Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies

10/12/2011

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

Printer Friendly version in PDF format (28 pages) [Free PDF reader Exit disclaimer]

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 ASPEs 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 Floridas 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 childrens benefits be paid to a third party who will ensure benefits are spent to meet the childrens 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 individuals 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:

  • Is the intent of the proposal to identify those in need of treatment or to exclude from assistance those with substance use disorders?
  • Who is tested, applicants, persons receiving assistance, or both?
  • Is testing for cause, (i.e. because some behavior provides a reason to suspect substance abuse) or is either everyone or a random sample tested without suspicion?
  • What consequences result from a positive test?
  • Are there procedural protections against false positive results?
  • Are there restrictions to prevent disclosure and misuse of test results?
  • Does the proposal include features intended to protect children from negative consequences of the denial of benefits?
  • Does the State or do clients pay the up-front costs of drug tests?

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 Floridas new TANF drug testing law indicate that parents testing positive will be reported to the States 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]

Michigans 1999 program of suspicionless drug testing of TANF recipients was suspended by the courts after operating only a few weeks, and Floridas 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 Constitutions 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.  Idahos estimate includes the cost of making programming changes to the States information system. Floridas law and Alabamas 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:

  • Purchasing the drug tests, including initial and retests
  • Laboratory fees
  • Staff time to administer the tests
  • Staff time to monitor compliance and eligibility
  • Staff time to deal with increased administrative hearings
  • Modifying facilities to accommodate the testing
  • Modifying computer programs to include drug testing in eligibility
  • Substance abuse treatment
  • Hiring a contractor to administer the tests
  • Legal fees if the law is challenged

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 Floridas new drug testing policy have cited an estimate of $30 per TANF recipient for the drug tests being required of applicants,[36] though the States 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 Idahos 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 Louisianas 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 childrens benefits are intended to ensure funds are spent on childrens 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.  Floridas 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 studys 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
StateBill Number (and year)Status (as of 6/15/2011)Target PopulationTesting MethodSubstance(s) IncludedProcedural SafeguardsConsequences of a Positive TestIs Substance Abuse Treatment or Child Well-Being Addressed?Other/Comments
US CongressS. 83 and H.R. 1769(2011)Referred to committeeRequires states to certify that TANF applicants have been drug tested and states may include continued (random or set) testing of recipientsNot specifiedControlled substance as defined in section 102 of the Controlled Substance Act.Not specifiedIneligible 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. 
AlabamaSenate Bill 496 (2011)Pending Committee ActionAny person applying for temporary cash payments (dependent children under 18 are excluded)Chemical, biological or physical instrumental analysisDrug 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 prescriptionMay retake the test one or more timesIneligible for benefit for one yearReapplication allowed after 6 months for documented treatment completion; If parent is ineligible, child remains eligible and payment is made to designated payeeCost 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 ActionRandom testing of adult applicants plus required testing for someone who appears or acts in way that suggests they may be under the influenceBlood or urineSchedule I, Schedules II-IV without valid RxResults not admissible in criminal proceeding without consent of person testedIneligible for benefits  
 

