These six states varied in their spending patterns, both before and after FY 2000, though we found that some regional differences in spending patterns of poor states before 2000 have declined in strength in recent years. For the most part, spending trends evident among the poor states before 2000 continued after that year: medical assistance expanded; cash assistance spending remained low and fairly static; and non-health social services programs grew slowly or, in states where fiscal problems were most acute, not at all.
What accounts for these patterns of change and differences across states? We explored several factors in the site visits. But our major finding was that the state differences and the trends in various program functions stemmed in part from differences in how states made decisions in major program areas. Each of the major functional areas in social services- cash assistance, Medicaid, and non-health social services-were dominated by a distinct mode of decision-making. These modes varied by who participated in or controlled the decisions, the frequency of major choices, and the criteria brought to bear on decisions. These distinct decision-making styles might help account for different decision outcomes and changes over time.
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