We researched two key program characteristics to ensure that the three states varied on important factors. The first is whether the foster care programs are administered at the state or county level. The foster care programs in two of the states, California and Pennsylvania, are state supervised and county administered, while the program in Florida is state-administered (Child Welfare League of America 1999). Thus, we might expect to see more intrastate variation in utilization patterns in the two county-administered programs.
The second characteristic is the presence of a health passport program.(4) All three states have implemented health passport programs statewide, with Florida's and Pennsylvania's passports dating back to 1989 and 1990, respectively. California's health passport program was implemented statewide in February 1995. None of the states use an electronic (computerized) passport record (Lutz and Horvath 1997).