Arizona

House Bill 2011b Senate Bill 1011 (2010)Transmitted to governor and signedAll adult recipients receiving TANF with reasonable causeNot specifiedControlled substances without Rx Ineligible for benefits for one year All bills have identical language
 Senate Bill 1620 (2011)Transmitted to governor and signedAll adult recipients receiving TANF with reasonable causeNot specifiedControlled substances without Rx Ineligible for benefits for one year Same language as 2010 bills
CaliforniaSenate Bill 384 (2009) and Assembly Bill 730 (2011)IntroducedRandom testing to determine  ongoing eligibilityUnspecified "chemical" testSchedule I, Schedule II (cocaine, opium, phencyclidine, methamphetamine), prescriptions without Rx Benefits discontinued if treatment is not completed1 year treatment program to continue receiving benefits2009 and 2011 language nearly identical
ConnecticutSenate Bill 395 (2011)Referred to committeePeriodic testing on all recipients over 18Not specifiedIllegal 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 terminatedTreatment or education required for continued receipt 
FloridaHouse Bill 353 and Senate Bill 556 (2011)Signed into lawAll applicants (excludes dependent children under 18)Not specified, but consistent with Florida statute 112.0455 (also vague)Not specifiedRetesting allowedIneligible 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 payeeCost 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
GeorgiaHouse Bill 464 (2011)IntroducedEach recipient would be tested randomly once a yearNot specifiedMarijuana or controlled substances without valid RxRetesting allowed; results not used for other purposesIneligible for benefit until clean test (2nd failure leads to two years of ineligibility) Testing cost to be deducted from benefits
IowaHouse File 356 and Senate File 90Both referred to committeeAdult applicants (at application) and recipients (annually, assigned random month)Blood or urine (Senate bill has additional specifications)Marijuana or controlled substances without valid RxNot 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
IllinoisHouse Bill 11 (2011)Referred to committeeMay 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 annuallyTo be reported by Department of Human Services annuallyMandatory re-test of original sampleIneligible for benefits if not participating in drug treatment program  
Illinois (continued)House Bill 1402 (2011)Referred to committeeRandom testing of applicantsTo be reported by Department of Human Services annuallyTo be reported by Department of Human Services annually Ineligible for benefit for 1 yearTreatment must be completed within 60 days to continue to receive benefit (plus clear test after treatment is over); other family members remain eligibleRequires testing to file  for nomination for state senator or representative
IndianaHouse Bills 1452 and 1559 and Senate Bill 568 (all 2011)Referred to committeeUniversal testing of applicants;  recipients over 18 to be tested based on reasonable suspicionUrinalysisControlled substances without RxAppeals available, all positive samples are retested before action is takenIneligible for benefit for 1 yearIf completing rehab program, TANF benefits available on day of treatment completion; child remains eligibleIncludes language about exclusion from Medicaid for positive test; drug testing language similar between all bills
KentuckyHouse Bill 208 (2011)Referred to committeeAll applicants and ongoing recipients (recipients tested once each year by random month assignment)Urinalysis or blood testSchedule I, Schedules II-IV without valid RxResults not admissible in criminal proceeding without consent of person testedIneligible for benefit  
 House Bill 402 (2011)Referred to committeeApplicants and ongoingAll complete pencil/paper questionnaire;  blood or urine test required if questionnaire responses indicate a possible issueSchedule I, Schedules II-IV without valid RxResults not admissible in criminal proceeding without consent of person tested60 day grace period for positive test followed by re-test (paid for by person being tested); if this test is positive, benefits are terminatedChild and other family members remain eligible 
LouisianaHouse Bill 611 (2010)Referred to committeeExpands mandatory drug testing to all adult recipients receiving cash assistance (FITAP)Whatever is most cost effectiveAt minimum: marijuana, hashish, cocaine, opiates, methamphetamines, benzodiazepines, amphetamines, and phencyclidineFollow up tests permitted for those who fail initial screening   
 House Bill 617 (2010)Passed in House, Referred to committee in Senate20% of applicants and recipients tested (down from 50% in previous legislation)Whatever is most cost effectiveAt minimum: marijuana, hashish, cocaine, opiates, methamphetamines, benzodiazepines, amphetamines, and phencyclidine    
 House Bill 7 (2011)Passed in House, Referred to committee in SenatePossible drug testingNot specified    Nearly identical to HB 617 (2010) added specification on random testing and clarifies funding issues
MassachusettsHouse Bill 974 (2011)Referred to committeeRandom testing for those receiving benefits who have prior drug-related convictionNot specifiedNot specified May be ineligible to receive benefits if not going through treatment"Remedies" will be provided to those with positive test 
