Weekly Wonk: Entitlement to What, Exactly?
Entitlement to what, why data matters, plus Wonk makes you an offer you can’t refuse
Curated by Founder Zach Laris, with contributions from the Wonk Team.
From the Founder’s Desk
Wonk Goes Premium, Nebulous Entitlements, & What We Lose When We Lose Key Data
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In This Weekly Wonk
This week we’re previewing Laura Radel’s incisive new Decoded brief, sharing a Data Drop commentary, and as always boosting key signals you need on your radar.
Title IV-E Is An Entitlement Program. But An Entitlement to What?
What makes this essential
Laura Radel’s new analysis shows that when we argue about the foster care “entitlement”, we’re arguing over a program that doesn’t really exist anymore.
This is critical for anybody who cares about the future of child welfare financing, and the structure of child and family policy broadly.
How Cuts to Health Surveys Impact Data on Children and Families
We also have a deep dive from Robin Ghertner about the state of survey data, and why it matters for policy.
What makes this essential
Robin tracks the erosion of programs maintaining these data, and connects it to the nuances of crafting child and family policy.
It’s not an academic exercise; these are the sources that powered recent Wonk Data Drops.
Let’s get into it.
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Strategic Snippet
Decoded: Title IV-E Is An Entitlement Program. But An Entitlement to What?
Wonk Senior Contributor Laura Radel’s new premium Decoded brief breaks down how Title IV-E foster care is and is not a traditional entitlement, and why that matters.
What’s in a Name?
What makes a program an entitlement is an inherent guarantee; benefits flow when potential recipients meet the eligibility criteria.
That comes with dedicated mandatory funding, avoiding the appropriations process. Funds increase to cover the cost.
From Dedication to Drift
As Laura points out, entitlement programs are meant to be a bulwark against changes in need.
Through that lens, Title IV-E foster care has drifted, as this snippet shows:
In the Foster Care Program, the entitlement label gets murky. Placement in foster care isn’t experienced as a “benefit” by families, and funds don’t go directly to them.
Some of the funding goes to the foster family to pay room and board costs for the child.
But an ever-larger share goes to states’ administrative costs; not just “overhead” but things like staff training and case management.
This is unlike any other entitlement program.
What it pays for is important, but it’s not a clear direct throughline from federal funding to a specific benefit to the individual eligible child.
By 2023, foster care maintenance payments represented more than half of total IV-E foster care claims in only three states.
In more than half of states foster care payments made up less than one-third of claims.
Why it Matters
This shift toward IV-E foster care increasingly funding agency infrastructure isn’t an indicator of bad faith by states.
It’s a rational response to structural tension in the program’s design.
Too often, child welfare financing debates focus on a surface binary: "protecting the entitlement" or “promoting flexibility”.
Laura’s analysis shows that those arguments are about a program that has already transformed into something else entirely.
This reframes the central question for financing policy.
Instead of “what maintains an entitlement?”, it’s “entitlement to what, and for whom?”
Go deeper: get the whole brief when you pre-register for premium.
Weekly Wonk Deep Dive
Wonk Founding Director of Strategic Policy Intelligence Robin Ghertner digs into how changes to federal health surveys may affect child and family policy.
If you’re not in the weeds of federal data but want to know how it shapes policy and decisions, this piece is for you.
Robin’s insights come from 15 years leading federal teams using data to improve decision making.
I encourage you to read the full article, excerpted here.
How Cuts to Health Surveys Impact Data on Children and Families
By Robin Ghertner, Founding Director of Strategic Policy Intelligence
HHS reorganizations, staffing cuts, and budget pressures will lead to changes to the survey data that inform our understanding of children’s health and wellbeing.
Here are some examples of the stakes.
Moving Key Health Data Offices to the Office of the Secretary
In March and May HHS proposed moving the National Center for Health Statistics (NCHS) out of CDC and the Agency for Healthcare Research and Quality (AHRQ) to the Office of the Secretary.
Among other surveys, NCHS runs the National Survey of Children’s Health, which we’ve used to look at mental health challenges faced by children in foster care.
