families, recipients, and the public to continue to develop policy may be desirable. In any case, given the current state of affairs and the strong desirability of, at a minimum, a coherent and defensible national approach, steps should be taken to provide some uniform national policies and improved consistency. This report provides information, analysis, conclusions, and recommendations to the sponsor, the Department of Health and Human Services, regarding the issues that the department raised as particular concerns and regarding additional issues that were identified as currently salient.