Cash and Non-Cash Benefits for Persons with Limited Income: Eligibility Rules, Recipient and Expenditure Data, FY1981-83

Congressional research reportJun 18, 1984

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R e p o r t No. 84-99 EPW

CASH AND NON-CASH BENEFITS FOR PERSONS WI7lti LIMITED INCOME:

ELIGIBILITY RULES, RECIPIENT AND EXPENDITURE DATA, FY 1981-83

Compiled

Vee Burke

Specialist i n Social Legislation

Education and Public Welfare Division

Updated

J u n e 1 8 , 1984

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ABSTRACT

T h i s r e p o r t summarizes b a s i c e l i g i b i l i t y r u l e s , a s o f May 1984,

f o r more t h a n 70 c a s h and non-cash

p e r s o n s o f l i m i t e d income.

programs t h a t b e n e f i t p r i m a r i l y

It a l s o g i v e s funding formulas, b e n e f i t

l e v e l s , a n d , f o r f i s c a l y e a r s 1981-1983,

r e c i p i e n t numbers and expen-

d i t u r e d a t a f o r e a c h program.

Update o f

83-110 EPW

Cash and Non-Cash B e n e f i t s f o r P e r s o n s w i t h L i m i t e d Income :

E l i g i b i l i t y R u l e s , R e c i p i e n t and E x p e n d i t u r e D a t a , FY 1981-83

82-113 EPW

Cash and Non-Cash B e n e f i t s f o r P e r s o n s w i t h L i m i t e d Income:

E l i g i b i l i t y R u l e s , R e c i p i e n t and E x p e n d i t u r e D a t a , FY 1978-80

81-44 EPW

Cash and Non-Cash B e n e f i t s f o r P e r s o n s w i t h L i m i t e d Income:

E l i g i b i l i t y R u l e s , R e c i p i e n t and E x p e n d i t u r e D a t a , FY 1977-79

79-216 EPW

Cash and Non-Cash B e n e f i t s f o r P e r s o n s w i t h L i m i t e d Income:

E l i g i b i l i t y R u l e s , R e c i p i e n t and E x p e n d i t u r e D a t a , FY 1976-78

Income S e c u r i t y f o r P e r s o n s w i t h L i m i t e d Income:

Program Summaries, R e c i p i e n t and E x p e n d i t u r e D a t a ,

76-5 ED

F e d e r a l and S t a t e - L o c a l E x p e n d i t u r e s f o r Income

T r a n s f e r s t o P e r s o n s w i t h L i m i t e d Income. FY 1975-76

CONTRIBUTORS

The f o l l o w i n g CRS a n a l y s t s and s p e c i a l i s t s c o n t r i b u t e d program

d a t a and r u l e s t o t h i s r e p o r t . Unless o t h e r w i s e i d e n t i f i e d each i s

a member of t h e Education and P u b l i c Welfare D i v i s i o n of CRS.

Boren, Susan

Guaranteed s t u d e n t l o a n s

National d i r e c t student loans

Burke, Vee

Aid t o f a m i l i e s w i t h dependent

c h i l d r e n (AFDc)

Earned income t a x c r e d i t (EITC)

Emergency a s s i s t a n c e

Emergency food d i s t r i b u t i o n and s h e l t e r

General a s s i s t a n c e (medical c a r e

and non-medical c a r e components)

General a s s i s t a n c e t o I n d i a n s

Supplemental s e c u r i t y income (SSI)

C a h i l l , Kenneth

Low-income energy a s s i s t a n c e

I r w i n , Paul

V o c a t i o n a l e d u c a t i o n work-study

program

Jones, Jean

C h i l d c a r e food program.

School b r e a k £ a s t program

School l u n c h program

S p e c i a l m i l k program

S p e c i a l supplemental food program

f o r women, i n f a n t s , and c h i l d r e n (WIG)

Summer food s e r v i c e program f o r

children

Klebe, Edward

Community h e a l t h c e n t e r s

Crippled c h i l d r e n ' s s e r v i c e s

Health professions student loans

and s c h o l a r s h i p s

Indian health services

M a t e r n a l and c h i l d h e a l t h s e r v i c e s

Migrant h e a l t h c e n t e r s

Nursing s t u d e n t l o a n s and s c h o l a r s h i p s

Lyke, Bob

Chapter 1 m i g r a n t e d u c a t i o n program

Migrant h i g h s c h o o l e q u i v a l e n c y program

(HEP

C o l l e g e a s s i s t a n c e m i g r a n t program (CAMP)

McClure, Barbara

Dependency and indemnity compensation

for parents of veterans

Medical care for veterans with a nonservice-connected disability

Pensions for needy veterans, their

dependents and survivors

Milgram, Grace*

Low-rent public housing

Section 8 Lower-income housing

assistance

O'Shaughnessy, Carol

Nutrition program for the elderly

Foster grandparents

Senior community service employment

program for older Americans

Senior companions

Osmon, David

Special programs for students from

disadvantaged backgrounds (TRIO)

programs

Supplemental educational opportunity

grants

O'Sullivan, Jennifer

Medicaid

Richardson, Joe

Food distribution program for needy

families

Food stamps

Spar, Karen

Comprehensive employment and training

services (CETA Titles 11-B and 11-C)

Job corps (CETA Title IV-B)

Public service employment

(CETA Titles 11-D and VI)

Summer youth employment program

Title IV-C)

Youth employment demonstration programs (CETA Title IV-A)

Legal services

Title XX Social services

Work incentive program (WIN)

Stephan, Sharon

Adoption assistance

Foster care

Headstart

Stevens, Anne

Follow through

Ellender fellowships

Tager, Evelyn

Weatherization assistance

Vanhorenbeck, Susan

I n d i a n housing improvement g r a n t s

Sec. 101 r e n t supplements

Sec. 235 homeownership a s s i s t a n c e

Sec. 236 i n t e r e s t r e d u c t i o n payments

Sec. 502 r u r a l h o u s i n g l o a n s

Sec. 504 r u r a l h o u s i n g r e p a i r l o a n s

and g r a n t s

Sec. 514 farm l a b o r housing l o a n s

and Sec. 516 farm l a b o r h o u s i n g g r a n t s

Sec. 515 r u r a l r e n t a l h o u s i n g

loans

Sec. 523 r u r a l s e l f - h e l p housing

technical assistance grants

Joyce, V i a l e t

A s s i s t a n c e t o c e r t a i n Cuban r e f u g e e s

(cash)

A s s i s t a n c e t o r e f u g e e s and cuban/

Haitian e n t r a n t s (cash)

Medical a s s i s t a n c e t o c e r t a i n Cuban

refugees

Medical a s s i s t a n c e t o r e f u g e e s and

~uban/Haitianrefugees

S o c i a l s e r v i c e s f o r r e f u g e e s and cuban/

Haitian entrants

Wolfe, Mark

C o l l e g e work-study program

F e l l o w s h i p s f o r g r a d u a t e and professional study

P e l 1 g r a n t s ( f o r m e r l y b a s i c educat i o n a l opportunity grants)

Deborah Johnson typed t h e r e p o r t , w i t h p a t i e n c e and s k i l l .

Mary P i l o t e prepared t h e g r a p h s .

* Member o f t h e Economics D i v i s i o n

CONTENTS

............................................

A . N a t u r e o f P r o g r a m s ..................................

B . B i l l i o n - D o l l a r P r o g r a m s i n FY 1 9 8 1 ..................

C . G r o w t h i n S p e n d i n g ..................................

1. S h a r e of G r o s s N a t i o n a l P r o d u c t ................

2 . S h a r e o f F e d e r a l B u d g e t ........................

3 . S h a r e of W e l f a r e O u t l a y s P a i d by F e d e r a l F u n d s .

D . C o m p o s i t i o n o f B e n e f i t s .............................

INCOME TESTS O F THE BENEFIT PROGRAMS ....................

INTRODUCTION

POVERTY THRESHOLDS AND OTHER MEASURES

OF NEED

................................................

CATALOGUE OF PROGRAMS OFFERING CASH AND NON-CASH

BENEFITS TO PERSONS O F L I M I T E D INCOME

..................

MEDICAL A I D

...........................................

..............................

........

...........................

.............................

...........................

..........................................

............................

.......

...............................

MEDICAID

MEDICAL CARE FOR VETERANS WITH A NON-SERVICECONNECTED D I S A B I L I T Y

GENERAL ASSISTANCE (MEDICAL CARE COMPONENT)

MATERNAL AND CHILD HEALTH SERVICES. T I T L E V O F

THE SOCIAL SECURITY ACT

INDIAN HEALTH SERVICES

COMMUNITY HEALTH CENTERS

MEDICAL ASSISTANCE TO REFUGEES AND CUBAN/HAITIAN

ENTRANTS

MIGRANT HEALTH CENTERS

MEDICAL ASSISTANCE TO CERTAIN CUBAN REFUGEES

CRIPPLED CHILDREN'S SERVICES, T I T L E V O F THE

SOCIAL SECURITY ACT

CASH A I D

.....

.................

.....................................

AID TO F A M I L I E S WITH DEPENDENT CHILDREN (AFDC)

SUPPLEMENTAL SECURITY INCOME (SSI)

PENSIONS FOR NEEDY VETERANS. T H E I R DEPENDENTS.

AND SURVIVORS

.... 64

.................... 68

........................................ 7 0

......................... 7 1

..................................... 7 3

....................................... 7 5

...................... 7 7

................................ 80

........................................ 81

GENERAL A S S I S T A N C E (NON-MEDICAL CARE COMPONENT)

EARNED INCOME TAX C R E D I T (EITC)

F O S T E R CARE

A S S I S T A N C E TO REFUGEES AND CUBANIHAITIAN

ENTRANTS (CASH COMPONENT)

EMERGENCY A S S I S T A N C E TO NEEDY F A M I L I E S WITH

CHILDREN (EA)

DEPENDENCY AND INDEMNITY COMPENSATION F O R PARENTS

OF VETERANS

GENERAL A S S I S T A N C E TO I N D I A N S

ADOPTION A S S I S T A N C E

A S S I S T A N C E TO CERTAIN CUBAN REFUGEES (CASH

COMPONENT)

FOOD A I D

........................................ 8 2

................................... 8 7

....................... 90

............................. 92

.................. 93

........................................ 95

............................ 9 7

........... 99

....... 99

................ 101

FOOD STAMPS

SCHOOL LUNCH PROGRAM ( F R E E AND REDUCEDP R I C E SEGMENTS)

S P E C I A L SUPPLEMENTAL FOOD PROGRAM FOR WOMEN.

INFANTS. AND CHILDREN ( W I C )

S P E C I A L FOOD DONATIONS

N U T R I T I O N PROGRAM FOR THE ELDERLY

SCHOOL BREAKFAST PROGRAM ( F R E E AND REDUCED-PRICE

SEGMENTS)

C H I L D CARE FOOD PROGRAM

SUMMER FOOD S E R V I C E PROGRAM FOR CHILDREN

FOOD D I S T R I B U T I O N PROGRAM FOR NEEDY F A M I L I E S

S P E C I A L M I L K PROGRAM (FREE SEGMENT)

HOUSING AND A I D

.......... 103

............................ 106

.................... 109

............. 111

............ 113

........................... 116

....................... 119

........................................ 1 2 2

............... 123

.................. 1 2 4

........................................ 1 2 5

S E C T I O N 8 LOWER-INCOME HOUSING A S S I S T A N C E

LOW-RENT P U B L I C HOUSING

S E C T I O N 502 RURAL HOUSING LOANS

SECTION 515 RURAL RENTAL HOUSING LOANS

S E C T I O N 2 3 6 I N T E R E S T REDUCTION PAYMENTS

S E C T I O N 2 3 5 HOMEOWNERSHIP A S S I S T A N C E

F O R LOW-INCOME F A M I L I E S

S E C T I O N 101 RENT SUPPLEMENTS

S E C T I O N 504 RURAL HOUSING R E P A I R LOANS

AND GRANTS

S E C T I O N 514 FARM LABOR HOUSING LOANS

AND S E C T I O N 516 FARM HOUSING GRANTS

I N D I A N HOUSING IMPROVEMENT GRANTS

S E C T I O N 523 RURAL SELF-HELP TECHNICAL

ASSISTANCE

EDUCATION A I D

........................... 1 2 6

............................... 1 2 9

.......................................... 1 3 2

......................... 134

......... 135

................ 136

...................... 138

....................... 139

..................................... 1 4 2

............ 143

.... 144

... 146

...... 1 4 7

............................... 149

.......... 150

............. 151

GUARANTEED STUDENT LOANS

PELL GRANTS ( F o r m e r l y B a s i c E d u c a t i o n a l

Opportunity Grants)

HEADSTART

COLLEGE WORK-STUDY PROGRAM

SUPPLEMENTAL EDUCATIONAL OPPORTUNITY GRANT

CXAPTER 1 MIGRANT EDUCATION PROGRAM

NATIONAL DIRECT STUDENT LOANS

SPECIAL PROGRAMS FOR STUDENTS FROM DISADVANTAGED

BACKGROUNDS (TRIO PROGRILYS)

FOLLOW THROUGH

VOCATIONAL EDUCATION WORK-STUDY PROGRAM

FELLOWSHIPS FOR GRADUATE AND PROFESSIONAL STUDY

HEALTH PROFESSIONS STUDENT LOANS AND SCHOLARSHIPS

MIGRANT HIGH SCHOOL EQUIVALENCY PROGRAM (HEP)

ELLENDER FELLOWSHIPS

COLLEGE ASSISTANCE MIGRANT PROGRAM (CAMP)

NURSING STUDENT LOANS AND SCHOLARSHIPS

J O B S AND TRAINING A I D

COMPREHENSIVE EMPLOYMENT AND TRAINING SERVICES

(CETA T I T L E S 1 1 - B AND 11-C)

SUMMER YOUTH EMPLOYMENT PROGRAM (CETA T I T L E IV-C)

J O B CORPS (CETA T I T L E IV-B)

SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM

WORK INCENTIVE PROGRAM

YOUTH EMPLOYMENT DEMONSTRATION PROGRAMS

(CETA T I T L E IV-A)

FOSTER GRANDPARENTS

PUBLIC SERVICE EMPLOYMENT (CETA

T I T L E S 11-D AND I V )

SENIOR COMPANIONS

....................... 153

.. 155

........................ 1 5 7

........ 159

............................. 161

................................. 1 6 2

................................ 164

............................... 165

.................................. 166

OTHER SERVICES

.. LEGAL

T I T L E XX SOCIAL SERVICES ........................... 1 6 7

SERVICES ..................................... 169

. EMERGENCY FOOD DISTRIBUTION AND SHELTER PROGRAM .... 1 7 1

. SOCIAL SERVICES FOR REFUGEES AND cUBAN/BAITIAN

ENTRANTS ........................................ 1 7 3

ENERGY A I D

. LOW-INCOME ENERGY ASSISTANCE ....................... 1 7 5

. WEATHERIZATION ASSISTANCE .......................... 1 7 8

LIST OF TABLES

Expenditures of Major Needs-Tested Benefit

Programs. FY 1981-83

................................