AHRQ runs the Medical Expenditure Panel Survey (MEPS), which we used to understand psychotropics and mental health faced by children at risk of entering foster care.
NCHS and AHRQ are supposed to produce objective data that are measured consistently over time – meaning you can trust that a number for 2025 is directly comparable to a number for 2015.
Becoming part of the Office of the Secretary would subject them to the whims and pressures of changing political leadership.
This could put data quality at risk, which in turn could affect the decisions federal and state governments make.
Staff Cuts to the Most Important Behavioral Health Survey
The National Survey on Drug Use and Health (NSDUH), tracks mental health and substance use and treatment access.
The NSDUH lead and the entire office that runs it were let go in April’s Reduction in Force.
Without staff to lead the survey effort, it’s questionable whether it can continue without significant data problems.
Why it Matters: How Surveys Feed Research and Drive Child Welfare Policy
For years the federal government has looked to save money by using administrative and claims data it already collects through normal business operations.
Agencies have questioned whether surveys are cost effective.
But surveys offer benefits to research that other sources do not - their measures can be higher quality, they can allow comparison groups, and they may be less subject to bias.
To a non-research crowd this might seem like semantics, but a number of topics important to child welfare leaders cannot be addressed without health surveys.
Child welfare agencies face so many challenges today that solid data can help address. They want to know if services work, who is being excluded, and how to prioritize budgets.
If agencies like CDC, SAMHSA, and AHRQ face cuts or reorgs that diffuse their mission, those surveys may sunset or either go away or lose their value.
It may not happen overnight. But losing these data sources may raise questions about where decision makers on child and family issues will be able to turn for understanding key issues.
Robin digs into this in the full article, check it out here.
Wonkatizer
Signals to watch, distilled down for you
North Carolina Cuts Medicaid Rates Across the Board
Effective October 1, North Carolina is cutting Medicaid payment rates 3-10% across providers.
State leaders cited a budget shortfall and the recently enacted One Big Beautiful Bill Act.
The deepest cuts will impact autism and disability services.
Why it Matters
Medicaid already pays service providers rates far below those of Medicare.
Budgetary pressures will increase that tension and raise questions about the sustainability of access to care.
Strategic Implications
10% cuts to residential services and autism therapy are likely to impact already strained services.
What First Movers Are Doing
Providers can prep to brief policymakers by stress-testing their payer mix to identify vulnerability and viability.
Forward-thinking Medicaid directors are contingency planning; child welfare agency leaders are already asking to be at that table.
What to Watch
Whether this spreads beyond North Carolina and how rate reductions impact provider sustainability and patient access.
Leaked MAHA Report Signals New Psychotropic Scrutiny
A newly leaked Make America Healthy Again (MAHA) commission report includes plans for a working group scrutinizing psychotropic medications for children, such as antidepressants and stimulants for ADHD.
Why it Matters
Children in foster care have higher rates of both mental health conditions and prescription of these medications.
Debates over appropriate prescribing are not new to child welfare policy.
Foundational questions about the appropriateness of psychotropic medications for children have new momentum, and could augur larger policy changes than prescribing oversight.
Strategic Implications
The working group aims to address the prescribing of these medications to children broadly.
Will a broad policy address different needs for children in care?
What First Movers Are Doing
Proactive child welfare agencies are auditing their psychotropic medication oversight protocols and preparing for MAHA questions.
Residential treatment providers are preparing for Medicaid headwinds and impeded medication access.
What to Watch
Whether child welfare gets a seat at the working group table.
From Our Radar to Yours
Forward guidance on what Wonks are tracking
Return from Recess
Between now and the next session of Congress, we will see the shape of FY26 talks and how likely a shutdown is.
What to track
How many appropriations bills move, and how many get stuck
The more that advance, the greater the pressure for a deal.
Whether the White House proposes new rescissions packages or retains FY25 funds rather than releasing them.
ACF Nominee Awaiting Confirmation
His nomination appears likely to advance.
What to Track
How his priorities continue or change what acting Assistant Secretary Gradison has focused on.
Any early proposals that indicate where he is going to focus his time and attention.
That covers it for this week. Stay sharp, Wonks.
~Z