaken or after 90 days and negative test if no treatment is available Benefits can resume when treatment is completed; child and other family members remain eligible  
Michigan House Bill 4409 Passed in House, Senate referred to committee Substance abuse treatment/testing for those failing to meet compliance goals Not specified         Original bill included language about a pilot program for drug testing for eligibility but was not included in the bill that passed the House
Minnesota House Bill 3698 (2010) Referred to committee Initial eligibility and ongoing extension of benefits Not specified Not specified   Ineligible until negative drug test, if more than 2 tests failed there is 30% reduction in benefit for assistance unit, 3rd failure and recipient is permanently disqualified from cash AND food Agency required to conduct assessment and offer services; Benefit for entire assistance unit paid in vendor form for shelter and utilities  
  House Bill 1120 (2011) Introduced Initial eligibility and random screening of ongoing recipients Not specified Drugs and alcohol Not specified Ineligible for benefits until a pattern of negative test results is established Not specified Applicant/recipients must pay for test
Mississippi House Bill 122 (2010) Died in committee Random tests of recipients over 13 to determine ongoing eligibility Not specified Controlled substance without valid Rx   Ineligible for benefits, 2 later, clean tests before benefits are reinstated (not less than 3 months apart)   Persons failing test are required to pay the cost of test
Mississippi (continued) House Bill 675 (2010) and House Bill 660 Died in committee Random tests of recipients over 13 to determine ongoing eligibility Not specified Controlled substance without valid Rx   Ineligible for benefits for not less than 90 days and requires another drug test   Bills are very similar
  Senate Bill 2853 (2010) and Senate Bills 2759 and 2011 (both in 2011) Died in Committee Random testing of recipients Not specified     Ineligible for benefits for 1 year (for Senate Bill 2011, length of termination determined by number of positive tests    
  House Bill 1291(2011) Died in Committee Any person over 18 receiving benefits Not specified     First positive test: no benefits for 90 days, 2nd positive test: no benefits for 180 days, 3rd positive test, no benefits for one year (after which time an additional test is administered)    
Missouri House Bill 73 (2011) Passed House and Senate, signed by the  Governor Work-eligible applicants and recipients with reasonable cause Not specified Controlled substance without valid Rx Administrative hearing before benefits are denied Ineligible for benefits for one year Referral to drug treatment program; Children and other household members otherwise eligible can continue to receive benefits through 3rd party payee  
  Senate Bills 5, 7, 74 and 169 (combined) Introduced At time of application or interim change, case workers may file report on applicants or recipients of TANF for child abuse that results from substance abuse  (leads to subsequent testing) Not specified Controlled substance without valid Rx   Ineligible for benefits for 2 years unless treatment is completed Referral to treatment program; child and other family members remain eligible  
Nebraska HB 221 (2011) Referred to committee Applicants and recipients with probable cause Not specified Controlled substance without valid Rx Administrative hearing to determine if positive test is accurate, decision of hearing may be appealed Ineligible for benefits for one year Referral to substance abuse treatment program  
New Mexico House Bill 210 (2011) Died in committee Recipients with individualized suspicion and as condition of eligibility Blood, hair, or urine Controlled substance without valid Rx None specified If treatment is refused, ineligible of benefits for one year and until treatment is completed Automatic treatment referral; benefits continue if in treatment  
New York A04474 (2011) Refer to social services Adult applicant or recipient over 18 Urinalysis Alcohol and/or substance abuse   Ineligible for benefits (for first failing to participate in treatment, denial lasts 45 days or until person participates in treatment) Social service agency refers for treatment; other family members receive public assistance through safety net assistance  
  A 227 and A174 (2011) Refer to social services Applicants who are otherwise eligible To be established by commissioner To be established by commissioner None specified Required to undergo treatment, otherwise ineligible for benefit Treatment required for positive test (or benefits terminated)  
North Carolina Senate Bill 121 (2011) Refer to committee Applicants and recipients Not specified Substance abuse None specified Required to undergo treatment Treatment required  
Oklahoma House Bills 1407,1649, 1939, and 2532; Senate Bills 390, 769, 1392, and 2112 (all 2009) All bills but 390 and 1392 Referred to Committee;  390 passed Senate, sent to house, passed house but unable to agree in committee Applicant as condition of eligibility       Ineligible for benefits (Senate bill allows for treatment and receipt of benefit if in treatment) House Bills have same, very basic, language
  House Bill 1083 (2011) Referred to committee Applicants for state benefits (including spouses and dependents) and every 180 days ongoing Urinalysis Limited to  Schedule I substances Retest and appeal allowed Ineligible for benefits (applicants for 90 days, recipients for 1 year) Children under 12 are tested every 2 years and if positive for drugs are referred to family and child services Costs deducted from first month benefits