Total Expenditures for Income-Tested Benefits ........

Recent Trends by Form of Benefit. FY 1981-1983 ......

Share of Federal Budget Used for Need-Tested

Benefits

............................................ 10

Composition of Need-Tested Benefits ................. 14

Income Eligibility Tests Used by Benefit

Programs

........................................ 16

Bureau of the Census Poverty Thresholds in 1983 ..... 22

1984 Federal Poverty Income Guidelines .............. 23

Eligibility Levels for Free and Reduced-Price Meals

for the Period July 1. 1984-June 30. 1985

........... 24

Sununary of Annual Budgets for a Four-Person Family

at Three Levels of Living. Urban United States.

Autumn 1981 (U.S. Department of Labor. Bureau of

of Labor Statistics..

issued April 16. 1982

.......... 25

Sumnary of Annual Budgets for a Retired Couple at

Three Levels of Living. Urban United States. Autumn

1981 (u.s. Department of Labor. Bureau of Labor

Statistics..

issued July 30. 1982

.................... 26

Need-Based Benefits: Expenditure and Enrollment

Data. by Program and Form of Benefit. FY 1980-83

.... 181

.MEDICAL BENEFITS ................................. 182

.CASH BENEFITS .................................... 183

.FOOD BENEFITS .................................... 184

.HOUSING BENEFITS ................................. 185

.EDUCATION AID .................................... 186

.JOBS AND TRAINING ................................ 187

.SERVICES ......................................... 188

.ENERGY AID ....................................... 189

LIST OF CHARTS

. Total Expenditures for Income-Tested Benefits ....... 3

2 . Composition of Need-Based Benefit Dollar. FY68 ...... 12

. Composition of Need-Based Benefit Dollar. FY83 ...... 13

INTRODUCTION

More t h a n 70 b e n e f i t programs 11 p r o v i d e c a s h and non-cash

a i d t h a t i s d i r e c t e d p r i m a r i l y t o p e r s o n s w i t h l i m i t e d income.

These b e n e f i t programs c o s t $127.3 b i l l i o n i n f i s c a l y e a r (FYI

1983, up 7.3 p e r c e n t from FY 1982, and e q u a l t o 3.9 p e r c e n t o f

t h e g r o s s n a t i o n a l p r o d u c t . F e d e r a l f u n d s p r o v i d e d 75 p e r c e n t

o f t h e t o t a l . A f t e r a d j u s t m e n t f o r p r i c e i n f l a t i o n , 1983

w e l f a r e s p e n d i n g was up 3 p e r c e n t from 1982, b u t down 3 p e r c e n t

from t h e peak l e v e l o f 1981. Measured i n c o n s t a n t v a l u e d o l l a r s ,

1983 o u t l a y s w e r e t h e second s m a l l e s t s i n c e 1980.

C o l l e c t i v e l y , t h e s e b e n e f i t programs c o n s t i t u t e t h e p u b l i c

"welfare" system, i f w e l f a r e i s d e f i n e d a s income-tested o r

need-based b e n e f i t s . Most o f t h e programs b a s e e l i g i b i l i t y on

i n d i v i d u a l , h o u s e h o l d , o r f a m i l y income, b u t some u s e g r o u p o r

a r e a income t e s t s ; and a few o f f e r h e l p on t h e b a s i s o f presumed

need.

T h i s r e p o r t c o n s i s t s o f a c a t a l o g u e o f 74 need-based programs. F o r e a c h i t p r o v i d e s t h e f u n d i n g f o r m u l a , e l i g i b i l i t y

r e q u i r e m e n t s , and b e n e f i t l e v e l s . A t t h e back o f t h e r e p o r t

a t a b l e g i v e s e x p e n d i t u r e and r e c i p i e n t d a t a f o r FY 1981-1983

by program.

Of FY 1983 w e l f a r e d o l l a r s , 61.5 p e r c e n t were s p e n t on

m e d i c a l a i d and c a s h r e l i e f ( 3 4 and 27 p e r c e n t , r e s p e c t i v e l y ) .

Food b e n e f i t s a c c o u n t e d f o r 14 p e r c e n t o f t h e t o t a l , and 1 5

p e r c e n t was i n t h e form o f h o u s i n g b e n e f i t s , j o b s - t r a i n i n g ,

and e n e r g y a i d . The r e m a i n i n g 9 p e r c e n t went f o r e d u c a t i o n

a i d and o t h e r s e r v i c e s . ( S e e t a b l e 1 f o r FY 1981-1983 summary, page 2 . )

11 The l i s t o f 74 programs i n t h e t a b l e o f c o n t e n t s i n c l u d e s one ( P u b l i c S e r v i c e ~ m p l o y m e n)t t h a t ended on September 30,

1981, and a n o t h e r ( ~ m e r g e n c yFood D i s t r i b u t i o n and S h e l t e r

program) t h a t was s c h e d u l e d t o end i n 1984. The number o f programs i s somewhat a r b i t r a r y . For example, G e n e r a l A s s i s t a n c e ,

l i s t e d u n d e r b o t h c a s h and m e d i c a l a i d , c o u l d b e r e g a r d e d i n s t e a d

a s a s i n g l e program.

15,600.0

Food b e n e f i t s

7,516.3

3,324.1

2,008.9

Jobs & t r a i n i n g

Services

Energy a i d

NOTE: Program d a t a on which t h i s t a b l e i s b a s e d a r e found i n t a b l e 1 2 .

4,710.2

Education

Housing b e n e f i t s 10,455.5

21,566.2

$22,091.7

Cash a i d

Medical c a r e

S e e page 181.

Chart 1

Total Expenditures for Income-Tested Benefits

......................

Ed Current Dollars

.............................................

Constant 1972 Dollars

Fiscal Year

N a t u r e o f Programs

Most of t h e s e programs p r o v i d e income " t r a n s f e r s . "

T h a t i s , t h e y t r a n s f e r income, i n t h e form o f c a s h , goods,

o r s e r v i c e s , t o p e r s o n s who make no payment and r e n d e r no

s e r v i c e i n r e t u r n . However, i n t h e c a s e o f t h e j o b and t r a i n i n g programs and some e d u c a t i o n a l b e n e f i t s , r e c i p i e n t s must

work o r s t u d y f o r wages, t r a i n i n g a l l o w a n c e s , s t i p e n d s ,

g r a n t s , o r loans.

T h i s r e p o r t e x c l u d e s income m a i n t e n a n c e programs t h a t a r e

n o t income t e s t e d , i n c l u d i n g s o c i a l i n s u r a n c e , many v e t e r a n s '

b e n e f i t s , and a l l b u t one t a x t r a n s f e r program.

Thus, i t

e x c l u d e s s o c i a l s e c u r i t y c a s h b e n e f i t s , unemployment i n s u r a n c e , and Medicare. The f i r s t o f t h e s e programs i n FY 1983

p a i d o u t 34 p e r c e n t more t h a n a l l i n c o m e - t e s t e d programs, o r a

t o t a l o f $170.7 b i l l i o n , f i n a n c e d from p a y r o l l t a x c o l l e c t i o n s .

The r e p o r t a l s o e x c l u d e s payments, even though f i n a n c e d w i t h

g e n e r a l r e v e n u e s , t h a t may be r e g a r d e d a s " d e f e r r e d compensat i o n , " s u c h a s v e t e r a n s ' e d u c a t i o n a l b e n e f i t s ($1.7 b i l l i o n

i n 1 9 8 3 ) , v e t e r a n s ' h o u s i n g b e n e f i t s , and m e d i c a l c a r e f o r

v e t e r a n s with a service-connected d i s a b i l i t y .

The r e p o r t i n c l u d e s one t a x - t r a n s f e r program, t h e r e b a t a b l e e a r n e d income c r e d i t f o r low-income w o r k e r s w i t h

c h i l d r e n . T h i s program r e d u c e s t h e t a x e s o f working f a m i l i e s

w i t h g r o s s income below $10,000 and makes d i r e c t payments t o

t h o s e whose income i s below t h e income t a x t h r e s h o l d . O t h e r

t a x t r a n s f e r s a r e e x c l u d e d b e c a u s e t h e y a r e n o t income t e s t e d .

Tax t r a n s f e r s ( a l s o known a s t a x e x p e n d i t u r e s ) i n c r e a s e f a m i l i e s '

d i s p o s a b l e income by r e d u c i n g t h e i r t a x l i a b i l i t y . Examples

a r e t h e d e d u c t i b i l i t y o f mortgage i n t e r e s t and p r o p e r t y t a x e s

on owner-occupied p r o p e r t y ($20.8 b i l l i o n and $8 b i l l i o n r e s p e c t i v e l y , i n 1983) and t h e p a r e n t a l p e r s o n a l exemption f o r

s t u d e n t s aged 19 and o v e r ($1.0 b i l l i o n i n 1 9 8 3 ) .

B i l l i o n - D o l l a r Programs i n FY 1983

I n FY 1983 a t o t a l o f 20 income-tested programs s p e n t more

t h a n $1 b i l l i o n e a c h i n F e d e r a l , S t a t e , and l o c a l f u n d s . The

l i s t was l e d by M e d i c a i d , which c o s t more t h a n t h e sum o f t h e

n e x t two programs, Aid t o F a m i l i e s w i t h Dependent C h i l d r e n

(AFDc) and food s t a m p s . H e r e a r e t h e 20 programs and t h e i r

FY 1983 e x p e n d i t u r e s .

B i 11i o n s

Percent

I n c r e a s e From

FY 1981

Medicaid

$34.96

AFDC

15.39

Food s t a m p s

13.27

SS I

10.10

S e c t i o n 8 lower income

4.99

housing a s s i s t a n c e

Medical c a r e f o r v e t e r a n s

w i t h a non-service4.41

connected d i s a b i l i t y

3.89

Veterans' pensions

Low-rent pub1 i c h o u s i n g

3.21

3.10

Guaranteed s t u d e n t l o a n s

Pel1 grants (formerly

B a s i c E d u c a t i o n a l Oppor2.86

t u n i t y Grants)

General a s s i s t a n c e

2.44

( m e d i c a l c a r e component)

S c h o o l l u n c h ( f r e e and

2.41

reduced-price segments)

2.40 b /

T i t l e XX s o c i a l s e r v i c e s

S e c t i o n 502 r u r a l hous2.33

ing loans

General a s s i s t a n c e (cash

and non-medical c a r e v e n d o r

2.11

payments )

Low-income e n e r g y a s s i s t a n c e 1.90

Earned income t a x c r e d i t

1.80

Comprehensive employment

and t r a i n i n g s e r v i c e s

(CETA T i t l e s 1 1 - B and

11-C

1.76

S p e c i a l s u p p l e m e n t a l food

program f o r women, i n f a n t s

1.16

and c h i l d r e n (WIG)

Heads t a r t

1.13

-a /

Not a p p l i c a b l e .

b/ F e d e r a l d o l l a r s o n l y .

o u t l a y s a f t e r 1981.

D a t a a r e u n a v a i l a b l e on S t a t e t o t a l

c / S t a t e d a t a a r e u n a v a i l a b l e t o c a l c u l a t e percentage change

i n t o t a l spending.

T r e n d s i n Spending

T o t a l e x p e n d i t u r e s on c a s h and non-cash w e l f a r e programs

w e r e e i g h t t i m e s g r e a t e r i n 1983 t h a n i n 1968. Even a f t e r

a l l o w a n c e f o r p r i c e i n f l a t i o n , s p e n d i n g more t h a n t r i p l e d

d u r i n g t h e 1 3 y e a r s . Measured i n c o n s t a n t 1972 d o l l a r s , i t

c l i m b e d from $19.9 b i l l i o n i n FY 1968 t o a peak of $61.3 b i l l i o n i n FY 1981, a p e r i o d when t h e U.S. p o p u l a t i o n grew by

15 percent.

P e r c a p i t a w e l f a r e s p e n d i n g grew i n r e a l t e r m s

( c o n s t a n t 1972 d o l l a r s ) from $100 i n FY 1968 t o $266 i n

FY 1981, an i n c r e a s e o f 166 p e r c e n t , However, i n FY 1982,

w e l f a r e s p e n d i n g f a i l e d t o k e e p pace w i t h i n f l a t i o n f o r t h e

f i r s t t i m e s i n c e 1973. 21 I n r e a l t e r m s w e l f a r e o u t l a y s f e l l

5 . 5 p e r c e n t ($3.4 b i l l i z n i n 1972 d o l l a r s ) . Only s l i g h t l y

more t h a n h a l f o f t h i s was r e s t o r e d by i n c r e a s e d s p e n d i n g i n

1983. C h a r t 1 and t a b l e 2 show t h e c o u r s e o f w e l f a r e s p e n d i n g

i n b o t h c u r r e n t and c o n s t a n t d o l l a r s .

During 1968-1978, Congress l i b e r a l i z e d some o l d w e l f a r e programs and e s t a b l i s h e d new o n e s .

Some o f t h e m a j o r e x p a n s i o n s

follow:

e f f e c t i v e i n 1969 Congress g a v e a work i n c e n t i v e bonus

t o a l l m o t h e r s who r e c e i v e d AFDC c h e c k s ; t h e bonus, v i r t u a l l y

r e p e a l e d i n l a t e 1981, was t h e r i g h t t o a w e l f a r e supplement even

a f t e r t h e i r e a r n i n g s r o s e above t h e S t a t e s t a n d a r d o f need. I n

1969, minimum r e n t s f o r p u b l i c h o u s i n g were a b o l i s h e d ( r e i n s t i t u t e d , a t a low l e v e l , i n 1 9 7 4 ) . By 1970 amendment, t h e food

stamp program was c o n v e r t e d i n t o a F e d e r a l income g u a r a n t e e i n

participating counties.

