ASPE Reports
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ASPE Data Point
Seventy Percent of States Report that Administrative Burden is a Barrier to Provider Participation in CCDF
This Data Point describes the barriers related to provider participation identified by states and territories in their FY25-27 Plans. The analysis identifies several major barriers to provider participation in CCDF, including examples of administrative burden reported by states. Key findings include:
Policy BriefVisualization
Structural Fragmentation Contributes to Administrative Complexity in Child Welfare Funding
The majority of federal child welfare funding is distributed across at least 14 federal programs or grants, including Title IV-E foster care. Federal funding accounts for less than half (43 percent) of total state child welfare agency spending; most funding comes from state and local funds.
Report
Longitudinal Maternal & Infant Health Information for Research FHIR Implementation Guide: Maternal Mental Health Use Case
Building on a previously funded OS-PCORTF initiative, this project piloted a new maternal mental health use case for the Longitudinal Maternal & Child Health Information for Research Fast Healthcare Interoperability Resources® (FHIR) Implementation Guide. The pilot focused on mothers experiencing depression, anxiety, bipolar disorder, or psychosis during pregnancy and the postpartum period,…
ASPE Data Point
The U.S. Age-Adjusted Death Rate Reached a Record Low in 2025: What Drove the Decline?
This ASPE Data Point examines changes in U.S. age-adjusted mortality between 2024 and 2025 using CDC mortality data and Census population estimates. It compares population estimation methods and analyzes contributions by age and cause of death, with a focus on unintentional injuries and opioid overdoses. The report also discusses recent policy context.
ASPE Issue Brief
Project Update: Child Welfare and Health Infrastructure for Linking and Data Analysis of Resources, Effectiveness, and Needs Initiative
This brief describes progress in the Child Welfare and Health Infrastructure for Linking and Data Analysis of Resources, Effectiveness, and Needs (CHILDREN) Initiative, which is in its fourth year. At this time, four jurisdictions participate in the CHILDREN Initiative: District of Columbia, Iowa, Oklahoma, and Wyoming. Iowa and Oklahoma are engaging in feasibility studies to determine readiness…
ASPE Issue Brief
Financing Medicaid Through Provider Taxes on Hospitals: Spillover Effects on Employment-Based Coverage Premiums
This brief examines how hospital provider taxes used to finance Medicaid relate to premiums for employment-sponsored health insurance. Using state-level employer survey data and a staggered-adoption research design, it assesses tax implementation, Medicaid payment policies, and commercial insurance costs, with discussion of implications for wages and the 2025 Working Families Tax Cut legislation.
ASPE Data Point
Health and Economic Benefits Associated with Increased Kidney Transplantation Following the Advancing American Kidney Health Initiative in 2019
This Data Point report examines kidney transplantation following the 2019 Advancing American Kidney Health initiative. It uses transplant trends and economic modeling to assess policy-associated changes in transplant volume and their potential health and economic benefits through 2040. The analysis considers benefits from reduced mortality, improved quality of life, and less time spent on…
Strategic Plan
Kidney Care National Plan
The Kidney Care National Plan examines the federal role in kidney care and approaches to address chronic kidney disease and kidney failure. It covers prevention and early detection, dialysis care, kidney transplantation and living donation, alongside payment incentives, competition, regulatory oversight, patient safety, and research and innovation across the continuum of care in the United States.
Case Study
A Home for Every Child Case Studies: Briefs from Five States with Some of the Highest Home-to-Child Ratios
The Administration for Children and Families’ initiative, A Home for Every Child, is designed to help achieve at least a one-to-one ratio of foster homes available for children and youth in foster care, where the numerator is the number of foster homes available and the denominator is the number of children in care. The goal may be accomplished by tailoring strategies to recruit prospective…
Case StudyResearch Brief
Strategies to Improve the Ratio of Homes Available to Children in Foster Care: Findings from Five States
The goal of the Administration for Children and Families’ (ACF’s) A Home for Every Child initiative is to have a safe and supportive home available for every child or youth in foster care. ACF measures the initiative’s success by a one-to-one home-to-child ratio, meaning there are as many foster homes available as there are children in foster care. In 2025, the national ratio was 57 foster homes…
ASPE Issue Brief
Mission vs. Margin: Misaligned Incentives in the 340B Drug Pricing Program
Efforts by CMS to reform the 340B Drug Pricing Program aim to decrease financial incentives that place revenue over patients' health outcomes and access to care. The report examines program growth, consolidation, and Medicare drug spending, including an analysis of how reimbursement changes affected hospital outpatient payments.