MarylandHouse Bill 585 (2011)Unfavorable report by appropriations; withdrawn by sponsorAdult recipients receiving benefitsNot specifiedControlled, dangerous substancesNot specifiedIneligible unless treatment is undertaken or after 90 days and negative test if no treatment is availableBenefits can resume when treatment is completed; child and other family members remain eligible 
MichiganHouse Bill 4409Passed in House, Senate referred to committeeSubstance abuse treatment/testing for those failing to meet compliance goalsNot 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
MinnesotaHouse Bill 3698 (2010)Referred to committeeInitial eligibility and ongoing extension of benefitsNot specifiedNot 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 foodAgency required to conduct assessment and offer services; Benefit for entire assistance unit paid in vendor form for shelter and utilities 
 House Bill 1120 (2011)IntroducedInitial eligibility and random screening of ongoing recipientsNot specifiedDrugs and alcoholNot specifiedIneligible for benefits until a pattern of negative test results is establishedNot specifiedApplicant/recipients must pay for test
MississippiHouse Bill 122 (2010)Died in committeeRandom tests of recipients over 13 to determine ongoing eligibilityNot specifiedControlled 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 660Died in committeeRandom tests of recipients over 13 to determine ongoing eligibilityNot specifiedControlled 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 CommitteeRandom testing of recipientsNot 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 CommitteeAny person over 18 receiving benefitsNot 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)  
MissouriHouse Bill 73 (2011)Passed House and Senate, signed by the  GovernorWork-eligible applicants and recipients with reasonable causeNot specifiedControlled substance without valid RxAdministrative hearing before benefits are deniedIneligible for benefits for one yearReferral 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)IntroducedAt 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 specifiedControlled substance without valid Rx Ineligible for benefits for 2 years unless treatment is completedReferral to treatment program; child and other family members remain eligible 
NebraskaHB 221 (2011)Referred to committeeApplicants and recipients with probable causeNot specifiedControlled substance without valid RxAdministrative hearing to determine if positive test is accurate, decision of hearing may be appealedIneligible for benefits for one yearReferral to substance abuse treatment program 
New MexicoHouse Bill 210 (2011)Died in committeeRecipients with individualized suspicion and as condition of eligibilityBlood, hair, or urineControlled substance without valid RxNone specifiedIf treatment is refused, ineligible of benefits for one year and until treatment is completedAutomatic treatment referral; benefits continue if in treatment 
New YorkA04474 (2011)Refer to social servicesAdult applicant or recipient over 18UrinalysisAlcohol 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 servicesApplicants who are otherwise eligibleTo be established by commissionerTo be established by commissionerNone specifiedRequired to undergo treatment, otherwise ineligible for benefitTreatment required for positive test (or benefits terminated) 
North CarolinaSenate Bill 121 (2011)Refer to committeeApplicants and recipientsNot specifiedSubstance abuseNone specifiedRequired to undergo treatmentTreatment required 
OklahomaHouse 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 committeeApplicant 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 committeeApplicants for state benefits (including spouses and dependents) and every 180 days ongoingUrinalysisLimited to  Schedule I substancesRetest and appeal allowedIneligible 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 servicesCosts deducted from first month benefits
 Senate Bill 538 (2011)Referred to committeeRandom testing of recipients of benefitsNot specifiedNot specifiedNone specifiedIneligible for benefits for failure to comply with substance abuse programSubstance abuse program referral for positive tests and test refusalState elected officials subject to same testing requirements
 House Bill 1067 (2011)Referred to committeeRecipientsNot specifiedNot specifiedConfirmatory test necessaryIneligible for benefitsNone 
OregonSenate Bill 538 (2011)Referred to committeeRequired for initial eligibility and every six months thereafterNot specifiedNot specified Ineligible for benefits for 2 years  
PennsylvaniaHouse 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 SenateRequired for ongoing eligibility (all recipients over 18 and under 75)/random selection of no less than 20% in 6 month periodUrine sample (for H.B. 1297, urinalysis, blood, or other scientific study allowed)Controlled substance defined by section 2 P.L. 233, no 64Re-tests allowed, test result not to be shared with law enforcementIneligible for benefitsFree treatment availableHouse bills are very similar, Senate bill is more concise but similar
South DakotaHouse Bill 1152 (2011)Referred to committee, amendment to  require  suspicion  failed in House, no further actionRandom screening of any adult recipientNot specifiedControlled substance without valid RxFor those who test positive, entitled to administrative hearing to determine test validity and contest suspended benefitsIneligible for benefits for 1 yearReferred to appropriate professional or agency assistance 