By 1972 amendment, b a s i c e d u c a t i o n a l

o p p o r t u n i t y g r a n t s were a d o p t e d f o r a l l needy c o l l e g e s t u d e n t s

( e x t e n d e d t o "middle-income" s t u d e n t s by 1978 l a w ) . I n 1972,

e f f e c t i v e i n 1974, a F e d e r a l c a s h income g u a r a n t e e ( S S I ) was

e n a c t e d f o r t h e a g e d , b l i n d , and d i s a b l e d . E f f e c t i v e i n 1974,

food stamps were e x t e n d e d t o a l l c o u n t i e s , p r o v i d i n g a n a t i o n a l

I n 1975, a r e b a t income g u a r a n t e e i n t h e form o f food stamps.

a b l e t a x c r e d i t was a d o p t e d f o r low-income w o r k e r s w i t h

c h i ld ren

I n 1981, however, Congress moved t o r e s t r i c t e l i g i b i l i t y

f o r some programs and t o l o w e r some b e n e f i t s . F o r example, i t

imposed g r o s s income e l i g i b i l i t y l i m i t s f o r AFDC and food

s t a m p s , reduced AFDC and food stamp b e n e f i t s f o r f a m i l i e s

ante

/ F e d e r a l o u t l a y s f o r s i x m a j o r income and m e d i c a l a s s i s t -2programs

( a n d program g r o u p s ) f o r low income p e r s o n s , a s

mesured i n c o n s t a n t d o l l a r s , d e c l i n e d 3 p e r c e n t from FY 1972 t o

FY 1973. I n a l l o t h e r y e a r s , from FY 1964 t o FY 1981, s u c h o u t lays rose.

The programs: m e d i c a i d , s u b s i d i z e d h o u s i n g payments,

food stamp program, c a s h a s s i s t a n c e , and v e t e r a n s ' p e n s i o n s .

J.S. L i b r a r y o f Congress.

Congressional Research Service.

1985

budget p e r s p e c t i v e s : F e d e r a l s p e n d i n g f o r t h e human r e s o u r c e

[ b y ] R i c h a r d Rimkunas and Gene F a l k [ w a s h i n g t o n ] 1984.

programs.

CRS R e p o r t 84-35 EPW. p. 159.

w i t h e a r n i n g s , r a i s e d p u b l i c h o u s i n g r e n t s , and reduced subs i d i e s f o r s c h o o l l u n c h e s . E f f e c t i v e i n FY 1983, i t tempora r i l y reduced t h e food stamp g u a r a n t e e .

As t a b l e 2 shows, t h e a n n u a l r a t e o f growth i n t o t a l exp e n d i t u r e s f o r need-based b e n e f i t s d e c l i n e d i n t h e l a t t e r p a r t

of t h i s p e r i o d . Measured i n c o n s t a n t d o l l a r s , t h e i n c r e a s e

i n s u c c e s s i v e 5-year p e r i o d s was: 1968-73, 81 p e r c e n t ;

1973-1978, 54 p e r c e n t ; 1978-1983, 7 p e r c e n t . F u r t h e r , as

mentioned b e f o r e , r e a l s p e n d i n g d e c l i n e d i n 1982.

TABLE 2.

Fiscal year

T o t a l E x p e n d i t u r e s f o r Income-Tested

Benefits

--I-------

Current d o l l a r s a T

( b i l l i o n s ) --

C o n s t a n t 1972 d o l l a r s b/

(

)

----

a / FY 1968 and FY 1973 d a t a a r e from "Income S e c u r i t y

f o r ~ m e r i c a n :s Recommendations o f t h e P u b l i c W e l f a r e S t u d y

R e p o r t o f t h e Subcommittee on F i s c a l P o l i c y of t h e J o i n t Economic

Committee. December 5 , 1974. T a b l e 4 , page 28. D a t a f o r o t h e r

years:

-- FY 1975 d a t a , CRS m u l t i l i t h 77-152 ED, p. 1. From t h e

t o t a l , t h e n e t sum o f $441 m i l l i o n h a s b e e n s u b t r a c t e d - $297 m i l l i o n was added t o c o r r e c t an e r r o r i n h o u s i n g

o u t l a y s , and $738 m i l l i o n was d e d u c t e d b e c a u s e o f a

r e v i s e d e s t i m a t e of medical b e n e f i t s f o r v e t e r a n s witho u t a service-connected d i s a b i l i t y .

-- FY 1976 d a t a , CRS r e p o r t 79-216 EPW, p. 2. From t h e t o t a l ,

t h e n e t sum o f $950 m i l l i o n h a s been subtracted--$I336

m i l l i o n and $142 m i l l i o n i n lower e s t i m a t e s o f m e d i c a l

spending f o r v e t e r a n s without a service-connected d i s a b i l i t y and f o r G e n e r a l A s s i s t a n c e (GA) m e d i c a l a i d , r e s p e c t i v e l y , o f f s e t i n p a r t by t h e a d d i t i o n o f $28 m i l l i o n ,

t h e sum s p e n t on w e a t h e r i z a t i o n .

-- FY 1977 d a t a , CRS r e p o r t 51-44 EPW, p. 2 . From t h e t o t a l ,

t h e sum o f $1.3 b i l l i o n h a s been s u b t r a c t e d - - $ 1 , 0 5 0 and

$250 m i l l i o n i n lower e s t i m a t e s of m e d i c a l s p e n d i n g f o r

v e t e r a n s w i t h o u t a s e r v i c e - c o n n e c t e d d i s a b i l i t y and f o r

GA m e d i c a l a i d , r e s p e c t i v e l y .

-- FY 1978 d a t a , CRS r e p o r t 82-113 EPW, p. 2.

-- FY 1979-80 d a t a , CKS r e p o r t 83-110 EPW, p. 2 . From t h e

1979 and 1980 t o t a l s , $57 m i l l i o n and $76.1 m i l l i o n ,

r e s p e c t i v e l y , h a v e been d e d u c t e d t o c o r r e c t a n e r r o r i n

reported outlays for n u t r i t i o n for the elderly.

-- FY 1981-83 d a t a , p. 2 o f t h i s r e p o r t .

b/ C u r r e n t d o l l a r s have been t r a n s l a t e d i n t o 1972 cons t a n t - v a l u e d o l l a r s by u s e o f t h e i m p l i c i t p r i c e d e f l a t o r s

f o r t h e g r o s s n a t i o n a l p r o d u c t : f i s c a l y e a r s 1968, 0.80675;

1973, 1.0232; 1975, 1.2217; 1975, 1.3066; 1977, 1.3951;

1978, 1.4904; 1979, 1.5964, 1980, 1.7329, 1981, 1.9143; 1982,

2.0469; and 1983, 2.1346.

The 1982 w e l f a r e c u t b a c k s a r e r e f l e c t e d i n t a b l e 3 , which

p r e s e n t s 1981-83 s p e n d i n g t o t a l s i n c o n s t a n t d o l l a r s , by form

o f b e n e f i t . A s t h i s t a b l e shows, s p e n d i n g d e c l i n e d i n r e a l

t e r m s i n 1982 f o r m e d i c a l a i d , c a s h a i d , f o o d b e n e f i t s , j o b s

and t r a i n i n g , s e r v i c e s , and e n e r g y a i d . Growth resumed i n 1983

f o r m e d i c a l a i d , food b e n e f i t s , and e n e r g y a i d , b u t c o n t i n u e d t o

d e c l i n e f o r c a s h a i d , j o b s and t r a i n i n g , and s e r v i c e s .

I n c o n s t a n t d o l l a r s , spending increased during both

y e a r s f o r e d u c a t i o n a i d and h o u s i n g b e n e f i t s .

TABLE 3.

Recent T r e n d s by Form o f B e n e f i t , FY 1981-1983 a /

FY 1982

FY 1 9 8 3

FY 1 9 8 3 a s

FY 1981

outlays

percentage of

outlays

( b i l l i o n s o f c o n s t a n t 1972 d o l l a r s )

1981

M e d i c a l Aid

Cash

Food B e n e f i t s

Housing

Education

Jobs-Training

Services

Energy Aid

-a /

D a t a s o u r c e s a r e t h e same a s f o r t a b l e 2.

b/ The r i s e i n e d u c a t i o n ' s s h a r e o f n e e d - t e s t e d b e n e f i t s

from i 9 8 1 t o 1983 i s d u e i n p a r t t o t h e FY 1982 r e s t o r a t i o n o f

a n income t e s t f o r t h e G u a r a n t e e d S t u d e n t Loan Program (GSLP).

As a r e s u l t , t h e program was r e t u r n e d t o t h i s r e p o r t ' s i n v e n t o r y

a f t e r a n a b s e n c e i n 1979-81, when i t had n o income t e s t .

Share of Gross National Product

A s a percentage of g r o s s n a t i o n a l product (GNP), w e l f a r e

o u t l a y s more t h a n d o u b l e d from 1968 t o 1976, t h e n w e r e r e l a t i v e l y

s t e a d y . I n 1981 t h e s h a r e r o s e t o a peak o f 4.07 p e r c e n t .

The

s h a r e o f GNP u s e d f o r i n c o m e - t e s t e d b e n e f i t programs was a s

follows:

S h a r e o f F e d e r a l Budget

The s h a r e o f t h e F e d e r a l b u d g e t u s e d f o r b e n e f i t programs

f o r t h e needy more t h a n doubled from 1968 t o 1976 and peaked

i n 1978-1979 a t 14.1 p e r c e n t . However, i t began d r o p p i n g i n

1980 and i n 1983 f e l l t o 12 p e r c e n t , l o w e s t s i n c e 1973. T a b l e

4 summarizes t h i s .

TABLE 4.

S h a r e o f F e d e r a l Budget Used f o r Need-Tested B e n e f i t s

Federal spending

Total

Federal

f or

need-tested b e n e f i t s a /

outlays

( b i l l i o n s o f currTnt d o l l a r s )

Share of Federal

budget f o r

need-tested b e n e f i t s

(percent)

-a / D a t a s o u r c e s a r e t h e same a s f o r t a b l e 2, p. 6.

S h a r e o f Welfare O u t l a y s P a i d by F e d e r a l Funds

The F e d e r a l Government's s h a r e of o u t l a y s f o r n e e d - t e s t e d

programs climbed 9 p e r c e n t from 1968 t o 1979 and t h e n d e c l i n e d

somewhat, a s f o l l o w s :

Composition of B e n e f i t s

The l a r g e s t i n c r e a s e s d u r i n g 1968-83 i n need-based b e n e f i t

e x p e n d i t u r e s were i n forms o t h e r t h a n c a s h . The r e s u l t i s a

d r a m a t i c change i n t h e composition of t h e b e n e f i t d o l l a r . A t t h e

s t a r t o f t h e p e r i o d 46.9 c e n t s p e r b e n e f i t d o l l a r were g i v e n a s

c a s h , but by 1983 t h e c a s h s h a r e had f a l l e n t o 27.1 c e n t s , a

d r o p of 20 c e n t s p e r d o l l a r (42 p e r c e n t ) . The s h a r e o f a i d

provided a s food and h o u s i n g more t h a n doubled d u r i n g t h e p e r i o d ,

r i s i n g from 10.1 c e n t s p e r b e n e f i t d o l l a r t o 24.5 c e n t s . The

s h a r e g i v e n a s medical a i d r o s e 3.5 c e n t s ( 1 5 p e r c e n t ) , b u t t h e

s h a r e provided a s j o b s and t r a i n i n g and o t h e r s e r v i c e s d e c l i n e d

2.3 c e n t s (29 p e r c e n t ) .

This i s summarized i n C h a r t s 2 and 3. T a b l e 5 shows,

f u r t h e r , t h a t i n t h e 4 y e a r s , 1979-83, t h e r e was a s i g n i f i c a n t

s h i f t toward a i d i n t h e form o f medical b e n e f i t s , food, educat i o n , and energy a s s i s t a n c e . I n t h i s p e r i o d t h e s h a r e o f a i d

g i v e n a s j o b s - t r a i n i n g plunged 7.1 c e n t s p e r b e n e f i t d o l l a r

(78 p e r c e n t ) .

Chart 2

Composition of Need-Based Benefit Dollar

Fiscal Year 1968

Services

7 Is7

Education

5.4%

Housing ,

4.9%

Jobs - Training

4.7%

Percentages do not sum to 100% due to rounding.

Chart 3

Composition of Needs-Based Benefit Dollar

Fiscal Year 1983

Energy

1.6%

Education

6.8%

Percentages do not sum to 100% due to rounding.

TABLE 5.

Form o f aid

Composition of Need-Tested Benefits a/

FY 1968 FY 1979

FY 1980 FY 1981 FY 1982

(percentage share of total aid)

Medical Aid

Cash

Food Benefits

Housing

Education Aid

Jobs-Training

Services

Energy Aid

-a/ Data sources are the same as for table 2.

-b/ Total does not add because of rounding.

F Y 1983

INCOME TESTS OF THE BENEFIT PROGRAMS

Almost 90 p e r c e n t o f t h e p r o g r a m s i n t h i s r e p o r t h a v e a n

e x p l i c i t t e s t o f i n c o m e . The o t h e r s b a s e e l i g i b i l i t y o n a r e a

o f r e s i d e n c e , e n r o l l m e n t i n a n o t h e r w e l f a r e program, o r o t h e r

f a c t o r s t h a t presume n e e d .

The e x p l i c i t income t e s t s a r e o f f i v e k i n d s :

1 . Income c e i l i n g r e l a t e d t o o n e o f t h e F e d e r a l Governm e n t ' s o f f i c i a l p o v e r t y measures ( c e n s u s Bureau p o v e r t y

t h r e s h o l d s o r F e d e r a l p o v e r t y income g u i d e l i n e s ) .

tics'

Income l i m i t r e l a t e d t o S t a t e o r a r e a m e d i a n income.

3 . Income l i m i t r e l a t e d t o t h e B u r e a u o f L a b o r S t a t i s lower-level budgets.

Income b e l o w a b s o l u t e d o l l a r s t a n d a r d .

Income l e v e l deemed t o i n d i c a t e "need."

T a b l e 6 c l a s s i f i e s t h e 74 programs 3 / i n t h i s r e p o r t by

t y p e o f income t e s t .

I t shows t h a t f o u r F e d e r a l c a s h b e n e f i t p r o g r a m s u s e an

a b s o l u t e F e d e r a l d o l l a r c e i l i n g . The o t h e r s , i n c l u d i n g Aid t o

F a m i l i e s w i t h Dependent C h i l d r e n ( l a r g e s t c a s h program), b a s e

e l i g i b i l i t y on S t a t e d e c i s i o n s a b o u t income n e e d , a s d o e s

M e d i c a i d , t h e l a r g e s t w e l f a r e p r o g r a m o f a l l . Most f o o d

b e n e f i t p r o g r a m s t i e e l i g i b i l i t y t o t h e F e d e r a l p o v e r t y income

guidelines.

Many h o u s i n g p r o g r a m s b a s e e l i g i b i l i t y on a r e a

m e d i a n income.

J o b programs, on t h e o t h e r hand, t e n d t o u s e

o f f i c i a l p o v e r t y m e a s u r e s o r BLS income s t a n d a r d s , w h i c h e v e r

a r e higher.

The b e n e f i t p r o g r a m s u s e income t e s t s t o d e c i d e e l i g i b i l i t y a n d , i n some c a s e s , t o d e c i d e w h e t h e r t o g i v e f r e e

s e r v i c e o r t o charge a fee.