  Senate Bill 538 (2011) Referred to committee Random testing of recipients of benefits Not specified Not specified None specified Ineligible for benefits for failure to comply with substance abuse program Substance abuse program referral for positive tests and test refusal State elected officials subject to same testing requirements
  House Bill 1067 (2011) Referred to committee Recipients Not specified Not specified Confirmatory test necessary Ineligible for benefits None  
Oregon Senate Bill 538 (2011) Referred to committee Required for initial eligibility and every six months thereafter Not specified Not specified   Ineligible for benefits for 2 years    
Pennsylvania House Bills 860 and 1856 and Senate Bill 832 (all 2009); and House bill 1297 Senate Bill 719 (2011) All bills but House Bill 1297 referred to committee; House Bill 1297 passed House and referred to committee in Senate Required for ongoing eligibility (all recipients over 18 and under 75)/random selection of no less than 20% in 6 month period Urine sample (for H.B. 1297, urinalysis, blood, or other scientific study allowed) Controlled substance defined by section 2 P.L. 233, no 64 Re-tests allowed, test result not to be shared with law enforcement Ineligible for benefits Free treatment available House bills are very similar, Senate bill is more concise but similar
South Dakota House Bill 1152 (2011) Referred to committee, amendment to  require  suspicion  failed in House, no further action Random screening of any adult recipient Not specified Controlled substance without valid Rx For those who test positive, entitled to administrative hearing to determine test validity and contest suspended benefits Ineligible for benefits for 1 year Referred to appropriate professional or agency assistance  
  House Bill 1120 (2011) Referred to committee Applicants or recipients with reasonable cause Blood or bodily substance Controlled drug or substance Not specified Ineligible for benefits for 1 year; those who refuse to take a test are ineligible for 6 months Not specified  
Rhode Island House Bill 6249 Referred to committee All adult cash welfare applicants To conform with standards from Department of Health Controlled substance Additional tests allowed under conditions to be specified Ineligible for benefits for 1 year for first positive test and 3 years for second positive test; those completing treatment  may reapply after 6 months List of treatment facilities provided but cost of treatment is not covered; Children remain eligible with payment made to protective payee Applicant must pay for test but benefit will be increased by test amount if test is negative
South Carolina House Bill 4358 (2011) Referred to committee Adult TANF applicants Not specified Controlled substance Additional tests allowed under conditions to be specified Ineligible for benefits for 1 year for first positive test and 3 years for second positive test; May reapply after 6 months with documented completion of treatment List of treatment facilities provided but cost of treatment is not covered; Children remain eligible with payment made to protective payee Applicant must pay for test but benefit will be increased by test amount if test is negative
Tennessee Senate Bill 48/House Bill 230 (2011) Referred to committee Recipients with reasonable cause Not specified Controlled substance without valid Rx Automatic re-test to rule out false-positive, with opportunity to appeal the re-test Ineligible for benefits for 1 year    
  House Bill 365 (2011) Referred to committee All applicants before benefit is given; recipients at least yearly afterward Blood or urine Schedule I, Schedules II-IV without valid Rx Results not admissible in criminal proceeding without consent of person tested Ineligible for benefits   Fiscal note mentions that suspicionless testing is unlawful (so there will be no cost)
  House Bill 0957/ Senate Bill 0652 (2011) Referred to committee Each adult recipient who is otherwise eligible for public assistance or who the department has reasonable cause to believe engages in the illegal use of controlled substances Not specified Controlled substance without valid Rx Given opportunity for appeal Ineligible for benefits for 1 year unless seeking treatment Opportunity for treatment before or after positive test with continued benefits  
Tennessee (continued) Senate Bill 983 (2011) Referred to committee As condition of eligibility (initial or ongoing not specified) Not specified Substance abuse Automatic re-test to rule out false-positive, with opportunity to appeal the re-test      
Texas House Bill 139 (2011) Introduced Each adult applicant to determine eligibility Not specified Controlled substance without valid Rx Automatic re-test and opportunity for public hearing Ineligible for benefits for 1 year Child remains eligible  
Virginia House Bill 925, Senate Bill 59, Senate Bill 781  and House Bill  2154, House Joint Resolutions 616 and 87 (all 2010) 925, 59, and 2154 left in committee, 781 passed Senate and House left in appropriations Applicants and recipients screened to determine probable cause "Standardized screening instrument" "illegal substances"   Ineligible for benefits for 1 year Child remains eligible through payments to 3rd party  
West Virginia House Bill 3079 and House Bill 2965 (All 2011) Referred to committee Random test of all applicants and recipients plus probable cause testing Commissioner of Division of Human Services will determine Not specified 2 tests required before benefits are denied (tests are 30 days apart and denial cannot happen until 2nd test); test results not shared for other purposes Ineligible for benefits for 2 years Benefits remain for those in treatment As part of bill, legislators must also be tested and they lose pay and benefits (but no job) for positive test, nearly same wording between two bills