Research Brief
Children in Child Welfare are More Likely to be Prescribed Psychotropic Medication than Other Children on Medicaid: Findings from Florida and Kentucky
The use of psychotropic medications in children is a complex issue for parents, caregivers, health care professionals, researchers, and policymakers. Psychotropic medications are used to treat behavioral health conditions. When these medications are prescribed appropriately, they can be effective in managing behavioral health symptoms. This brief looks at psychotropic prescribing patterns for…
ASPE Issue Brief
States Routinely Request to Increase LIHEAP’s Weatherization Cap, but Must Repeat the Process Every Year
KEY POINTSThe Low-Income Home Energy Assistance Program (LIHEAP) allows states to allocate up to 15 percent of program funds for weatherization activities and repairs that maximize energy efficiency. Since Fiscal Year 2016 (FY16), states have devoted an average of around nine percent of LIHEAP dollars to weatherization annually.States can also request a waiver to allocate up to 25 percent of…
Research Brief
Directed by Executive Order: Reconsideration of the Regulatory Costs of Head Start’s 2016 Final Rule
The 2016 Head Start Program Performance Standards final regulation anticipated that improved quality would justify potential reductions in access. Executive Orders 13563 and 13610 direct agencies to measure actual regulatory results and periodically review existing significant regulations, modifying, streamlining, expanding, or repealing them in accordance with what has been learned.The tradeoffs…
Report
Evidence-Based Measures for Chronic Disease Outcomes: A Review of Available Measures for Emergent HIV Therapies
Executive SummaryBackground. The U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) supports intradepartmental efforts to build data capacity for patient-centered outcomes research and to improve evidence generation for healthcare decision-making. ASPE contracted with NORC at the University of Chicago to conduct an environmental scan…
Report
Evidence-Based Measures for Chronic Disease Outcomes: A Review of Available Measures for Emergent Sickle Cell Disease Therapies
Executive SummaryBackground. The United States (U.S.) Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) supports intradepartmental efforts to build data capacity for patient-centered outcomes research and to improve evidence generation for healthcare decisionmaking. ASPE contracted with NORC at the University of Chicago to conduct an…
ASPE Issue Brief
Head Start Operates Within Existing State Child Care Licensing Infrastructure and Includes Established Supports for Alignment and Coordination Between Systems
This brief examines the relationship between Head Start programs and state child care licensing systems. Drawing on federal administrative data, it describes licensing status, the state provider landscape, Early Head Start-Child Care Partnerships, and Head Start Collaboration Offices, with attention to state structures and processes involved in coordination across early care and education systems.
ASPE Issue Brief
Nearly a Quarter of LIHEAP Funds Are Not Spent on Direct Household Energy Assistance, with Four Percent Reserved in FY25
This brief examines how states allocated Low Income Home Energy Assistance Program (LIHEAP) funds from FY16 through FY25, including spending on direct energy assistance, weatherization, administrative and other activities, and funds carried over to subsequent fiscal years. Key findings include:
Report
Market Forces in Medicare Reimbursement: Traditional Medicare, Medicare Advantage, and Provider Resource Constraints
This report examines market forces in Traditional Medicare and Medicare Advantage reimbursement. It presents an economic framework for analyzing provider labor, facility capacity, input costs, payment rules, and federal spending. Topics cover workforce supply, scope-of-practice rules, telehealth, provider taxes, and Medicaid financing, with a focus on provider constraints and plan payment systems.
ASPE Issue Brief
Research Does Not Identify an Optimal Teacher-Child Ratio That Improves Child Outcomes, Though More Stringent Ratios May Increase Per Child Spending
KEY POINTSChild care and early childhood education licensing regulations are set by states and identify minimum standards that programs must meet to be licensed to operate.When covered by both federal rules and state licensing systems, Head Start programs are required to follow the more stringent requirement.Most research identifies mixed, weak, or no relationship between teacher-child ratio