Some p r o g r a m s a d m i t a l i m i t e d

p e r c e n t a g e o f r e c i p i e n t s w i t h income a b o v e t h e i r c u s t o m a r y

limits.

An e x a m p l e i s H e a d s t a r t .

3/ The t o t a l number o f c l a s s i f i c a t i o n s i n t a b l e 6 e x c e e d s

7 4 b e c a u s e many p r o g r a m s h a v e a l t e r n a t i v e income t e s t s .

TABLE 6.

Income E l i g i b i l i t y T e s t s Used by B e n e f i t P r o g r a m s

Limit related to:

Official

poverty

BLS

measure b u d g e t s

Program 11

State1

area

median

income

Dollar

amount

Income

deemed

"needy"

Area

Enrollment

i n other

r e s i d e n c e program

Other

MEDICAL BENEFITS

1. Medicaid

10.

..........................................................

X 2 1 -------------- X

.................................................................

......................................

X 21

Medical c a r e f o r v e t e r a n s with

non-service

disability

General a s s i s t a n c e( m e d i c a l )

M a t e r n a l and c h i l d h e a l t h

.......................

X 41

......................................................

-------- x y .....................................

services

I n d i a n h e a l t h services

Community h e a l t h c e n t e r s

Medical a i d f o r refugees

and C u b a n / H a i t i a n e n t r a n t s

M i g r a n t h e a l t h c e n t e r s ---------Medical a i d f o r c e r t a i n

Cuban r e f u g e e s

C r i p p l e d c h i l d r e n ' s s e r v i c e s ----

........................................

..............................................................

......................................................

pensions

x y

x 21

........................................................................

X 41

CASH AID

1 1 . AFDC

1 2 . SSI

1 3 . veterans'

x 2/

x I1

x y

TABLE 6 .

Income E l i g i b i l i t y T e s t s Used b y B e n e f i t Programs

(Cont'd)

Limit r e l a t e d t o :

Program 1 1

Official

poverty

BLS

measure budget

State1

area

median

income

Dollar

amount

Incomr

deemed

"needy"

HOUSING BENEFITS

33. S e c . 8 lower-income h o u s i n g

41.

Farm l a b o r h o u s i n g l o a n s

Area

Enral lment

in other

r e s i d e n c e pragram

Other

TABLE 6 .

Income E l i g i b i l i t y T e s t s Used by B e n e f i t P r o g r a m s ( C o n t ' d )

Limit related to:

Official

BLS

poverty

measure budgets

Program I-/

State/

area

median

income

Dollar

mount

Income

deemed

"needy"

Area

residence

JOBS AND TRAINING

6 0 . Comprehensive e m ~ l o v m e n t

g/------------....................

and t r a i n i n g s e r v i c e s

Summer y o u t h employment 201

Job corps 2 0 1

S e n i o r comumn i t y s e r v i c e

employment

Work i n c e n t i v e p r o g r a m (WIN)

Youth employment D e m o n s t r a t i o n p r o g r a m s 2 2 / ---------------F o s t r r g r a n d p a r e n t s -------------P u b l i c s e r v i c e employment 261

S e n i o r companions

.......................

------

----

----------------

SERVICES

6 9 . T i t l e XX s o c i a l s e r v i c e s 2 5 /

7 0 . ~~~~l s e r v i c e s

71. Emergency f o o d d i s t r i b u t i o n

and s h e l t e r

- .......................................

x 21

------------------X

.....................................................................................

ENERGY AID

Enrollment

in other

program

Other

11 S h o r t t i t l e s and a b b r e v i a t i o n s a r e u s e d i n t h i s t a b l e .

contezts for f u l l t i t l e s .

See t a b l e o f

-21 Need i s d e c i d e d by S t a t e ( o r l o c a l i t y ) .

-3 / V e t e r a n must s w e a r t h a t h e c a n n o t pay f o r c a r e .

The s t a t e d p u r p o s e o f t h e M a t e r n a l and C h i l d H e a l t h (MCH) S e r v i c e s

lock- rant law i s t o e n a b l e S t a t e s t o a s s u r e a c c e s s t o q u a l i t y MCH s e r v i c e s

t o m o t h e r s and c h i l d r e n , p a r t i c u l a r l y t h o s e w i t h low income ( 9 r l i m i t e d a v a i l a b i l i t y o f h e a l t h s e r v i c e s ) . The law d e f i n e s low income i n t e r m s o f t h e F e d e r a l

T h i s b l o c k g r a n t which t o o k e f f e c t i n FY 1981, i n c l u d e s

poverty guidelines.

funding f o r c r i p p l e d c h i l d r e n ' s s e r v i c e s .

-51 The law l i m i t s f r e e c a r e t o t h o s e below p o v e r t y .

-6 1 A l l r e s i d e n t s o f t h e a r e a s e r v e d a r e e l i g i b l e , b u t f e e s must b e c h a r g e d

t h e non-poor.

-71 For b a s i c SSI payment from t h e U.S.

-8 1 S t a t e s d e c i d e need f o r a n o p t i o n a l S t a t e supplement t o SSI.

For a b l i n d o r d i s a b l e d c h i l d .

101 Food stamp e l i g i b i l i t y i s a c c e p t e d a s d o c u m e n t a t i o n o f e l i g i b i l i t y f o r

t h e f r e e s c h o o l l u n c h and f r e e s c h o o l b r e a k f a s t programs.

111 R e g u l a t i o n s p r o v i d e t h a t income l i m i t s s h a l l n o t b e lower t h a n t h o s e f o r

f r e e o r r e d u c e d - p r i c e h e a l t h c a r e , p r o v i d e d t h e s e l i m i t s a r e between 100 and 185

percent of poverty.

121

need7

The law r e q u i r e s p r e f e r e n c e f o r t h o s e w i t h g r e a t e s t economic o r s o c i a l

131 Need i s d e c i d e d by a n e e d s a n a l y s i s s y s t e m a u t h o r i z e d by t h e H i g h e r

~ d u c x i o nAct and u p d a t e d a n n u a l l y by t h e S e c r e t a r y o f E d u c a t i o n .

141 Need i s d e c i d e d by t h e e d u c a t i o n a l i n s t i t u t i o n , by u s e o f a n e e d s

a n a l F i s s y s t e m approved by t h e S e c r e t a r y of E d u c a t i o n .

151 There i s no income t e s t .

t o beneedy.

16/

M i g r a t o r y c h i l d r e n and s t u d e n t s a r e presumed

Need i s d e c i d e d by t h e e d u c a t i o n a l i n s t i t u t i o n .

1 7 1 F o r f o r g i v e n e s s o f l o a n s made t o needy s t u d e n t s who f a i l t o c o m p l e t e

studzs.

181 Need f o r l o a n s i s d e c i d e d by t h e e d u c a t i o n a l i n s t i t u t i o n , by u s e o f a

n e e d F a n a l y s i s s y s tem approved by t h e S e c r e t a r y of E d u c a t i o n " i n c o m b i n a t i o n

w i t h o t h e r i n f o r m a t i o n " a b o u t t h e s t u d e n t ' s f i n a n c e s . For a l l h e a l t h p r o f e s s i o n a l s c h o l a r s h i p s and f o r l o a n s t o s t u d e n t s o f m e d i c i n e and o s t e o p a t h y ,

F e d e r a l r e g u l a t i o n s d e f i n e t h e r e q u i r e d " e x c e p t i o n a l f i n a n c i a l need."

1 9 1 Law makes e l i g i b l e s e c o n d a r y s t u d e n t s who a r e "economically d i s a d v a z a g e d , " b u t d o e s n o t d e f i n e t h e t e r m . T h e r e a r e no r e g u l a t i o n s .

20/ C h a r t shows p r a c t i c e s u n d e r t h e Comprehensive Employment and

~ r a i x A

n c~t (CETA), which was r e p l a c e d by t h e J o b T r a i n i n g P a r t n e r s h i p

Act (JTPA), e f f e c t i v e i n FY 1984. The new law u s e s s i m i l a r e l i g i b i l i t y

r u l e s f o r t h e s e programs.

211 F e d e r a l p o v e r t y g u i d e l i n e s a r e u s e d i f h i g h e r t h a n BLS income

st a n z r d .

221

C h a r t shows p r a c t i c e s u n d e r CETA.

grant e f f e c t i v e i n FY 1983.

Program was r e p l a c e d by a b l o c k

231 I n S t a t e s t h a t p r o v i d e SSI s u p p l e m e n t s , income l i m i t s c a n exceed

125 p e r c e n t o f p o v e r t y .

24/

T h i s program was e n d e d , e f f e c t i v e FY 1982.

C h a r t shows p r a c t i c e i n

1981.

251 B e f o r e P.L. 97-35, F e d e r a l law s e t a n o u t e r e l i g i b i l i t y l i m i t r e l a t e d

t o ~ c t median

income and r e q u i r e d o n e - h a l f o f F e d e r a l m a t c h i n g f u n d s t o b e

used f o r w e l f a r e r e c i p i e n t s .

261 Need was d e c i d e d by v o l u n t a r y a g e n c i e s a d m i n i s t e r i n g t h e b e n e f i t s .

271 S t a t e s h a v e t h e o p t i o n o f s e t t i n g l i m i t s below o u t e r F e d e r a l c e i l i n g s

i n t z s category

POVERTY THRESHOLDS AND OTHER

MEASUKES OF NEED

On t h e n e x t pages a r e found:

E s t i m a t e d w e i g h t e d a v e r a g e p o v e r t y t h r e s h o l d s i n 1983, i s s u e d

by t h e Census Bureau i n J a n u a r y 1984.

F e d e r a l p o v e r t y income g u i d e l i n e s f o r 1984, i s s u e d by t h e

Department of H e a l t h and Human S e r v i c e s i n F e b r u a r y 1984. 1/

Income e l i g i b i l i t y l e v e l s f o r f r e e and reduced p r i c e m e a l s

f o r t h e p e r i o d J u l y 1, 1984-June 30, 1985 (130 p e r c e n t

and 185 p e r c e n t , r e s p e c t i v e l y , o f 1984 F e d e r a l p o v e r t y

income g u i d e l i n e s ) .

Annual b u d g e t s f o r a f o u r - p e r s o n u r b a n f a m i l y , a t t h r e e

l e v e l s o f l i v i n g , autumn 1981, i s s u e d by t h e Bureau o f

Labor S t a t i s t i c s i n A p r i l 1982.

Annual b u d g e t s f o r a r e t i r e d u r b a n c o u p l e , a t t h r e e l e v e l s

o f l i v i n g , autumn 1981, i s s u e d by t h e Bureau o f Labor

S t a t i s t i c s i n J u l y 1982.

1/ P u b l i c Law 97-35 r e q u i r e s t h e S e c r e t a r y o f H e a l t h and

~ u m a n - s e r v i c e s (HHS) t o r e v i s e a t l e a s t a n n u a l l y " t h e o f f i c i a l

p o v e r t y l i n e ( a s d e f i n e d by t h e O f f i c e o f Management and

The u p d a t i n g methodology was d e v e l o p e d by t h e

Budget).

O f f i c e o f Economic and O p p o r t u n i t y , c o n t i n u e d by t h e O f f i c e o f

Management and Budget, a n d , s i n c e e n a c t m e n t o f P.L. 97-35, h a s

been u s e d by t h e HHS S e c r e t a r y .

. ."

TABLE 7 .

Bureau o f t h e Census P o v e r t y T h r e s h o l d s

i n 1983

Estimated

weighted average

t h r e s h o l d : 1983 a /

.....................

.............

..........

2 p e r s o n s ....................

1 person

Under 65 y e a r s

65 y e a r s and o v e r

Householder under 65 y e a r s . .

H o u s e h o l d e r 65 y e a r s and o l d e r

....................

............

3 persons

4 persons

5 persons

6 persons

7 persons

8 persons

9 p e r s o n s o r more

----

F a c t o r u s e d t o u p d a t e 1982 t h r e s h o l d s :

-a /

1.03217

Census Bureau p r e s s r e l e - a s e , J a n u a r y , 25, 1984.

TABLE 8.

1984 Federal Poverty Income Guidelines a/

Poverty Guidelines for All States Except Alaska and Hawaii

Guideline

$ 4,980

6,720

8,460

10,200

11,940

13,680

15,420

17,160

Size of Family Unit

For family units with more than 8 members, add $1,740 for each

additional member.

Size of Familv Unit

Guideline

$ 6,240

8,410

10,580

12,750

14,920

17,090

19,260

21,430

For family units with more than 8 members, add $2,170 for each

additional member.

Poverty Guidelines for Hawaii

Size of Family Unit

Nonfarm Family Guideline

$ 5,730

For family units with more than 8 members, add $2,000 for each

additional member.

-a/ Source: 49 Federal Register. No. 39. Feb. 27, 1984, p. 7152.

TABLE 9

Eligibility Levels for Free and Reduced-Price

Meals for the Period July 1. 1984-June 30. 1985

Maximum income levels for

free and reduced-price meals

Family size

1983 Federal

poverty income Free meals

guidelines

130%

Reduced-price

meals 185%

48 States. District of Columbia. Territories excluding Guam

..................

4 ..................

5 ..................

6 ..................

7 ..................

8 ..................

Each additional

family member .......

$ 4.980

6. 720

8.460

10. 200

11.940

13. 680

15.420

17. 160

+1. 740

Alaska

.................. $ 6.240

.................. 8.410

.................. 10.580

4 ..................

12. 750

5 ..................

14. 920

6 ..................

17.090

19. 260

7 ..................

8 ..................

21. 430

Each additional

+ 2 . 170

family member ......

Hawaii and Guam

..................

.......

Each additional

family member

49 Federal Register

. No . 77. April 18.1984 . p . 15590.

TABLE 10. Summary of Annual Budgets f o r a Four-Person Family a t

Three L e v e l s of L i v i n g , Urban United S t a t e s , Autumn 1981 a /

(U.S. Department of Labor Bureau o f Labor S t a t i s t i c s - i s s u e d A p r i l 16, 1982)

Intermediate

budget

Higher

budget

$25,407

$38,060

18,240

25,008

5,843

7,366

5,546

8,423

2,372

3,075

1,333

1,947

508

719

1,443

1,505

1,196

1,972

62 1

1,021

1,718

1,036

1,703

1,993

1,596

4,443

9,340

Lower

budget

...................... $15,323

T o t a l f a m i l y consumption ........ 12,069

Food ......................... 4,545

Housing ....................... 2,817

1,311

T r a n s p o r t a t i o n ................

93 7

C l o t h i n g ......................

P e r s o n a l c a r e .................

397

Medical c a r e .................. 1,436

644

Other f a m i l y consumption ......