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Appendix B:
Tribal TANF Drug Testing Policies
Region Tribe Target Population Universal, Random, or for Cause? Frequency of Testing Substances Covered Consequences of a Positive Test
V Forest County Potawatomi Applicants and ongoing recipients Random For those with initial positive tests, additional tests for monitoring purposes could be required for a year or longer. Alcohol and other drugs, including prescription drugs Test refusal results in suspicion (1st refusal) or termination (subsequent refusal).  Those who test positive are required to have a substance abuse assessment and must comply with follow-up requirements under an employability plan.
V Lac du Flambeau Applicants and ongoing recipients Universal At initial application, 90 days after testing positive a second time, and annually for ongoing clients Benzodiazepines, barbiturates, marijuana, mehaqualone, oxycodones, propoxyphane, amphetamines, cocaine, methadone, opiates, phencyclidine Refusal to take the test results in failure to open a new case or closure of an existing case.  First failure results in mandatory AODA referral; second failure closes case for 90 days; third and subsequent failures close case for one year.
V Menominee Tribe Applicants Universal Upon application and then at least annually.  For cause testing may be conducted at any time. Cocaine metabolite, marijuana, opiates, amphetamines, phencyclidine, nitrites, and chromium Refusal to take the test results in ineligibility.  Current recipients who either test positive or refuse testing must obtain a substance abuse assessment and may be sanctioned or terminated from benefits for noncompliance with their treatment plan.
V Oneida Tribe[1] Applicants and ongoing recipients of cash payment assistance Universal When approved for TANF cash payment assistance Marijuana, amphetamines, benzodiazepines, sedatives, oxycotin, cocaine; tricyclic-antidepressants, opiates, propoxyphene (Darvon, Darvocets), barbiturates, and phencyclidine Refusal to take the test results in denial of TANF services for 90 days.  Those testing positive are referred for a substance abuse assessment and treatment/counseling recommendations become part of the individual’s employability plan.  Noncompliance results in 90-day closure of TANF cash payment.
V Sokaogon Participants who self-report a drug felony conviction Universal for the specific target population Not provided Amphetamines, cannabinoids, cocaine, opiates, and PCP Requirements to participate in rehaibilitation.
V Stockbridge-Munsee Tribe Applicants and ongoing recipients Universal for applicants; ongoing recipients are tested randomly and may be tested for cause At application and randomly thereafter Marijuana, opiates, phencyclidine, cocaine, and amphetamines Refusal results in denial of application or case closure for ongoing recipients.  Positive test for ongoing recipients results in vendor voucher payments for a minimum of 3 months, a substance abuse assessment is required.
VI Muscogee-Creek Nation[2] Ongoing recipients (family cases only) Not reported Not reported Not yet determined Substance abuse assessment and treatment compliance.
VII Winnebago Ongoing recipients Random and for cause The case managers try to test at least five clients a month. If a client is initially positive, the case manager tries to re-test at least every other month. Opiates, marijuana, methamphetamine, cocaine, and amphetamines Client is reported to child protective services and vendor payments are made until treatment recommendations have been completed.
VIII Confederated Salish and Kootenai Tribes Applicants Universal At application and if they are off the program for more than 30 days Marijuana, cocaine, amphetamines, opiates, methamphetamine, and oxycotin/codone Referral to child protective services and required substance abuse assessment.  Treatment/follow-up recommendations are incorporated into the client’s Individual Family Plan.
VIII Chippewa Cree Tribes of the Rocky Boy Reservation Applicants and ongoing recipients Universal at application and random thereafter At application and then annually Amphetamines, barbiturates, cocaine, marijuana, opiates, oxycodone, phencyclidine, and alcohol Required substance abuse assessment and compliance with treatment plan.
IX Yurok Tribe All adult members of TANF households, applicants and ongoing recipients Universal at application, both random and for cause thereafter At intake and then annually Amphetamine, methamphetamine, cocaine, opiates, marijuana, phencyclidine, oxycodone Required substance abuse assessment and required compliance with treatment plan.  Refusal is treated as a positive test.
IX Owens Valley Career Development Center Applicants and ongoing recipients subject to mandatory work requirements Universal and for cause At intake, at the time of job placement; for cause testing may be conducted at any time Not specified Referral for behavioral health treatment, hours for which may count toward work participation.
IX North Fork Rancheria Applicants and ongoing recipients Universal and random At intake, randomly thereafter and annually at recertification “All drugs including alcohol” Repeated refusal results in case closure.
IX Southern California Tribal Chairmen’s Association Applicants and ongoing recipients Universal,  random and for cause testing is conducted At intake and annually at recertification.  Random testing may be conducted at any time Amphetamines, cocaine metabolites, marijuana metabolites, opiates, phencyclidine Refusal results in denial/case closure. Positive test results in required assessment; treatment recommendations become part of the Family Success Plan.  Noncompliance results in case closure.
IX Hoopa Valley Tribe All adult TANF household members, protective payees and child care providers Universal, random, and for cause Universal at intake and recertification; randomly or for cause thereafter Amphetamine, methamphetamine, cocaine;,opiates, marijuana, PCP, barbiturates, benzodiazepine Required substance abuse assessment and services; protective payee.
IX Pasqua Yaqui Tribe Ongoing recipients and work experience participants Universal for work experience participants, others for cause Not reported Illegal substances Ongoing random testing; treatment referral
IX Soboba Adult applicants Universal for applicants, randomly for those who have previously tested positive Not reported All major drugs Refusal results in denial of benefits.  Positive tests results in treatment assessment and vendor payments.  Direct cash assistance may be restored if two random drug tests are clean within 90 days.
IX Round Valley Tribe Ongoing recipients For cause Upon further cause “All drugs including alcohol” Adult is removed from the grant; vendor payment is made for the remainder.  Treatment/counseling is required.
IX Graton Rancheria Applicants and ongoing recipients Universal, random and for cause At intake and every six months thereafter.  Occasional random and for cause testing is also conducted. Opiates, barbiturates, alcohol, methamphetamine, marijuana, amphetamines, PCP, cocaine Refusal results in progressive sanctions leading to case termination; positive tests result in referral for assessment and treatment.
X Cook Inlet Tribal Council Ongoing recipients For cause Depends on each case All alcohol/drugs Required substance abuse assessment; treatment recommendations become part of the family self sufficiency plan and subject to progressive sanctions.
X Lower Elwha Applicants Universal At intake Not reported Refusal results in denial of benefits. Positive test results in referral for assessment, treatment plan requirements.
Source:  Administration for Children and Families, Division of Tribal TANF Management
[1] New program to be implemented pending approval from the Tribe’s legal department.
[2] Testing program to begin October 2011.

