Presented by: Nelson Toth, Ph.D., Research Scientist , New York State?s Office of Alcoholism and Substance Abuse Services, 1450 Western Avenue, Albany, NY 12203. Voice: 518-485-0262; FAX: 518-457-1790; E-mail: NelsonToth@oasas.state.ny.us.

Research Objective: Examined here is the impact of welfare reform on the expected duration of AFDC, Home Relief, SSI and Medicaid Only assistance episodes for the NY State Alcohol and Other Drug (AOD) population. Accurate quantitative models of assistance episode duration are discussed and trends in the expected durations of these episodes are interpreted for the period 1993 through 1998.

Study Design: Empirical survival functions were obtained from survival analyses performed on assistance episode duration data for each cohort of individuals that initiated in any of four categories of assistance (AFDC, Home Relief, SSI and Medicaid Only) during any of the 24 quarter-year periods 1993 through 1998. Underlying probability density functions for episode duration were then derived from the survival functions. Many of these PDFs were well described as mixtures of gaussian and exponential densities. Model fits and parameter values were evaluated with techniques of non-linear regression.

Populations Studied: Medicaid-eligible individuals in New York State that received treatment for alcohol and/or other drug abuse during 1993 through 1998.

Principal Findings: The expected duration of AFDC assistance for the NY State Alcohol and Other Drug population demonstrated a monotonic decline from about 34 to 20 calendar months during the period 1993 through 1997, then remained approximately level through 1998. Other preliminary analyses suggest a similar decline in the expected duration of Home Relief, SSI and Medicaid Only assistance episodes.

Conclusions: Welfare reform initiatives have contributed to a dramatic reduction in the duration of public assistance episodes in New York State while application for assistance has also been reduced.

Implications for Policy: Welfare reform has reduced the number of individuals covered by Medicaid in New York State. As a result, qualification for, and access to, treatment for the abuse of alcohol and other drugs has been limited to the extent that other funding sources (e.g. Substance Abuse Prevention and Treatment Block Grant and related NY State funding) have been unable to assume responsibility for treatment costs that were formerly paid by Medicaid. The diminishing Medicaid caseload together with reductions in the periods of assistance undermine Medicaid Managed Care Organization?s ability to provide continuity of medical and substance abuse treatment to the AOD population.

Primary Funding Source: U.S. Substance Abuse and Mental Health Service Administration, Center for Substance Abuse Treatment, Grant # 5 UR TI 11285.