T o t a l budget

O t h e r items......................

P e r s o n a l income t a x e s ...........

----S o c i a l s e c u r i t y and d i s a b i l i t y

----

---

NOTE: Because o f rounding, sums o f i n d i v i d u a l items may n o t

equal t o t a l s .

a / L a s t r e l e a s e of 4-person f a m i l y budget d a t a . The Labor

~ e ~ a r t m e ne lti m i n a t e d t h e program a f t e r Congress passed t h e

Omnibus Budget R e c o n c i l i a t i o n Act of 1981. I t s a i d funds were

n o t a v a i l a b l e t o make changes r e q u i r e d t o c o n t i n u e t h e program.

TABLE 11. Summary of Annual Budgets f o r a R e t i r e d Couple a t

Three L e v e l s of L i v i n g , Urban United S t a t e s , Autumn 1 9 8 1 5 1

(u.s. Department o f Labor, Bureau o f Labor S t a t i s t i c s i s s u e d J u l y 30, 1982)

Lower

budget

---

- -

Intermediate

budget

Higher

budget

-b/ ................... $7,226

T o t a l f a m i l y consumption ......... 6,914

Food ........................... 2,183

Housing ........................ 2,377

T r a n s p o r t a t i o n .................

553

C l o t h i n g .......................

244

198

P e r s o n a l c a r e ..................

Medical c a r e c / ................ 1,085

O t h e r f a m i l y consumptions ......

27 5

311

Other i t e m s ......................

T o t a l budget

NOTE:

Because o f rounding, sums o f i n d i v i d u a l i t e m s may n o t

equal t o t a l .

a / L a s t r e l e a s e o f r e t i r e d c o u p l e budget d a t a . The Labor

~e~artmen

d its c o n t i n u e d t h e program a f t e r Congress passed t h e

Omnibus Budget R e c o n c i l i a t i o n Act of 1981. The Department s a i d

funds were n o t a v a i l a b l e t o make changes r e q u i r e d t o c o n t i n u e t h e

program.

b/ Beginning w i t h t h e autumn 1973 u p d a t i n g o f t h e budgets

f o r t z e r e t i r e d c o u p l e , t h e t o t a l budget i s d e f i n e d a s t h e sum

of " t o t a l f a m i l y consumption" and " o t h e r i t e m s . "

Income t a x e s

a r e n o t i n c l u d e d i n t h e t o t a l budgets.

c / The e s t i m a t e s f o r m e d i c a l c a r e c o n t a i n a p r e l i m i n a r y

e s t i m a t e f o r "out-of-pocket" c o s t s f o r Medicare.

CATALOGUE OF PROGRAMS OFFERING

CASH AND NON-CASH BENEFITS

TO PERSONS OF

LIMITED INCOME

MEDICAID*

Funding Formula

By law, t h e F e d e r a l Government h e l p s S t a t e s s h a r e i n t h e c o s t

o f Medicaid s e r v i c e s by means o f a v a r i a b l e m a t c h i n g f o r m u l a t h a t i s

a d j u s t e d b i e n n a l l y . The m a t c h i n g r a t e , which i s i n v e r s e l y r e l a t e d

t o a S t a t e ' s p e r c a p i t a income, r a n g e s from 50 t o 77.63 p e r c e n t i n

F i s c a l Y e a r s (FYs) 1984-85.

F o r FY 1983 t h e r a t e a v e r a g e d s l i g h t l y

more t h a n 5 4 p e r c e n t f o r t h e N a t i o n a s a whole. The F e d e r a l s h a r e

o f a d m i n i s t r a t i v e c o s t s g e n e r a l l y i s 50 p e r c e n t b u t a s h i g h a s 9 0

p e r c e n t f o r c e r t a i n i t e m s . P.L. 97-35, t h e Omnibus Budget

R e c o n c i l i a t i o n Act o f 1981, p r o v i d e d f o r a r e d u c t i o n i n t o t a l

F e d e r a l f u n d s t o which a S t a t e i s o t h e r w i s e e n t i t l e d i n FY82-FY84

u n l e s s c e r t a i n c o n d i t i o n s a r e met.

F e d e r a l Medical A s s i s t a n c e P e r c e n t a g e (FMAP)

The F e d e r a l s h a r e o f a S t a t e ' s m e d i c a l v e n d o r payments i s

c a l l e d t h e F e d e r a l m e d i c a l a s s i s t a n c e p e r c e n t a g e (FMAP). The

FMAP i s h i g h e r f o r S t a t e s w i t h l o w e r p e r c a p i t a incomes and

lower f o r S t a t e s w i t h h i g h e r p e r c a p i t a incomes. I f a s t a t e ' s

p e r c a p i t a income w e r e e q u a l t o t h e n a t i o n a l a v e r a g e p e r c a p i t a

income, i t s FMAP would b e 55 p e r c e n t . The law e s t a b l i s h e s

a minimum FMAP o f 50 p e r c e n t 11 and a maximum o f 8 3 p e r c e n t

( t h o u g h t h e h i g h e s t r a t e i n ~ y 8 4 - 8 5 i s 77.63 p e r c e n t f o r

Mississippi).

11 F o r FY84 and FY85, 1 3 S t a t e s and t h e D i s t r i c t o f Columbia

t h e maximum S t a t e s h a r e o f 50 p e r c e n t b e c a u s e t h e i r p e r c a p i t a

must

income i n t h e b a s e p e r i o d exceeded t h e n a t i o n a l a v e r a g e by more t h a n

5.4093 p e r c e n t . The S t a t e s a r e : A l a s k a , C a l i f o r n i a , C o l o r a d o , Conn e c t i c u t , Delaware, H a w a i i , I l l i n o i s , Maryland, Nevada, New J e r s e y ,

New York, Washington, and Wyoming.

pay

* R e g u l a t i o n s g o v e r n i n g Medicaid a r e found i n 42 C.F.R.

430-456.

The s t a t u t o r y f o r m u l a f o r d e t e r m i n i n g t h e FMAP f o l l o w s : 21

FMAP = 100%

- S t a t e s h a r e ( w i t h a minimum o f 50% and a maximum o f 8 3 % )

( S t a t e p e r c a p i t a income)

State share =

45%

( N a t i o n a l p e r c a p i t a income)

By law, between O c t o b e r 1 and November 30 of e a c h even-numbered

y e a r , t h e S e c r e t a r y o f HHS p r o m u l g a t e s t h e p e r c e n t a g e t h a t w i l l b e

i n e f f e c t f o r t h e 2-year p e r i o d b e g i n n i n g t h e f o l l o w i n g O c t o b e r .

The p e r c e n t a g e s a r e b a s e d on t h e a v e r a g e p e r c a p i t a income o f e a c h

S t a t e and t h e U n i t e d S t a t e s f o r t h e 3 most r e c e n t c a l e n d a r y e a r s

f o r which s a t i s f a c t o r y d a t a a r e a v a i l a b l e from t h e Department o f

Commerce. 31

The law p r o v i d e s one e x c e p t i o n t o t h e FMAP. Family p l a n n i n g

s e r v i c e s a r e f e d e r a l l y matched a t a 90 p e r c e n t r a t e .

ii.

A d m i n i s t r a t i v e Matching R a t e

The law s p e c i f i e s a F e d e r a l m a t c h i n g r a t e o f 50 p e r c e n t f o r

a d m i n i s t r a t i v e c o s t s w i t h t h e f o l l o w i n g e x c e p t i o n s : automated c l a i m s

p r o c e s s i n g s y s t e m s ( 9 0 p e r c e n t f o r development, 75 p e r c e n t f o r o p e r a t i o n ) , p r o f e s s i o n a l m e d i c a l p e r s o n n e l used i n program a d m i n i s t r a t i o n

( 7 5 p e r c e n t ) , e s t a b l i s h m e n t and o p e r a t i o n o f S t a t e f r a u d and a b u s e

c o n t r o l u n i t s (90 p e r c e n t f o r t h e f i r s t 3 y e a r s , 75 p e r c e n t t h e r e a f t e r ) , and u t i l i z a t i o n r e v i e w a c t i v i t i e s c o n d u c t e d by p r o f e s s i o n a l

s t a n d a r d s r e v i e w o r g a n i z a t i o n s on u t i l i z a t i o n and q u a l i t y c o n t r o l

peer review o r g a n i z a t i o n s under c o n t r a c t (75 p e r c e n t ) .

21 P.L. 97-35 r e q u i r e d t h e C o m p t r o l l e r G e n e r a l t o c o n d u c t a s t u d y

o f t h e FMAP and r e p o r t t h e r e s u l t s t o Congress by O c t o b e r 1, 1982.

The s t u d y was t o examine t h e f e a s i b i l i t y and c o n s e q u e n c e s o f r e v i s i n g

t h e f o r m u l a t o t a k e i n t o a c c o u n t : ( 1 ) t h e r e l a t i v e economic p o s i t i o n s and n e e d s o f t h e d i f f e r e n t S t a t e s ; ( 2 ) t h e d i f f e r e n t amounts

o f w e l f a r e payments; ( 3 ) t h e r e l a t i v e c o s t o f l i v i n g and unemployment r a t e s ; ( 4 ) t h e r e l a t i v e t a x a b l e w e a l t h and amount o f t a x e s

r a i s e d p e r c a p i t a ; and ( 5 ) o t h e r r e l e v a n t f a c t o r s b e a r i n g on an

e q u i t a b l e d i s t r i b u t i o n o f F e d e r a l f u n d s . The r e p o r t was i s s u e d

on March 9 , 1983.

31 I n t h e FY84-FY85 p e r i o d t h e S t a t e s and t h e D i s t r i c t o f

~ o l u m F i a f a l l i n t o r o u g h l y t h r e e g r o u p s u n d e r t h e Medicaid f o r m u l a :

F e d e r a l s h a r e between 50 and 55 p e r c e n t , 19 S t a t e s ; 55-65 p e r c e n t ,

1 7 S t a t e s ; 65-77.63 p e r c e n t , 1 5 S t a t e s . The r a t e f o r American Samoa,

Guam, P u e r t o R i c o , t h e V i r g i n I s l a n d s , and t h e N o r t h e r n M a r i a n a

I s l a n d s i s s e t by law a t 50 p e r c e n t . However, t h e law e s t a b l i s h e s

a n n u a l l i m i t s on F e d e r a l e x p e n d i t u r e s i n t h e s e o u t l y i n g a r e a s .

iii. R e d u c t i o n s i n Payments-. t o S t a t e s

P.L. 97-35, t h e Omnibus Budget R e c o n c i l i a t i o n Act o f 1981, prov i d e s f o r r e d u c t i o n s i n F e d e r a l Medicaid payments t o S t a t e s i n t h e

FY82-FY84 p e r i o d .

S t a t e s can l o w e r t h e r e d u c t i o n s o t h e r w i s e a p p l i c a b l e by m e e t i n g c e r t a i n c r i t e r i a a n d / o r by s p e n d i n g l e s s t h a n a

s p e c i f i e d t a r g e t amount.

The amount o f F e d e r a l m a t c h i n g payments t o which a S t a t e i s

o t h e r w i s e e n t i t l e d i s t o b e r e d u c e d by 3 p e r c e n t i n FY82, 4 p e r c e n t

i n FY83, and 4 . 5 p e r c e n t i n FY84. A S t a t e c a n l o w e r t h e amount o f

i t s r e d u c t i o n by 1 p e r c e n t a g e p o i n t f o r e a c h o f t h e f o l l o w i n g :

( 1 ) o p e r a t i n g a q u a l i f i e d h o s p i t a l c o s t r e v i e w program; 41 ( 2 ) s u s t a i n i n g a n unemployment r a t e e x c e e d i n g 150 p e r c e n t o f t h z n a t i o n a l

a v e r a g e ; and ( 3 ) d e m o n s t r a t i n g r e c o v e r i e s from f r a u d and a b u s e

a c t i v i t i e s , and w i t h r e s p e c t t o FY82, t h i r d - p a r t y r e c o v e r i e s e q u a l

t o 1 p e r c e n t o f F e d e r a l payments.

A S t a t e i s e n t i t l e d t o a d o l l a r - f o r - d o l l a r o f f s e t i n i t s reduct i o n s i f t o t a l F e d e r a l Medicaid e x p e n d i t u r e s i n a y e a r f a l l below

a s p e c i f i e d t a r g e t amount. I n no c a s e can t h e amount r e c o v e r e d

exceed t h e t o t a l amount o f r e d u c t i o n s . I n FY82, t h e t a r g e t amount

was e q u a l t o 109 p e r c e n t o f t h e S t a t e ' s e s t i m a t e f o r FY81. The law

s p e c i f i e s t h a t t h e FY83 and FY84 t a r g e t s s h a l l e q u a l t h e FY82 t a r g e t

i n c r e a s e d o r d e c r e a s e d by t h e p e r c e n t a g e change i n t h e i n d e x o f t h e

m e d i c a l c a r e component o f t h e consumer p r i c e i n d e x o v e r t h e same

p e r i o d . The FY 1983 t a r g e t e q u a l l e d 107.5 p e r c e n t o f t h e FY 1982

amount, and t h e FY 1984 t a r g e t i s e s t i m a t e d a t 116.5 p e r c e n t o f t h e

FY 1982 amount. A S t a t e e n t i t l e d t o an o f f s e t w i l l r e c e i v e payment

f o r s u c h amount d u r i n g t h e f i r s t q u a r t e r o f t h e f o l l o w i n g f i s c a l

y e a r . The law e x c l u d e s t h e f o l l o w i n g i t e m s from t h e d e t e r m i n a t i o n o f

(1)

w h e t h e r a S t a t e s p e n d s l e s s t h a n i t s t a r g e t amount f o r a y e a r :

a d j u s t m e n t s w i t h r e s p e c t t o p r i o r y e a r c l a i m s ; ( 2 ) i n t e r e s t p a i d on

d i s a l l o w a n c e s f o r p r i o r y e a r s ; ( 3 ) any o f f s e t payments t h e S t a t e h a s

r e c e i v e d f o r s p e n d i n g l e s s t h a n i t s t a r g e t amount i n t h e p r e v i o u s

y e a r , and ( 4 ) any o f t h e r e d u c t i o n s i n t h e F e d e r a l f u n d s a S t a t e

r e c e i v e s t h a t a r e imposed u n d e r t h e new law.

4 1 A q u a l i f i e d h o s p i t a l c o s t r e v i e w program i s one t h a t h a s

been e s t a b l i s h e d by s t a t u t e , i s o p e r a t e d d i r e c t l y by a S t a t e ,

a p p l i e s t o s u b s t a n t i a l l y a l l non-Federal h o s p i t a l s , and r e v i e w s a l l

non-Medicare i n p a t i e n t r e v e n u e s o r e x p e n s e s o r a t l e a s t 75 p e r c e n t

o f a l l r e v e n u e s o r e x p e n s e s i n c l u d i n g t h o s e a r i s i n g under Medicare.