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Appendix C:
Estimated Costs of Drug Testing Proposals
State Year Estimated Cost
(Source: State fiscal notes and bill summaries, State legislature websites)
Alabama[47] 2011 Cost unknown. Estimate would include cost to administer drug screening, give notice to applicants, and oversee operation and training. Persons being screened pay for the drug screening. If test negative, the department will reimburse the individual for the cost of the screening by increasing the amount of TANF benefits received by the amount paid for the drug screening.
Arizona[48] 2008 $3.4 million. Estimate includes just the initial test for applicants and recipients of TANF and General Assistance.
Florida[49] 2011 Cost unknown.  A pilot run between 1999 and 2001 was reported to cost $2.7 million.  The bill that has now been passed would require applicants to pay the cost of the drug test, which will be reimbursed if the applicant tests negative.
Idaho[50] 2010 $1,324,725 for all, $263,681 for 13% of participants. Estimates include testing, system programming, and treatment by a contractor.
Indiana[51] 2011 $173,000.  Estimate only includes the price of the test itself.
Louisiana[52] 2011 $92,487.  Estimate includes drug testing of 20% of recipients and treatment for 2% of those tested.
Maryland[53] 2011 $2.2 million. Estimate includes cost for additional TANF staff to monitor applications and eligibility and increased contract costs for staff and supplies to do the testing.
Missouri[54] 2011 Up to $1,904,632 (FY 12); Up to $2,204,202 (FY 13). Estimates include costs of increased staffing needs, including for increased administrative hearings, drug treatment, changes to electronic applications, and hiring contractors to administer the drug tests.
New York[55] 2011 $20 million. Estimate only includes the price of the test itself for all applicants and recipients.
Oklahoma[56] 2011 $2,161,179.  Estimate assumes that 10% of the TANF adult population would be randomly tested, all applicants would be tested, and the cost to administer a drug test is $49.
Tennessee[57] 2007 No cost. Estimate assumes that federal law prohibits drug testing as a condition of eligibility for TANF, as it does in Medicaid/Medicare and SNAP.
West Virginia[58] 2011 $148,580.  Estimate assumes that all applicants and 20% of recipients would be tested.

