ASPE Reports
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Report
Quantifying the Value of Consumer Choice: A Foundation for Regulatory Impact Analysis and Beyond
Executive SummaryRegulations often restrict the range of market choices available to consumers, yet they are promulgated without a quantitative analysis of that cost—a fundamental flaw in regulatory impact analysis. This paper fills the gap by supplying a portable choice-value factor. The factor compares value at the unconstrained mix with regulation-constrained value. That comparison is a…
ASPE Issue Brief
Frozen at $2,000 Since 1986: The Coverage of Non-Recurring Adoption Expenses Has Lost Two-Thirds of Its Purchasing Power Over 40 Years
KEY POINTSCoverage of non-recurring adoption expenses can help reduce upfront adoption costs for families – covering expenses like legal fees, court costs, home studies, and necessary transportation, food, and lodging – supporting permanency for children with special needs.A family receiving $2,000 in 1986 had almost three times the buying power of a family receiving the same amount in Fiscal…
ASPE Issue BriefReport
Aligning Initiatives to End the HIV Epidemic in the United States
KEY POINTSThe Ryan White HIV/AIDS Program (RWHAP) provides critical services to low-income people living with HIV (PLWH) by providing medical care, medications, and support services.The Ending the HIV Epidemic in the United States
Research Brief
Title IV-E Foster Care Eligibility Rates Have Declined While Determination Costs Have Increased: Meanwhile Eligibility Review Results Have Varied Since FY00
Title IV-E foster care eligibility has declined over time as eligibility requirements remain tied to income thresholds from 1996. From fiscal year 2011 (FY11) to FY24, the percentage of caseloads eligible for Title IV-E foster care maintenance payment (FCMP) reimbursement funds – the funds that help cover costs like shelter, care, and clothing for children – has declined by around 45 percent.…
ASPE Issue Brief
Over the Past 10 Years, Head Start Administrative Spending Remained Relatively Steady and Always Below the 15 Percent Statutory Ceiling
KEY POINTSThe Head Start Act sets a ceiling of 15 percent for development and administrative costs.The Head Start Act gives the HHS Secretary the flexibility to determine that administrative expenses are excessive below the 15 percent ceiling.Administrative expenses do not include program costs, which are those directly related to the provision of program component or direct service functions.
ASPE Issue Brief
Exposure to Domestic Violence/Intimate Partner Violence Is Associated With Child Welfare System Involvement
KEY POINTSExisting research shows that children’s exposure to domestic violence (DV)/ intimate partner violence (IPV) increases the likelihood of involvement with the child welfare system (including child protective services (CPS) involvement and foster care entry).
ASPE Issue Brief
From FY16 to FY25, Fewer Head Start Families Received Comprehensive Services and the Percentage of Families Receiving Services Also Declined for Many Categories
This brief examines how Head Start’s comprehensive service delivery changed between the 2015-2016 (FY16) and 2024-2025 (FY25) program years, focused on volume (total number) and rate (percent) of children and families who received comprehensive services. Key findings include:
ASPE Issue Brief
Structure Matters: How State Child Support Program Administration and Procedures Can Impact Federal Spending and Support Order Establishment Performance
KEY POINTSFederal spending per child support case increased from $374.31 to $435.82 (in inflation adjusted dollars) between Fiscal Year 2015 (FY15) and FY24. However, total federal spending fell from about $5.2 billion to $4.5 billion over the same period as caseloads declined by roughly 2 million cases.