Q u a l i f y i n g programs must a s s u r e t h e S e c r e t a r y t h a t e a c h e n t i t y

which pays f o r h o s p i t a l s e r v i c e s , employees, and p a t i e n t s ( i n c l u d i n g t h e M e d i c a r e and Medicaid programs) i s p r o v i d e d s u b s t a n t i a l l y

e q u a l t r e a t m e n t . F o r a p p r o v a l o f i t s p l a n , moreover, a S t a t e must

show t h a t t h e a n n u a l r a t e o f i n c r e a s e i n a g g r e g a t e h o s p i t a l i n p a t i e n t c o s t s p e r c a p i t a o r p e r a d m i s s i o n h a s r i s e n a t l e a s t 2 perc e n t a g e p o i n t s l e s s ( u s i n g a I-, 2-, o r 3-year b a s e ) t h a n t h e r a t e

o f i n f l a t i o n i n a l l S t a t e s w i t h o u t q u a l i f y i n g programs.

The r e d u c t i o n and o f f s e t p r o v i s i o n s d o n o t a p p l y t o t h e t e r r i t o r i e s . 5 1 They a l s o d o n o t a p p l y t o A r i z o n a , which d i d n o t h a v e a

~ e d i c a i d - p r o g r a m when t h e s p e n d i n g r e d u c t i o n p r o v i s i o n s were

approved. 6-l

E l i g i b i l i t y Requirements

E l i g i b i l i t y f o r Medicaid i s l i n k e d t o a c t u a l o r p o t e n t i a l

r e c e i p t o f c a s h a s s i s t a n c e u n d e r t h e programs of Aid t o F a m i l i e s

w i t h Dependent . C h i l d r e n (AFDc) and S u p p l e m e n t a l S e c u r i t y Income

( S S I ) f o r t h e aged, b l i n d , and d i s a b l e d ; t h e r e a r e two c l a s s e s o f

e l i g i b i l i t y u n d e r Medicaid: c a t e g o r i c a l l y needy and m e d i c a l l y

needy.

A l l S t a t e Medicaid programs c o v e r t h e " c a t e g o r i c a l l y needy."

I n g e n e r a l , t h e s e a r e p e r s o n s r e c e i v i n g c a s h a i d from AFDC o r SSI.

Each S t a t e h a s t h e o p t i o n o f r e s t r i c t i n g Medicaid c o v e r a g e o f SSI

r e c i p i e n t s by r e q u i r i n g them t o meet any more s t r i n g e n t e l i g i b i l i t y

r u l e t h a t t h e S t a t e a p p l i e d on J a n u a r y 1, 1972, t o Medicaid c o v e r a g e

o f needy aged, b l i n d , o r d i s a b l e d a d u l t s i n programs t h a t preceded

SSI. S t a t e s c h o o s i n g t h e more r e s t r i c t i v e c r i t e r i a must a l l o w a p p l i c a n t s t o d e d u c t m e d i c a l e x p e n s e s from income i n d e t e r m i n i n g e l i g i b i l i t y . 7 1 S t a t e s a l s o may c o v e r a d d i t i o n a l p e r s o n s a s c a t e g o r i c a l l y neTdy; t h e s e i n c l u d e p e r s o n s r e c e i v i n g S t a t e supplement SSI

payments ( S S P ) , p e r s o n s who would b e e l i g i b l e f o r c a s h a s s i s t a n c e

except t h a t they a r e r e s i d e n t s i n medical i n s t i t u t i o n s (such a s

s k i l l e d n u r s i n g f a c i l i t i e s ) , o r c h i l d r e n between a g e s 18 and 20 o r

any r e a s o n a b l e c l a s s i f i c a t i o n o f s u c h c h i l d r e n . S t a t e s may a l s o

e x t e n d c o v e r a g e t o unemployed f a t h e r s and t h e i r f a m i l i e s o r c h i l d r e n o f unemployed f a t h e r s .

S t a t e s must e x t e n d Medicaid e l i g i b i l i t y t o aged, b l i n d , and d i s a b l e d p e r s o n s who w e r e e l i g i b l e f o r Medicaid i n December 1973 ( b e f o r e

t h e s t a r t o f SSI on J a n u a r y 1, 1974) a s l o n g a s t h e y meet t h e 1973

c r i t e r i a ; p e r s o n s r e c e i v i n g mandatory S t a t e s u p p l e m e n t a r y payments;

51 As n o t e d b e f o r e , a c e i l i n g i s imposed on F e d e r a l Medicaid

f u n d i z g f o r t h e o u t l y i n g a r e a s ; w i t h i n t h e c e i l i n g , t h e i r F'MAP i s

50 p e r c e n t .

6 1 Beginning Oct. 1, 1982, A r i z o n a began i m p l e m e n t a t i o n o f a

t h r e e x y e a r d e m o n s t r a t i o n p r o j e c t u n d e r which s p e c i f i e d s e r v i c e s a r e

t o b e p r o v i d e d t o t h e i n d i g e n t on a p r e p a i d b a s i s .

71 As of Aug. 1, 1983, t h e f o l l o w i n g 14 S t a t e s employed more

r e s t r T c t i v e c r i t e r i a t h a n SSI i n d e t e r m i n i n g Medicaid e l i g i b i l i t y :

C o n n e c t i c u t , Hawaii, I l l i n o i s , I n d i a n a , M i n n e s o t a , M i s s o u r i , Nebraska,

New Hampshire, North C a r o l i n a , N o r t h Dakota, Ohio, Oklahoma, Utah,

and V i r g i n i a .

p e r s o n s who would b e e l i g i b l e f o r c a s h a i d e x c e p t f o r a S t a t e b a r r i e r

d i s a l l o w e d by Medicaid law; and p e r s o n s a c t u a l l y r e c e i v i n g SSI a n d / o r

SSP payments who l o s e t h e i r e l i g i b i l i t y f o r SSI o r SSP s o l e l y because

of a c o s t - o f - l i v i n g s o c i a l s e c u r i t y i n c r e a s e . Medicaid coverage a l s o

must b e extended f o r 4 a d d i t i o n a l months t o c e r t a i n f a m i l i e s whose

AFDC c a s h a s s i s t a n c e h a s been t e r m i n a t e d provided t h e y had r e c e i v e d

AFDC f o r a t l e a s t 3 o f t h e p r e c e d i n g 6 months; t h i s e x t e n s i o n a p p l i e s

only t o f a m i l i e s whose AFDC c o v e r a g e h a s been t e r m i n a t e d due t o

i n c r e a s e d income from, o r i n c r e a s e d h o u r s o f , employment.

S t a t e s a l s o may c o v e r t h e "medically needy" under t h e i r Medicaid

programs. These a r e p e r s o n s whose income a n d / o r r e s o u r c e s ( a s counted

under e l i g i b i l i t y r u l e s of t h e r e l e v a n t program o f c a s h a i d ) i s above

t h e S t a t e s t a n d a r d f o r c a s h a s s i s t a n c e , 8/ provided t h a t : ( 1 ) t h e y

a r e aged, b l i n d , d i s a b l e d , o r members of-families w i t h dependent

c h i l d r e n , and ( 2 ) t h e i r income ( a f t e r d e d u c t i n g i n c u r r e d medical

expenses) f a l l s below t h e S t a t e m e d i c a l l y needy s t a n d a r d . 9 / P r i o r

t o enactment of P.L. 97-35, S t a t e s having m e d i c a l l y needy programs

were r e q u i r e d t o o f f e r comparable c o v e r a g e t o a l l f o u r groups ( i . e . ,

aged, b l i n d , d i s a b l e d , and members of f a m i l i e s w i t h c h i l d r e n ) . P.L.

97-35 p r o v i d e s t h a t i f a S t a t e o f f e r s m e d i c a l l y needy c o v e r a g e t o

any group, i t must p r o v i d e ambulatory s e r v i c e s t o c h i l d r e n and pren a t a l and d e l i v e r y s e r v i c e s f o r p r e g n a n t women.

Benefits

S t a t e Medicaid programs must o f f e r t h e f o l l o w i n g s e r v i c e s t o

c a t e g o r i c a l l y needy r e c i p i e n t s : i n p a t i e n t and o u t p a t i e n t h o s p i t a l

s e r v i c e s ; l a b o r a t o r y and X-ray s e r v i c e s ; s k i l l e d n u r s i n g f a c i l i t y

(SNF) s e r v i c e s f o r t h o s e o v e r age 21; home h e a l t h s e r v i c e s f o r t h o s e

e n t i t l e d t o SNF c a r e ; e a r l y and p e r i o d i c s c r e e n i n g , d i a g n o s i s , and

t r e a t m e n t (EPSDT) f o r t h o s e under age 21; f a m i l y p l a n n i n g s e r v i c e s

and s u p p l i e s ; and p h y s i c i a n s ' s e r v i c e s . They a l s o may p r o v i d e

medical s e r v i c e s such a s d r u g s , i n t e r m e d i a t e c a r e f a c i l i t y ( I c F ) s e r a

v i c e s , e y e g l a s s e s , i n p a t i e n t p s y c h i a t r i c c a r e f o r i n d i v i d u a l s under

age 21 o r o v e r 65. S t a t e s a r e p e r m i t t e d t o e s t a b l i s h l i m i t a t i o n s

8/ P a r t i c i p a t i n g S t a t e s s e t t h e i r own m e d i c a l l y needy income

s t a n d z r d s w i t h i n an o u t e r F e d e r a l l i m i t . By law, t h e l i m i t i s 133 1 / 3

p e r c e n t o f t h e maximum sum paid i n t h e AFDC program t o a u n i t o f t h e

same s i z e .

9/ A s o f J a n u a r y 1984, t h e f o l l o w i n g 35 S t a t e s and j u r i s d i c tions-had m e d i c a l l y needy programs : Arkansas, C a l i f o r n i a , C o n n e c t i c u t ,

D i s t r i c t o f Columbia, Guam, Hawaii, I l l i n o i s , Kansas, Kentucky,

L o u i s i a n a , Maine, Maryland, M a s s a c h u s e t t s , Michigan, Minnesota, Mont a n a , Nebraska, New Hampshire, New York, North C a r o l i n a , North Dakota,

Northern Mariana I s l a n d s , Oklahoma, Oregon, Pennsylvania, P u e r t o Rico,

Rhode I s l a n d , Tennessee, Utah, Vermont, V i r g i n I s l a n d s , V i r g i n i a ,

Washington, West V i r g i n i a , and Wisconsin.

on t h e amount of c a r e p r o v i d e d u n d e r a s e r v i c e c a t e g o r y ( s u c h a s

l i m i t i n g t h e number o f d a y s o f c o v e r e d h o s p i t a l c a r e o r number o f

physicians' services).

P r i o r t o e n a c t m e n t o f P.L. 97-35, S t a t e s h a v i n g m e d i c a l l y needy

programs w e r e r e q u i r e d , a s a minimum, t o o f f e r t h i s p o p u l a t i o n g r o u p

e i t h e r a l l o f t h e mandatory s e r v i c e s , o r a l t e r n a t i v e l y t h e c a r e and

s e r v i c e s l i s t e d i n 7 o f t h e 17 p a r a g r a p h s i n t h e law d e f i n i n g c o v e r e d

s e r v i c e s , p r o v i d e d t h e y met c e r t a i n c o n d i t i o n s ( i n c l u d i n g o f f e r i n g a

mix o f i n s t i t u t i o n a l and n o n i n s t i t u t i o n a l s e r v i c e s ) . P.L. 97-35

s p e c i f i e s t h a t : ( 1 ) i f a S t a t e p r o v i d e s m e d i c a l l y needy c o v e r a g e t o

any g r o u p , i t must p r o v i d e a m b u l a t o r y s e r v i c e s t o c h i l d r e n and pren a t a l and d e l i v e r y s e r v i c e s f o r p r e g n a n t women; ( 2 ) i f a S t a t e prov i d e s i n s t i t u t i o n a l s e r v i c e s f o r any m e d i c a l l y needy g r o u p , i t must

a l s o p r o v i d e a m b u l a t o r y s e r v i c e s f o r t h i s p o p u l a t i o n g r o u p ; and ( 3 )

i f t h e S t a t e p r o v i d e s m e d i c a l l y needy c o v e r a g e f o r p e r s o n s i n i n t e r m e d i a t e c a r e f a c i l i t i e s f o r t h e m e n t a l l y r e t a r d e d (ICF/MRS), i t must

o f f e r t o a l l g r o u p s c o v e r e d i n i t s m e d i c a l l y needy program t h e same

mix o f i n s t i t u t i o n a l and n o n i n s t i t u t i o n a l s e r v i c e s a s r e q u i r e d u n d e r

p r i o r law.

F e d e r a l law, a s m o d i f i e d by P.L. 97-248, t h e Tax E q u i t y and

F i s c a l R e s p o n s i b i l i t y Act o f 1982, p e r m i t s S t a t e s t o impose c o s t sharing charges f o r a l l persons f o r a l l services with t h e following

exceptions:

-- S t a t e s a r e b a r r e d from imposing s u c h c h a r g e s on a l l c a t e g o r i c a l l y and m e d i c a l l y needy c h i l d r e n u n d e r age 18;

S t a t e s may p r o v i d e t h a t no copayments would b e imposed

f o r c h i l d r e n aged 1 8 t o 21.

-- S t a t e s a r e b a r r e d from imposing copayments on s e r v i c e s

r e l a t e d t o pregnancy ( i n c l u d i n g p r e n a t a l , d e l i v e r y ,

and p o s t partum s e r v i c e s ) . S t a t e s may p r o v i d e t h a t no

copayments would b e imposed f o r any s e r v i c e p r o v i d e d t o

p r e g n a n t women. These l i m i t a t i o n s a p p l y b o t h t o t h e

c a t e g o r i c a l l y needy and m e d i c a l l y needy.

-- S t a t e s a r e b a r r e d from imposing copayments on s e r v i c e s

p r o v i d e d t o c a t e g o r i c a l l y and m e d i c a l l y needy i n p a t i e n t s

i n SNFs and ICFs who a r e r e q u i r e d t o spend a l l t h e i r

income f o r m e d i c a l e x p e n s e s e x c e p t f o r t h e amount

exempted f o r p e r s o n a l n e e d s .

-- S t a t e s may n o t impose copayments on f a m i l y p l a n n i n g o r

emergency s e r v i c e s f o r e i t h e r t h e c a t e g o r i c a l l y needy

o r m e d i c a l l y needy.