 House Bill 1120 (2011)Referred to committeeApplicants or recipients with reasonable causeBlood or bodily substanceControlled drug or substanceNot specifiedIneligible for benefits for 1 year; those who refuse to take a test are ineligible for 6 monthsNot specified 
Rhode IslandHouse Bill 6249Referred to committeeAll adult cash welfare applicantsTo conform with standards from Department of HealthControlled substanceAdditional tests allowed under conditions to be specifiedIneligible for benefits for 1 year for first positive test and 3 years for second positive test; those completing treatment  may reapply after 6 monthsList of treatment facilities provided but cost of treatment is not covered; Children remain eligible with payment made to protective payeeApplicant must pay for test but benefit will be increased by test amount if test is negative
South CarolinaHouse Bill 4358 (2011)Referred to committeeAdult TANF applicantsNot specifiedControlled substanceAdditional tests allowed under conditions to be specifiedIneligible 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 treatmentList of treatment facilities provided but cost of treatment is not covered; Children remain eligible with payment made to protective payeeApplicant must pay for test but benefit will be increased by test amount if test is negative
TennesseeSenate Bill 48/House Bill 230 (2011)Referred to committeeRecipients with reasonable causeNot specifiedControlled substance without valid RxAutomatic re-test to rule out false-positive, with opportunity to appeal the re-testIneligible for benefits for 1 year  
 House Bill 365 (2011)Referred to committeeAll applicants before benefit is given; recipients at least yearly afterwardBlood or urineSchedule I, Schedules II-IV without valid RxResults not admissible in criminal proceeding without consent of person testedIneligible 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 committeeEach 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 substancesNot specifiedControlled substance without valid RxGiven opportunity for appealIneligible for benefits for 1 year unless seeking treatmentOpportunity for treatment before or after positive test with continued benefits 
Tennessee (continued)Senate Bill 983 (2011)Referred to committeeAs condition of eligibility (initial or ongoing not specified)Not specifiedSubstance abuseAutomatic re-test to rule out false-positive, with opportunity to appeal the re-test   
TexasHouse Bill 139 (2011)IntroducedEach adult applicant to determine eligibilityNot specifiedControlled substance without valid RxAutomatic re-test and opportunity for public hearingIneligible for benefits for 1 yearChild remains eligible 
VirginiaHouse 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 appropriationsApplicants and recipients screened to determine probable cause"Standardized screening instrument""illegal substances" Ineligible for benefits for 1 yearChild remains eligible through payments to 3rd party 
West VirginiaHouse Bill 3079 and House Bill 2965 (All 2011)Referred to committeeRandom test of all applicants and recipients plus probable cause testingCommissioner of Division of Human Services will determineNot specified2 tests required before benefits are denied (tests are 30 days apart and denial cannot happen until 2nd test); test results not shared for other purposesIneligible for benefits for 2 yearsBenefits remain for those in treatmentAs 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
RegionTribeTarget PopulationUniversal, Random, or for Cause?Frequency of TestingSubstances CoveredConsequences of a Positive Test
VForest County PotawatomiApplicants and ongoing recipientsRandomFor those with initial positive tests, additional tests for monitoring purposes could be required for a year or longer.Alcohol and other drugs, including prescription drugsTest 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.
VLac du FlambeauApplicants and ongoing recipientsUniversalAt initial application, 90 days after testing positive a second time, and annually for ongoing clientsBenzodiazepines, barbiturates, marijuana, mehaqualone, oxycodones, propoxyphane, amphetamines, cocaine, methadone, opiates, phencyclidineRefusal 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.
VMenominee TribeApplicantsUniversalUpon application and then at least annually.  For cause testing may be conducted at any time.Cocaine metabolite, marijuana, opiates, amphetamines, phencyclidine, nitrites, and chromiumRefusal 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.
VOneida Tribe[1]Applicants and ongoing recipients of cash payment assistanceUniversalWhen approved for TANF cash payment assistanceMarijuana, amphetamines, benzodiazepines, sedatives, oxycotin, cocaine; tricyclic-antidepressants, opiates, propoxyphene (Darvon, Darvocets), barbiturates, and phencyclidineRefusal 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 individuals employability plan.  Noncompliance results in 90-day closure of TANF cash payment.
VSokaogonParticipants who self-report a drug felony convictionUniversal for the specific target populationNot providedAmphetamines, cannabinoids, cocaine, opiates, and PCPRequirements to participate in rehaibilitation.