ASPE Issue Brief
HHS' Historical Approach to Head Start Regulation Following the 2007 Statutory Reauthorization has Increased Costs and Reduced Access, without Substantial Quality Gains
This brief describes HHS' historical approach to Head Start regulation following the 2007 statutory reauthorization. Key findings include:
Case Study
How Texas Achieves Strong Program Integrity in CCDF: Practical Considerations for State CCDF Lead Agencies
To facilitate cross-state learning, the Office of Child Care (OCC), in partnership with the Assistant Secretary for Planning and Evaluation (ASPE), is launching a snapshot series to highlight promising state practices. This inaugural snapshot highlights practices that improve child, family, and program outcomes in state Child Care and Development Fund (CCDF) programs and describes promising…
Research Brief
Title IV-E Foster Care Program and Administration National Average Effective Federal Match Rates are Less than Half Statutory Match Rates
States, territories, and tribes can receive partial reimbursement for Title IV-E foster care program costs for eligible children. The statutory federal match rate varies depending on the program category. Because state foster care programs also serve many children who are not eligible for partial federal reimbursement through the Title IV-E program, the “effective” federal match rate for state…
Report
An Overview of State-Directed Payments and Medicaid Provider Taxes: History and Potential Effects of the Working Families Tax Cut Legislation on Health Care Costs
Health care provider taxes and state-directed payment policies in the Working Families and Tax Cut legislation are expected to reduce non-Medicaid prices by up to 3.5 percent in markets with provider taxes and reduce spending on Medicaid, commercial and Medicare coverage. Our spending estimates indicate that there will be an additional $29 billion in federal savings on Medicare and…
Report
Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy
Let us begin with a distinction that conventional health-policy debate often obscures: health is not the same as healthcare, healthcare is not the same as health insurance, and insurance is not the endpoint. Insurance, payment rules, and coverage matter, but they do not examine a patient, discover a drug, help an older person get out of bed, remind a diabetic to check blood sugar, or get anyone…
Research Brief
The Statute Provides More Flexibility for Review than Allowed by the Current Title IV-E Prevention Services Clearinghouse Handbook of Standards and Procedures
After initial implementation, there is an opportunity to increase the kinds of prevention programs and services for which jurisdictions can receive federal support by using the full flexibility Congress provided in the Family First Prevention Services Act (FFPSA). There is a potential gap between statutory requirements and requirements in the Title IV-E Prevention Services Clearinghouse handbook…
Report
Framework for a Public Repository of Artificial Intelligence Training Datasets Using EHR Data for Comparative Effectiveness Research & A Pediatric ADHD Patient-Centered Outcomes Annotation Schema
Artificial intelligence (AI) tools, particularly those that use natural language processing (NLP), are becoming increasingly prominent in healthcare delivery. For these systems to operate safely and reliably in clinical settings, they require high-quality training datasets drawn from multiple sources, including electronic health record (EHR) data, that closely reflect real-world conditions.…
Research Brief
The CAPTA State Grant Program Represents Less Than One Percent of Child Welfare Spending but Places Many Requirements on States to Drive System Design
States use Child Abuse Prevention and Treatment Act (CAPTA) State Grant Program funds to support child protective services (CPS). Funds tend to be invested in system infrastructure improvements including workforce training, policy and protocol development, data system enhancements and reporting, and quality assurance. To receive funding for the CAPTA State Grant Program, states are required to…
ASPE Data Point
Estimates of Child Care Subsidy Eligibility & Receipt for Fiscal Year 2022
In 2022, 11.8 million children were eligible for childcare subsidies under federal rules; under state rules – which can be more restrictive – 9.1 million were eligible.1.8 million children received subsidies, representing 16 percent of those eligible under federal rules and 20 percent under state rules.Children living in deeper poverty were more likely to receive subsidies than those who were…
Report
Harnessing the Value of Electronic Health Record Data for Research
The United States (U.S.) faces urgent health challenges, including poor maternal and childhood health outcomes, childhood obesity, opioid use disorder, cancer, and chronic conditions, which require personalized care tailored to each patient’s unique circumstances. Patient-centered outcomes research (PCOR) and comparative clinical effectiveness research (CER) help identify the most effective…
ASPE Issue Brief
The Changing Insulin Affordability Landscape: Lower Out-of-Pocket Costs and Expanded Access Pathways
Average out-of-pocket spending for insulin has declined across commercial insurance, Medicare, and cash/assistance channels in recent years. Competition among manufacturers and retailers, combined with consumer-empowerment tools such as TrumpRx, has substantially improved insulin affordability. Across every major payer category—Medicare, Medicaid, private insurance, and the uninsured—multiple…
ASPE Data Point
Increases in Head Start Change in Scope Requests from FY21 to FY24 Have Resulted in the Largest Reduction of Funded Slots in the History of Head Start
The total number of Head Start Change in Scope requests increased from 104 in FY21 to 886 in FY24. The majority of Change in Scope requests were for enrollment reductions, with over 19 times as many requests in FY24 as compared to FY21. Despite the federal operations budget for Head Start increasing by about 11 percent between FY22 and FY24, Change in Scope requests during that period resulted…