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References

[1] Metsch, L.R. and Pollack, H.A. (2005).  Welfare Reform and Substance Abuse.  The Milbank Quarterly 83(1):65-99. (http://onlinelibrary.wiley.com/doi/10.1111/j.0887-378X.2005.00336.x/pdf)

[2] Valbrun, M. (2011).  Budget-Conscious States Rethink Food Stamps Ban for Drug Felons.  The Cincinnati Herald, April 23, 2011. (http://www.thecincinnatiherald.com/news/2011-04-23/News/BudgetConscious_States_Rethink_Food_Stamp_Ban_for_.html)

[3] Government Accountability Office (2005).  Various Factors May Limit the Impacts of Federal Laws that Provide for Denial of Selected Benefits.  DC: U.S. Government Accountability Office. (http://www.gao.gov/new.items/d05238.pdf)

[4] Lewis, M. and Kenefick, E. (2011).  Random Drug Testing of TANF Recipients is Costly, Ineffective and Hurts Families.  TANF Policy Brief. Washington, DC: CLASP. (http://www.clasp.org/admin/site/publications/files/0520.pdf)

[5] National Center on Addiction and Substance Abuse at Columbia University (1994).  Substance Abuse and Women on Welfare.  New York:  National Center on Addiction and Substance Abuse. (http://www.casacolumbia.org/templates/publications_reports.aspx)