-- S t a t e s a r e p r e c l u d e d from imposing copayments on c a t e g o r i c a l l y needy HMO e n r o l l e e s . They may a l s o exempt

t h e m e d i c a l l y needy from such c h a r g e s .

A l l copayment c h a r g e s must b e "nominal" i n amount, w i t h o n e

e x c e p t i o n . The S e c r e t a r y may waive t h e "nominal" r e q u i r e m e n t s

i n t h e c a s e o f non-emergency s e r v i c e s p r o v i d e d i n emergency rooms

where t h e S t a t e h a s e s t a b l i s h e d , s u b j e c t t o t h e s t a t i s f a c t i o n o f

t h e S e c r e t a r y , t h a t a l t e r n a t i v e s o u r c e s o f nonemergency s e r v i c e s

ate a c t u a l l y a v a i l a b l e and a c c e s s i b l e . I n s u c h c a s e s t h e S t a t e

may impose a c h a r g e u p t o t w i c e t h e amount d e f i n e d a s nominal.

I n FY 1382, e s t i m a t e d a v e r a g e a n n u a l Medicaid payments p e r

r e c i p i e n t were as f o l l o w s : aged, $3,222; b l i n d , $2,048; d i s a b l e d ,

$3,702; c h i l d r e n , $369; and a d u l t s i n AFDC f a m i l i e s , $772. The

e s t i m a t e d a v e r a g e a n n u a l payment f o r a l l g r o u p s was $1,343.

FY 1983 program c o s t s t o t a l e d $35.0 b i l l i o n , an i n c r e a s e o f

7.7 p e r c e n t o v e r t h e $32.4 b i l l i o n r e c o r d e d i n FY 1982.

MEDICAL CARE FOR VETERANS WITH A NON-SERVICE-CONNECTED

DISABILITY

Funding Formula

T h i s program i s funded 100 p e r c e n t by t h e F e d e r a l Government. 1 /

E l i g i b i l i t y Requirements 2 /

P o t e n t i a l l y , a b o u t 5 p e r c e n t o f t h e U.S. p o p u l a t i o n i s e l i g i b l e

t o r e c e i v e f r e e V e t e r a n s A d m i n i s t r a t i o n (VA) m e d i c a l c a r e . V e t e r a n s

w i t h a c c e s s t o m e d i c a l c a r e i n c l u d e f o u r sometimes o v e r - l a p p i n g

groups: ( 1 ) v e t e r a n s with service-connected d i s a b i l i t i e s ; (2) r e c i p i e n t s o f v e t e r a n s ' p e n s i o n s ; ( 3 ) v e t e r a n s 65 y e a r s and o l d e r ; ( 4 )

v e t e r a n s o f any war, o r o f s e r v i c e a f t e r J a n u a r y 3 1 , 1955, w i t h nons e r v i c e - c o n n e c t e d d i s a b i l i t i e s f o r which t h e y swear t h a t t h e y c a n n o t

d e f r a y m e d i c a l e x p e n s e s . ( I t s h o u l d b e n o t e d t h a t v e t e r a n s o v e r 65

y e a r s of age o r i n r e c e i p t of v e t e r a n s ' pension a r e n o t r e q u i r e d t o

s t a t e under o a t h t h a t t h e y a r e unable t o d e f r a y t h e c o s t of such

c a r e . ) Based on VA e s t i m a t e s f o r FY83, a p p r o x i m a t e l y 58 p e r c e n t o f

m e d i c a l c a r e i s p r o v i d e d t o v e t e r a n s who meet a t e s t o f need, 3/

t h a t i s , v e t e r a n s who e i t h e r r e c e i v e a c a s h p e n s i o n o r a r e

medically indigent.

Benefit Levels

Benefits include prehospitalization, hospitalization, post

h o s p i t a l i z a t i o n , p r o s t h e t i c d e v i c e s and n u r s i n g home c a r e , domic i l i a r y care, medical devices, outpatient care, prescribed drugs

and m e d i c i n e , and t r a n s p o r a t i o n s e r v i c e s . FY83 o u t l a y s t o t a l l e d

$4.4 b i l l i o n , up 25 p e r c e n t from t h e FY81 t o t a l o f $3.5 b i l l i o n .

I n t h i s p e r i o d t h e e s t i m a t e d a v e r a g e m o n t h l y number o f r e c i p i e n t s

( n o t i n c l u d i n g o u t p a t i e n t s ) i n c r e a s e d by o n l y 7 p e r c e n t , from

63.5 t h o u s a n d t o 67.7 t h o u s a n d .

1/ However, t h r o u g h g r a n t s - i n - a i d , t h e VA a l s o a s s i s t s

s t a t e s t h a t p r o v i d e c a r e i n S t a t e v e t e r a n homes. The VA makes p e r

diem payments f o r t h e c a r e o f e l i g i b l e v e t e r a n s and p a r t i c i p a t e s

i n t h e c o s t o f c o n s t r u c t i n g S t a t e home f a c i l i t i e s .

2/ E l i g i b i l i t y r u l e s o f t h i s program a r e found i n 3 8 C.F.R.5

17.46~17.48 (1982).

3/ Based on VA e s t i m a t e t h a t 58 p e r c e n t o f v e t e r a n s r e c e i v i n g

VA m e x i c a l c a r e w e r e below t h e p o v e r t y l e v e l o f income.

GENERAL ASSISTANCE (MEDICAL CARE COMPONENTS) 1/

Funding Formula

No F e d e r a l f u n d s a r e a v a i l a b l e f o r t h i s program, which h e l p s

p e r s o n s who d o n o t q u a l i f y f o r Medicaid.

As o f l a t e 1982, m e d i c a l a s s i s t a n c e f o r c a s h r e c i p i e n t s o f

G e n e r a l A s s i s t a n c e (GA) and f o r o t h e r p e r s o n s i n e l i g i b l e f o r

Medicaid was f u l l y S t a t e funded i n 1 5 S t a t e s 2 / and t h e D i s t r i c t

o f Columbia. Twenty-three S t a t e s p r o v i d e d no-funds f o r l o c a l

m e d i c a l a i d programs. 31 E l e v e n S t a t e s g e n e r a l l y s h a r e d t h e c o s t

o f GA m e d i c a l a s s i s t a n c e w i t h l o c a l i t i e s . 4 / F i n a l l y , A r i z o n a ,

which h a s n e v e r o p e r a t e d a t r a d i t i o n a l ~ e d T c a i dprogram, on O c t o b e r 1 ,

1982, began a 3-year d e m o n s t r a t i o n p r o j e c t t h a t was judged t o be

q u a l i f i e d f o r F e d e r a l Medicaid f u n d s . Thus, i t now h a s no GA

m e d i c a l a s s i s t a n c e program.

1/ S t a t e d a t a r e p o r t e d h e r e a r e drawn from a s t u d y e n t i t l e d

" C h a ~ a c t e r i s t i c s o f G e n e r a l A s s i s t a n c e Programs, 1982," p r e p a r e d

by Urban Systems R e s e a r c h and E n g i n e e r i n g , l n c . , Cambridge, Massac h u s e t t s , f o r t h e U.S. Department o f H e a l t h and Human S e r v i c e s .

C o n t r a c t No. HHS-100-82-0038.

2/ A l a s k a , H a w a i i , Kansas, L o u i s i a n a , Maryland, M a s s a c h u s e t t s ,

~ i s s o y r i ,Oklahoma (which g i v e s a s s i s t a n c e i n t h e form o f l i m i t e d

c a s h f o r m e d i c a l e m e r g e n c i e s ) , Oregon, P e n n s y l v a n i a , Rhode I s l a n d ,

Vermont, Washington, West V i r g i n i a , and Wyoming.

3/ S t a t e s w i t h v e r y l i m i t e d c o u n t y programs: Alabama,

~ r k a n s a s , G e o r g i a , Kentucky, M i s s i s s i p p i , New Mexico, North Carol i n a , North Dakota, S o u t h C a r o l i n a , T e n n e s s e e , and Texas. O t h e r

S t a t e s w i t h county-funded a i d : Delaware, F l o r i d a , I d a h o , I n d i a n a ,

Iowa, Montana, Nebraska, Nevada, New Hampshire, S o u t h Dakota,

Vermont, and Wisconsin.

41 I n t h i s g r o u p a r e I l l i n o i s , which p r o v i d e s 100 p e r c e n t

s t a t e-funds f o r m e d i c a l a s s i s t a n c e i n Cook County ( C h i c a g o ) and

s e v e r a l downstate townships, but r e q u i r e s l o c a l funding elsewhere;

Michigan, which p r o v i d e s 100 p e r c e n t S t a t e f u n d s f o r o u t p a t i e n t

c a r e , none f o r i n p a t i e n t c a r e ; and Maine, which p r o v i d e s 100

percent S t a t e funds f o r a i d i n unorganized m u n i c i p a l i t i e s , but

r e q u i r e s o t h e r l o c a l i t i e s t o s h a r e funding.

E l i g i b i l i t y Requirements

To r e c e i v e GA m e d i c a l a s s i s t a n c e , a p e r s o n g e n e r a l l y must

be deemed needy and must l i v e where s u c h a i d i s a v a i l a b l e .

Many a r e a s u s e t h e same e l i g i b i l i t y r u l e s f o r GA m e d i c a l a s s i s t a n c e a s f o r GA c a s h a i d ( s e e program No. 1 4 ) . Some h a v e more

l i b e r a l r u l e s , and w i l l a i d t h e m e d i c a l l y needy, whose incomes

exceed l i m i t s f o r c a s h h e l p . When West V i r g i n i a s t o p p e d p a y i n g

f o r GA c a s h a s s i s t a n c e i n 1980, i t c o n t i n u e d t o fund m e d i c a l

a s s i s t a n c e u n d e r i t s program, G e n e r a l A s s i s t a n c e f o r D i s a b l e d

Adults.

Some c o u n t i e s o f f e r h e l p o n l y f o r m e d i c a l e m e r g e n c i e s .

Benefit Levels

The s c o p e o f m e d i c a l a s s i s t a n c e v a r i e s among S t a t e s a n d ,

o f t e n , w i t h i n them. I n c o u n t i e s w i t h v e r y l i m i t e d a i d , h e l p

u s u a l l y t a k e s t h e form o f m e d i c a l c a r e by c o u n t y h o s p i t a l s . As

o f l a t e 1982, t h r e e S t a t e s r e p o r t e d t h a t t h e i r programs o f GA

m e d i c a l a s s i s t a n c e were more comprehensive t h a n Medicaid:

A l a s k a , Rhode I s l a n d , and Wyoming. C o n n e c t i c u t s a i d i t s program was comparable t o t h a t o f M e d i c a i d . However, i n most

a r e a s , GA m e d i c a l a s s i s t a n c e was more l i m i t e d t h a n Medicaid.

For example, t h e Oklahoma program c o n s i s t e d o f a d d i n g up t o $70

f o r emergency m e d i c a l n e e d s t o a p e r s o n ' s c a s h r e l i e f g r a n t .

S e v e r a l S t a t e s r e p o r t e d c u t b a c k s i n GA m e d i c a l a s s i s t a n c e .

E f f e c t i v e i n J a n u a r y 1982, South C a r o l i n a e l i m i n a t e d m e d i c a l

b e n e f i t s f o r GA c a s h r e c i p i e n t s . E f f e c t i v e i n September 1982,

C a l i f o r n i a e l i m i n a t e d from S t a t e - o n l y Medical m e d i c a l l y i n d i g e n t

a d u l t s ( a g e d 21-64) who were n o t l i n k e d t o F e d e r a l a s s i s t a n c e

programs and gave b l o c k g r a n t s t o t h e c o u n t i e s t o e s t a b l i s h

I n 1983 I l l i n o i s

c o u n t y m e d i c a l programs t o a s s i s t s u c h p e r s o n s .

suspended i t s program o f Aid t o t h e M e d i c a l l y I n d i g e n t , which

had p r o v i d e d ongoing h o s p i t a l and p h y s i c i a n b e n e f i t s comparable

t o Medicaid f o r p e r s o n s i n e l i g i b l e f o r Medicaid t h r o u g h t h e S t a t e .

M i s s o u r i r e p o r t e d t h a t GA m e d i c a l s e r v i c e s had been " s i g n i f i c a n t l y

r e s t r i c t e d " i n 1981-82.

The U.S. Department of H e a l t h and Human S e r v i c e s e s t i m a t e d

t h a t S t a t e - l o c a l o u t l a y s f o r GA m e d i c a l a s s i s t a n c e (which i t

c a l l s " S t a t e - o n l y Medicaid") d e c l i n e d 1 8 p e r c e n t i n FY 1982.,

from t h e 1983 r e c o r d h i g h o f $3.2 b i l l i o n t o $2.6 b i l l i o n . I t s

p r e l i m i n a r y e s t i m a t e o f 1983 o u t l a y s i s $2.4 b i l l i o n , down

8 p e r c e n t from 1982.

MATERNAL AND CHILD HEALTH SERVICES, TITLE V OF THE

SOCIAL SECURITY ACT 1/

Funding Formula

1. P r e v i o u s A u t h o r i t y . F o r FY 1981 and p r e v i o u s f i s c a l

y e a r s , a b o u t 90 p e r c e n t o f t h e t i t l e V a p p r o p r i a t i o n had t o b e made

a v a i l a b l e f o r m a t e r n a l and c h i l d h e a l t h (MCH) and c r i p p l e d c h i l d r e n s

( C C ) s e r v i c e s w i t h t h e r e m a i n d e r d e s i g n a t e d f o r r e s e a r c h and t r a i n i n g

activities.

The MCH a p p r o p r i a t i o n was d i v i d e d i n t o h a l v e s , c a l l e d

Fund A and Fund B. Fund A was a p p o r t i o n e d among t h e S t a t e s by a

f o r m u l a s p e c i f i e d i n t h e law and r e q u i r e d S t a t e m a t c h i n g , d o l l a r

f o r d o l l a r . Each f i s c a l y e a r , a S t a t e r e c e i v e d from Fund A a g r a n t

o f $70,000, p l u s t h a t p o r t i o n o f t h e r e m a i n d e r o f Fund A which

equalled i t s p r o p o r t i o n a t e s h a r e of l i v e b i r t h s i n t h e United

S t a t e s . No S t a t e m a t c h i n g was r e q u i r e d f o r Fund B.

I n e a c h f i s c a l y e a r , $10 m i l l i o n was a l l o c a t e d from Fund B t o

S t a t e s and i n s t i t u t i o n s o f h i g h e r l e a r n i n g f o r e s t a b l i s h m e n t o f proj e c t s t o s e r v e t h e m e n t a l l y r e t a r d e d . Of t h e r e m a i n d e r , a t l e a s t 75

p e r c e n t was a l l o c a t e d t o S t a t e s on t h e b a s i s o f S t a t e p e r c a p i t a

income and t h e number o f l i v e b i r t h s , w i t h r u r a l b i r t h s g i v e n t w i c e

t h e w e i g h t o f u r b a n b i r t h s . These f u n d s w e r e i n t e n d e d t o a s s i s t

S t a t e s i n carrying out t h e i r S t a t e plans.