VStockbridge-Munsee TribeApplicants and ongoing recipientsUniversal for applicants; ongoing recipients are tested randomly and may be tested for causeAt application and randomly thereafterMarijuana, opiates, phencyclidine, cocaine, and amphetaminesRefusal 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.
VIMuscogee-Creek Nation[2]Ongoing recipients (family cases only)Not reportedNot reportedNot yet determinedSubstance abuse assessment and treatment compliance.
VIIWinnebagoOngoing recipientsRandom and for causeThe 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 amphetaminesClient is reported to child protective services and vendor payments are made until treatment recommendations have been completed.
VIIIConfederated Salish and Kootenai TribesApplicantsUniversalAt application and if they are off the program for more than 30 daysMarijuana, cocaine, amphetamines, opiates, methamphetamine, and oxycotin/codoneReferral to child protective services and required substance abuse assessment.  Treatment/follow-up recommendations are incorporated into the clients Individual Family Plan.
VIIIChippewa Cree Tribes of the Rocky Boy ReservationApplicants and ongoing recipientsUniversal at application and random thereafterAt application and then annuallyAmphetamines, barbiturates, cocaine, marijuana, opiates, oxycodone, phencyclidine, and alcoholRequired substance abuse assessment and compliance with treatment plan.
IXYurok TribeAll adult members of TANF households, applicants and ongoing recipientsUniversal at application, both random and for cause thereafterAt intake and then annuallyAmphetamine, methamphetamine, cocaine, opiates, marijuana, phencyclidine, oxycodoneRequired substance abuse assessment and required compliance with treatment plan.  Refusal is treated as a positive test.
IXOwens Valley Career Development CenterApplicants and ongoing recipients subject to mandatory work requirementsUniversal and for causeAt intake, at the time of job placement; for cause testing may be conducted at any timeNot specifiedReferral for behavioral health treatment, hours for which may count toward work participation.
IXNorth Fork RancheriaApplicants and ongoing recipientsUniversal and randomAt intake, randomly thereafter and annually at recertificationAll drugs including alcoholRepeated refusal results in case closure.
IXSouthern California Tribal Chairmens AssociationApplicants and ongoing recipientsUniversal,  random and for cause testing is conductedAt intake and annually at recertification.  Random testing may be conducted at any timeAmphetamines, cocaine metabolites, marijuana metabolites, opiates, phencyclidineRefusal 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.
IXHoopa Valley TribeAll adult TANF household members, protective payees and child care providersUniversal, random, and for causeUniversal at intake and recertification; randomly or for cause thereafterAmphetamine, methamphetamine, cocaine;,opiates, marijuana, PCP, barbiturates, benzodiazepineRequired substance abuse assessment and services; protective payee.
IXPasqua Yaqui TribeOngoing recipients and work experience participantsUniversal for work experience participants, others for causeNot reportedIllegal substancesOngoing random testing; treatment referral
IXSobobaAdult applicantsUniversal for applicants, randomly for those who have previously tested positiveNot reportedAll major drugsRefusal 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.
IXRound Valley TribeOngoing recipientsFor causeUpon further causeAll drugs including alcoholAdult is removed from the grant; vendor payment is made for the remainder.  Treatment/counseling is required.
IXGraton RancheriaApplicants and ongoing recipientsUniversal, random and for causeAt intake and every six months thereafter.  Occasional random and for cause testing is also conducted.Opiates, barbiturates, alcohol, methamphetamine, marijuana, amphetamines, PCP, cocaineRefusal results in progressive sanctions leading to case termination; positive tests result in referral for assessment and treatment.
XCook Inlet Tribal CouncilOngoing recipientsFor causeDepends on each caseAll alcohol/drugsRequired substance abuse assessment; treatment recommendations become part of the family self sufficiency plan and subject to progressive sanctions.
XLower ElwhaApplicantsUniversalAt intakeNot reportedRefusal 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 Tribes legal department.[2] Testing program to begin October 2011.

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Appendix C: Estimated Costs of Drug Testing Proposals
StateYearEstimated Cost (Source: State fiscal notes and bill summaries, State legislature websites)
Alabama[47]2011Cost 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]2011Cost 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]2011Up 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]2007No 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 Labors 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. Womens 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 Familys 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] Childrens 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/mJ...)

[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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