[6] The Substance Abuse and Mental Health Services Administration (2006).  Persons in Families Receiving Government Assistance.  The NHSDA Report. Rockville, Maryland:  Substance Abuse and Mental Health Services Administration. (http://oas.samhsa.gov/2k2/GovAid/GovAid.htm)

[7] Substance Abuse and Mental Health Services Administration (2011). Substance Abuse Treatment Admissions Receiving Public Assistancehttp://www.oas.samhsa.gov/2k11/300/300PubAssist2k11Web.pdf

[8] Legal Action Center (2009).  Opting Out of Federal Ban on Food Stamps and TANF.  (http://www.lac.org/toolkits/TANF/TANF.htm#summary)

[9] Hercik, J.M. and Holguin-Pena, A. (1998).  Progress and Promise of TANF Implementation:  Findings of the National Needs Assessment.  Washington, DC:  U.S. Department of Health and Human Services, Welfare Peer Technical Assistance Network. (http://peerta.acf.hhs.gov/uploadedFiles/tanfimp.pdf)

[10] Rubinstein, G. (2002).  The State of State Policy on TANF and Addiction. Washington, DC:  Legal Action Center. (http://www.lac.org/doc_library/lac/publications/state_of_state.pdf)

[11] Hercik, J.M. and Holguin-Pena, A. (2000).  A Look at State Welfare Reform Efforts to Address Substance Abuse.  Rockville, Maryland, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (http://www.peerta.acf.hhs.gov/uploadedFiles/8_case_studies_final.pdf)

[12] Feldstein, S.W. and Miller, W.R., (2006).  Does subtle screening for substance abuse work?  A review of the Substance Abuse Subtle Screening Inventory (SASSI).  Addiction 102:41-50. (http://www.ncbi.nlm.nih.gov/pubmed/17207122)

[13] Morgenstern, J., Riordan, A., Dephilippis, D, Irwin, T.W., Blanchard, K.A, McCrady, B.S. and McVeigh, K.H., (2001).  Specialized Screening Approaches Can Substantially Increase the Identification of Substance Abuse Problems Among Welfare Recipients.  Washington, DC:  U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. (http://aspe.hhs.gov/hsp/njsard00/screening-rn.htm)

[14] Henderson, S., Dohan, D., and Schmidt, L.A. (2006).  Barriers to Identifying Substance Abuse in the Reformed Welfare System.  Social Service Review 80(2):  217-238.

[15] Fischer, H. “Panel OKs Drug Testing for Welfare Recipients” in The Arizona Sun, February 23, 2011.  http://azdailysun.com/news/state-and-regional/article_09aad771-9ab6-5195-9a0e-2730bfaa589d.html

[16] Duplantier, W. “Missouri House Sends Welfare Drug Testing Measure to Governor” in The Southeast Missourian, May 11, 2011.

[17] CNN Wire Staff, “Florida Governor Signs Drug-Screen Measure” Cable News Network, June 1, 2011.  http://articles.cnn.com/2011-06-01/politics/florida.welfare.drug.testing_1_drug-testing-drug-screening-tanf?_s=PM:POLITICS

[18] Whittenburg, Catherine (August 24, 2011).  “Welfare Drug Testing Yields 2% Positive Results” in The Tampa Tribune.  (http://www2.tbo.com/news/politics/2011/aug/24/3/welfare-drug-testing-yields-2-percent-positive-res-ar-252458/)

[19] Tribal TANF drug testing policies were identified by ACF Regional Office Staff working with tribal TANF programs.

[20] There are several drug testing technologies available.  The most inexpensive and commonly used have relatively high false positive rates.  Best practice is to confirm positive results with more sensitive (though more expensive) tests that reduce inaccuracies (see the U.S. Department of Labor’s Frequently Asked Questions on Workplace Drug Testing, http://www.dol.gov/asp/programs/drugs/workingpartners/dfworkplace/dt.asp#q2).

[21] U.S. Department of Labor (n.d.).  Workplace Drug Testing (http://www.dol.gov/asp/programs/drugs/workingpartners/dfworkplace/dt.asp#q2) .  Accessed August 18, 2011.

