Research on the patterns of child care subsidy receipt identifies administrative practices as a major factor related to instability in subsidy receipt and care arrangement (Adams & Rohacek, 2010). Particularly, studies suggest that the eligibility reassessment process, which often requires agency visits and burdensome paperwork, is a key system-related factor contributing to instability among subsidy-receiving families (Grobe, Weber, & Davis, 2008; Ha, 2009). However, little is known about the mechanism and the extent to which the eligibility reassessment process affect subsidy and care instability, in the context of other family-related instability (e.g., employment or residential instability). To address this gap, this study evaluates recent administrative changes in the eligibility reassessment process in Massachusetts using qualitative interview and administrative data and examines how and the extent to which these administrative changes affect stability in subsidy receipt and care.

In 2012, the Massachusetts Department of Early Education and Care shifted the location and responsibility for child care voucher eligibility reassessment from seven regional Child Care Resource and Referral (CCR&R) agencies to contracted child care providers (providers that hold contracted slots with the state) for most children using vouchers in their care. Thus, families using vouchers at contracted providers go through their eligibility reassessment process directly with their care providers, rather than a regional CCR&R office. Using a mixed-methods design, we conduct 17 key informant interviews (including state staff, board members, and field representatives) and interviews with approximately 20-30 regional CCR&R staff to understand the implementation of the changes and identify 1) implementation variation, 2) fidelity to design, and 3) system-related factors that might affect subsidy stability, such as reassessment notification processes, a family’s proximity to reassessment location, reassessment appointment wait times, availability of reassessment via phone/online/fax, and variation in interpretations of eligibility regulations. Initial analyses suggest there is variation in reassessment practices across CCR&Rs and contracted providers, including locations, available hours, and technology used (e.g. online scheduling for appointments) for reassessment. Initial qualitative findings are used to inform administrative data analyses. Specifically, monthly MA administrative data on subsidy receipt and care arrangement from 2012-2013, merged with geocoded data on the distance between reassessment location and family homes, are used to conduct spell analysis to describe differences in the continuity of subsidy receipt (measured by the number of months of subsidy-receipt spells) and care arrangement (measured by the number of providers used during subsidy-receipt) between those who were affected by the administrative changes and those who were not. For multivariate analysis, we use event-history regression models to examine factors related to subsidy stability and a series of Poisson regression models to identify the mediating effects of subsidy receipt on the stability of care arrangement. We also conduct subgroup analysis, e.g. Hispanic and immigrant families, to examine differential impacts for diverse service populations.  

Findings from this study have implications for states seeking to 1) implement family-friendly policy changes that increase the stability of subsidy receipt and care arrangements and 2) learn about the successes and pitfalls to avoid when making such changes.