[22] Martin, D.M. (2010).  An Overview of Present and Future Drug Testing.  Journal of Global Drug Policy and Practice (3)4. (http://www.globaldrugpolicy.org/3/4/1.php)

[23] Center for Substance Abuse Treatment (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 05-4048. Rockville, MD: Substance Abuse and Mental Health Services Administration. (see chapter 9, Drug Testing as a Tool, at http://www.ncbi.nlm.nih.gov/books/NBK25811/)

[24] Pollack, H.A., Danziger, S., Jayakody, R. and Seefeldt, K.S. (2002).  Drug Testing Welfare Recipients – False Positives, False Negatives, Unanticipated Opportunities. Women’s Health Issues 12(1):  23-31. (http://www.whijournal.com/article/S1049-3867(01)00139-6/abstract)

[25] Personal communication July 7, 2011 with Carol Rest-Minceberg, Acting Director, Division of Workplace Drug Programs, Substance Abuse and Mental Health Services Administration.

[26] Crew, R.E. and Davis, B.C. (2003).  Assessing the Effects of Substance Abuse among Applicants for TANF Benefits:  The Outcome of a Demonstration Project in Florida.  Journal of Health and Social Policy 17(1): 39-53. (http://www.informaworld.com/smpp/content~db=all~content=a904538997)

[27] Meara, E. (2006).  Welfare Reform, Employment and Drug and Alcohol Use Among Low Income Women.  Harvard Review of Psychiatry, 14(4): 223-32. (http://informahealthcare.com/doi/abs/10.1080/10673220600883150)

[28] Schmidt, L., Weisner, C. and Wiley, J. (1998).  Substance Abuse and the Course of Dependency.  American Journal of Public Health 88(11):  1616-1622.  (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508566/)

[29] Schmidt, L., Zabkiewicz, D, Jacobs, L., and Wiley, J. (2007).  Substance Abuse and Employment among Welfare Mothers:  From Welfare to Work and Back Again?  Substance Use and Misuse 42:1069-1087. (http://www.ncbi.nlm.nih.gov/pubmed/17668326)

[30] Corman, H., Dave, D.M., Reichman, N.E. and Das, D. (2010).  Effects of Welfare Reform on Illicit Drug Use of Adult Women.  NBER Working Paper No. 16072.  (http://www.nber.org/papers/w16072)

[31] State legislative proposals were identified through a LexisNexis search and cross referenced with those cited in (Budd, 2011).

[32] Whittenburg, Christine (June 28, 2011).  “Failed drug test risky for parents” in The Tampa Tribune.  (http://www2.tbo.com/news/politics/2011/jun/28/MENEWSO3-failed-drug-test-risky-for-parents-ar-240350/)

[33] Phelps, S. (ed.) (2003).  Gale Encyclopedia of Everyday Law (http://www.enotes.com/everyday-law-encyclopedia/drug-testing-2)

[34] Budd, J.C. (2011).  Pledge Your Body for Your Bread:  Welfare, Drug Testing and the Inferior Fourth Amendment.  William and Mary Bill of Rights Journal 19:751. (http://scholarship.law.wm.edu/wmborj/vol19/iss3/6/)

[35] Overman, S. (2005).  Debating Drug Test ROI.  Staffing Management 1(3). (http://www.shrm.org/Publications/StaffingManagementMagazine/EditorialContent/Pages/0510_cover.aspx)

[36] Wftv.com, June 14, 2011.  The Real Cost of a New Drug Testing Law (http://www.wftv.com/news/28235065/detail.html)

[37] Miller, Debra (February 3, 2011).  Drug Testing of Welfare Recipients.  In Knowledge Center (e-newsletter of the Council of State Governments).  (http://knowledgecenter.csg.org/drupal/content/drug-testing-welfare-recipients)

[38] Information provided by the Administration for Children and Family’s Division of Tribal TANF Management.

[39] Idaho Department of Health and Welfare.  (Feb. 4, 2011). “Drug Testing Public Assistance Program Participants.”

[40] Louisiana Legislative Fiscal Office. (May 19, 2011). “Fiscal Note: Drug Testing 20% of FITAP Adult Recipients.”

[41] The Professional Staff of the Budget Committee. (Apr. 21, 2011).  “Bill Analysis and Fiscal Impact Statement: CS/CS/SB 556: Drug Screening/Beneficiaries/Temporary Assistance.”

[42] Children’s Sentinal Nutritional Assessment Program (2002).  The Impact of Welfare Sanctions on the Health of Infants and Toddlers.  Available at: http://www.childrenshealthwatch.org/upload/resource/welfare_7_02.pdf

[43] Idaho Department of Health and Welfare.  (Feb. 4, 2011). “Drug Testing Public Assistance Program Participants.”

[44] The Professional Staff of the Budget Committee. (Apr. 21, 2011).  “Bill Analysis and Fiscal Impact Statement: CS/CS/SB 556: Drug Screening/Beneficiaries/Temporary Assistance.”

[45] Crew, Robert E. and Belinda Creel Davis. (2003). “Assessing the Effects of Substance Abuse Among Applicants for TANF Benefits:  The Outcome of a Demonstration Project in Florida.” Journal of Health & Social Policy, vol. 17(1).

[46] Macdonald, Scott, et al. (2001). “Drug testing and mandatory treatment for welfare recipients.” International Journal of Drug Policy, 12, 249-257.

[47] Riddle, Rachel. (2011). “Fiscal Notes for SB496.” (http://alisondb.legislature.state.al.us/acas/ACTIONFiscalNotesFrame.asp?OID=73995&LABEL=SB496)

[48] Smith, Art. (2008). “Fiscal Analysis: HB 2678.” (http://www.azleg.gov/legtext/48leg/2r/fiscal/hb2678.doc.htm)

[49] The Florida Senate. (2011). “Bill Analysis and Fiscal Impact Statement: CS/SB 556: Drug Screening/Beneficiaries/Temporary Assistance.” (http://www.flsenate.gov/Session/Bill/2011/0556/Analyses/9/pWb5TDaaOHN/mJs9Yvi9hjGS8=%7C7/Public/Bills/0500-0599/0556/Analysis/2011s0556.pre.bc.PDF)

[50] Idaho Department of Health & Welfare. (2011). “Drug Testing Public Assistance Program Participants.” (http://www.idahoreporter.com/wp-content/uploads/2011/02/DHW-report.pdf)

[51] Indiana Legislative Services Agency. (2011). “Fiscal Impact Statement: HB 1452.” (http://www.in.gov/legislative/bills/2011/PDF/FISCAL/HB1452.002.pdf)

[52] Louisiana Legislative Fiscal Office. (2011). “Fiscal Note: Drug Testing 20% of FITAP Adult Recipients.” (http://www.legis.state.la.us/billdata/streamdocument.asp?did=748953)

[53] Maryland Department of Legislative Services. (2011). “Fiscal and Policy Note: House Bill 585.” (http://mlis.state.md.us/2011rs/fnotes/bil_0005/hb0585.pdf)

[54] Missouri Committee on Legislative Research Oversight Division. (2011). “Fiscal Note: SB 7.” (http://www.moga.mo.gov/oversight/OVER11/fispdf/0287-01N.ORG.PDF)

[55] New York State Assembly. (2011). “Bill A4474 Memo.” (http://assembly.state.ny.us/leg/?default_fld=&bn=A04474&term=2011&Memo=Y)

[56] Roberts, Dustin. (2011). “HB 1067 Bill Summary.” (http://webserver1.lsb.state.ok.us/cf/2011-12%20SUPPORT%20DOCUMENTS/BILLSUM/House/HB1067%20INT%20BILLSUM.DOC)

[57] White, James. (2007). “Fiscal Note: SB 102-HB 588.”

[58] Lewis, Michael J. (2011). “Fiscal Note Summary: HB3079.” (http://www.legis.state.wv.us/Fiscalnotes/FN(2)/fnsubmit_recordview1.cfm?RecordID=20055204)

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