The r e m a i n i n g 25 p e r c e n t

o r l e s s , known g e n e r a l l y a s "Reserve B" o r "RB" f u n d s , was r e t a i n e d

a t the Federal level f o r discretionary grants f o r special projects

of regional o r national significance.

1/ P.L. 97-35, t h e Omnibus Budget R e c o n c i l i a t i o n Act of 1981,

c o n s o i i d a t e d t h e MCH and CC programs i n t o an MCH b l o c k g r a n t w i t h

t h e f o l l o w i n g o t h e r F e d e r a l g r a n t programs:

services for disabled

c h i l d r e n e n r o l l e d i n t h e S u p p l e m e n t a l S e c u r i t y Income program, l e a d b a s e d p a i n t p o i s o n i n g p r e v e n t i o n , g e n e t i c d i s e a s e s , sudden i n f a n t

d e a t h syndrome, h e m o p h i l i a t r e a t m e n t c e n t e r s , and t h e a d o l e s c e n t

pregnancy program.

E f f e c t i v e O c t . 1 , 1981, S t a t e s c o u l d b e g i n

a d m i n i s t e r i n g MCH b l o c k g r a n t s . P.L. 97-35 p r o v i d e d t h a t t h e

S e c r e t a r y o f H e a l t h and Human S e r v i c e s would c o n t i n u e m a t c h i n g

g r a n t s u n d e r e x i s t i n g programs u n t i l a S t a t e assumed a u t h o r i t y

f o r t h e MCH b l o c k g r a n t , b u t s t i p u l a t e d t h a t S t a t e s must d o s o

b e f o r e O c t . 1, 1982. As o f August 1982, e v e r y S t a t e and t e r r i t o r y had begun implementing t h e b l o c k g r a n t .

Current Authoritv

F i f t e e n p e r c e n t o f t h e MCH b l o c k g r a n t a p p r o p r i a t i o n i n FY 1982,

and between 10 and 15 p e r c e n t i n FY 1983 and FY 1984, i s r e t a i n e d a t

t h e F e d e r a l l e v e l t o fund s p e c i a l p r o j e c t s , r e s e a r c h , t r a i n i n g and

g e n e t i c d i s e a s e and h e m o p h i l i a programs. The r e m a i n d e r o f t h e

a p p r o p r i a t i o n i s d i s t r i b u t e d among S t a t e s t o p r o v i d e s e r v i c e s . Each

S t a t e r e c e i v e s a s h a r e o f funds equal t o t h e proportion i t received

i n FY 1981 f o r t h e c o n s o l i d a t e d programs, e x c l u d i n g t h o s e i n t h e

set-aside.

S t a t e s must spend t h r e e S t a t e d o l l a r s f o r e v e r y f o u r

Federal d o l l a r s received through t h e block g r a n t .

Between 10 and 15 p e r c e n t o f t h e b l o c k g r a n t a p p r o p r i a t i o n i s

r e s e r v e d f o r MCH p r o j e c t s o f r e g i o n a l and n a t i o n a l s i g n i f i c a n c e ,

r e s e a r c h and t r a i n i n g , and g e n e t i c d i s e a s e and h e m o p h i l i a programs.

These programs a r e f e d e r a l l y a d m i n i s t e r e d .

E l i g i b i l i t y Requirements

1. P r e v i o u s A u t h o r i t y . For FY 1981 and p r e v i o u s f i s c a l

y e a r s , t i t l e V o f t h e S o c i a l S e c u r i t y Act a u t h o r i z e d S t a t e s t o u s e

F e d e r a l f u n d s t o e x t e n d and improve h e a l t h s e r v i c e s f o r m o t h e r s

and c h i l d r e n , " e s p e c i a l l y i n r u r a l a r e a s and i n a r e a s s u f f e r i n g

from s e v e r e economic d i s t r e s s . ' '

N e i t h e r i n t h e law n o r i n F e d e r a l

r e g u l a t i o n was income d e f i n e d , and e a c h S t a t e d e t e r m i n e d who was

e l i g i b l e f o r m a t e r n a l and c h i l d h e a l t h s e r v i c e s . F e d e r a l r e g u l a t i o n s s t a t e d t h a t income s t a n d a r d s u s e d by t h e S t a t e s i n d e t e r m i n i n g e l i g i b i l i t y f o r t r e a t m e n t and i n s e t t i n g f e e s c h e d u l e s must

c o n s i d e r f a m i l y s i z e and t h e f a m i l y ' s o t h e r f i n a n c i a l r e s p o n s i b i l i t i e s . I n o r d e r t o b e e n t i t l e d t o i t s a l l o t m e n t o f MCH f u n d s ,

Under

e a c h S t a t e was r e q u i r e d t o p r o v i d e a "program o f p r o j e c t s . "

t h i s program, S t a t e s had t o implement a p r o j e c t i n e a c h o f f i v e

a r e a s : m a t e r n i t y and i n f a n t c a r e , c h i l d r e n and y o u t h , f a m i l y plann i n g d e n t a l h e a l t h , and i n t e n s i v e i n f a n t c a r e .

2. C u r r e n t A u t h o r i t y .

For FY 1982 and s u b s e q u e n t f i s c a l

y e a r s , S t a t e s a r e t o u s e F e d e r a l f u n d s t o a s s u r e m o t h e r s and c h i l d r e n , - p a r t i c u l a r l y t h o s e w i t h low income o r l i m i t e d a v a i l a b i l i t y

of h e a l t h s e r v i c e s , a c c e s s t o q u a l i t y MCH s e r v i c e s . Low-income

p e r s o n s a r e d e f i n e d a s i n d i v i d u a l s o r f a m i l i e s w i t h a n income

below 100 p e r c e n t of t h e p o v e r t y l e v e l . 21

2 1 The 1984 F e d e r a l p o v e r t y g u i d e l i n e s were i s s u e d i n

~ e b r u a rby~ t h e Department of H e a l t h and Human S e r v i c e s ,

u s i n g t h e methodology o f t h e O f f i c e o f Management and Budget (OMB).

F o r a f a m i l y o f f o u r , t h e g u i d e l i n e i s $10,200 i n 1984.

Benefit Levels

1. P r e v i o u s A u t h o r i t y . For FY 1981 and p r e v i o u s f i s c a l

y e a r s , S t a t e s determined t h e l e v e l o f s e r v i c e s . R e g u l a t i o n s 3 /

d e f i n e d m a t e r n a l and c h i l d h e a l t h s e r v i c e s a s ( 1 ) t h e p r o v i s i %

of e d u c a t i o n a l , p r e v e n t i v e , d i a g n o s t i c and t r e a t m e n t s e r v i c e s ;

( 2 ) t h e development, s t r e n g t h e n i n g and improvement o f s t a n d a r d s

and t e c h n i q u e s r e l a t i n g t o s u c h s e r v i c e s and c a r e ; ( 3 ) t h e t r a i n i n g o f p e r s o n n e l engaged i n t h e p r o v i s i o n , development, s t r e n g t h e n i n g , o r improvement o f such s e r v i c e s and c a r e ; and ( 4 ) a d m i n i s t r a t i v e s e r v i c e s i n c o n n e c t i o n w i t h such s e r v i c e s and c a r e .

2. C u r r e n t A u t h o r i t y . For FY 1982 and subsequent f i s c a l

y e a r s , S t a t e s d e t e r m i n e t h e l e v e l o f s e r v i c e s . The law f o r b i d s

S t a t e s t o c h a r g e f e e s f o r s e r v i c e s provided t o p e r s o n s whose income i s below t h e p o v e r t y g u i d e l i n e .

-3/ 42 C.F.R.

S 51a. 1 0 1 ( j ) (19811,

INDIAN HEALTH SERVICES

Funding Formula

T h i s program i s 100 p e r c e n t funded by t h e F e d e r a l Government.

E l i g i b i l i t y Requirements

Persons e l i g i b l e under r e g u l a t i o n s o f t h e P u b l i c H e a l t h S e r v i c e I /

a r e persons of Indian ( o r Alaskan Native) d e s c e n t belonging t o t h e

I n d i a n , A l e u t , o r Eskimo community s e r v e d by t h e l o c a l h e a l t h f a c i l i t i e s and program and t h e non-Indian w i v e s o f s u c h p e r s o n s . I n a d d i t i o n , a p e r s o n may be r e g a r d e d e l i g i b l e i f he i s r e g a r d e d a s an I n d i a n

by t h e community i n which h e l i v e s . The program s e r v e s F e d e r a l r e s e r v a t i o n s , I n d i a n communities i n Oklahoma and C a l i f o r n i a , and I n d i a n ,

Eskimo, and A l e u t communities i n A l a s k a . I n a d d i t i o n , u n d e r t h e I n d i a n

H e a l t h Care Improvement Act o f 1976, P.L. 94-437, t h e I n d i a n H e a l t h

S e r v i c e c o n t r a c t s w i t h 37 u r b a n I n d i a n o r g a n i z a t i o n s t o make h e a l t h

s e r v i c e s more a c c e s s i b l e t o t h e u r b a n I n d i a n p o p u l a t i o n .

Benefit Levels

The I n d i a n H e a l t h S e r v i c e o f t h e P u b l i c H e a l t h S e r v i c e p r o v i d e s

h o s p i t a l , m e d i c a l , and d e n t a l c a r e . I n c l u d e d a r e o u t p a t i e n t s e r v i c e s

and t h e s e r v i c e s o f m o b i l e c l i n i c s and p u b l i c h e a l t h n u r s e s , a s w e l l

a s p r e v e n t i v e c a r e , i n c l u d i n g i m m u n i z a t i o n s and h e a l t h e x a m i n a t i o n s

o f s p e c i a l g r o u p s , s u c h a s s c h o o l c h i l d r e n . A l l s e r v i c e s a r e provided f r e e of charge t o beneficiaries.

B e n e f i t s i n c l u d e i n p a t i e n t and o u t p a t i e n t h e a l t h s e r v i c e s t h r o u g h

47 h o s p i t a l s and t h e i r o u t p a t i e n t d e p a r t m e n t s , 8 4 h e a l t h c e n t e r s

( i n c l u d i n g s c h o o l h e a l t h c e n t e r s ) , and 300 s m a l l h e a l t h s t a t i o n s

and s a t e l l i t e c l i n i c s ; c o n t r a c t s w i t h non-Federal h o s p i t a l s , c l i n i c s ,

p r i v a t e p h y s i c i a n s and d e n t i s t s ; and c o n t r a c t u a l a r r a n g e m e n t s w i t h

S t a t e and l o c a l h e a l t h o r g a n i z a t i o n s .

FY83 program e x p e n d i t u r e s t o t a l l e d $679.2 m i l l i o n , up 12 perc e n t from t h e FY83 t o t a l o f $606.3 m i l l i o n . The a n n u a l number o f

r e c i p i e n t s r o s e 10 p e r c e n t d u r i n g t h i s same t i m e , from a p p r o x i m a t e l y

750,000 t o a n e s t i m a t e d 883,000.

-1/

42 C.F.R.

§ 36.12

(1983).

COMMUNITY HEALTH CENTERS

Funding Formula

Under s e c t i o n 330 o f t h e P u b l i c H e a l t h S e r v i c e (PHS) A c t ,

c e n t e r s a r e funded and a d m i n i s t e r e d by t h e F e d e r a l Government.

S t a r t i n g i n FY 1983, S t a t e s have had t h e o p t i o n , u n d e r t h e author i t y o f t h e P r i m a r y C a r e Block G r a n t c r e a t e d by P.L. 97-35, t o

a d m i n i s t e r t h e community h e a l t h c e n t e r s program t h e m s e l v e s . 11

Under t h i s o p t i o n , S t a t e s r e c e i v e b l o c k g r a n t a l l o t m e n t s basTd on

t h e p r o p o r t i o n o f f u n d s awarded t o community h e a l t h c e n t e r s i n t h e

S t a t e i n FY 1982. I n o r d e r t o b e e l i g i b l e f o r g r a n t s u n d e r t h i s

b l o c k g r a n t , S t a t e s a r e r e q u i r e d t o match F e d e r a l f u n d s . F o r FY

1983, t h e m a t c h i n g r a t e i s 20 p e r c e n t o f a S t a t e ' s a l l o t m e n t ; f o r

FY 1984 i t i s 33-113 p e r c e n t .

I n S t a t e s which d o n o t c h o o s e t o a d m i n i s t e r t h i s b l o c k

g r a n t t h e m s e l v e s , t h e F e d e r a l Government c o n t i n u e s t o a d m i n i s t e r

t h e community h e a l t h c e n t e r s u n d e r t h e a u t h o r i t y o f s e c t i o n 330

o f t h e PHs Act.

E l i g i b i l i t y Requirements

S e c t i o n 330 o f t h e PHs Act p r o v i d e s s u p p o r t f o r t h e community

h e a l t h c e n t e r s , a term t h a t i n c l u d e s family h e a l t h c e n t e r s , comuni t y h e a l t h n e t w o r k s , neighborhood h e a l t h c e n t e r s , and o t h e r s i m i l a r

p r o j e c t s p r e v i o u s l y funded u n d e r t h e Economic O p p o r t u n i t y Act and

o t h e r l a w s . The law makes e l i g i b l e f o r s e r v i c e a l l r e s i d e n t s o f

an a r e a s e r v e d by a community h e a l t h c e n t e r , b u t r e g u l a t i o n s

l i m i t f r e e s e r v i c e t o t h o s e w i t h f a m i l y income below CSA p o v e r t y

guidelines.

The law s a y s t h a t c e n t e r s s h o u l d b e l o c a t e d i n " m e d i c a l l y unders e r v e d " a r e a s , t o be d e s i g n a t e d by t h e s e c r e t a r y o f H e a l t h and Human

S e r v i c e s (HHS). By r e g u l a t i o n , m e d i c a l l y u n d e r s e r v e d a r e a s a r e

d e s i g n a t e d by t a k i n g i n t o c o n s i d e r a t i o n s u c h f a c t o r s a s :

(1) r a t i o

of primary c a r e p h y s i c i a n s t o p o p u l a t i o n , ( 2 ) i n f a n t m o r t a l i t y r a t e ,

tion

West V i r g i n i a and t h e V i r g i n I s l a n d s assumed a d r n i n i s t r a -

of t h e b l o c k g r a n t i n FY 1983.

( 3 ) p e r c e n t a g e of p o p u l a t i o n aged 65 and o v e r , and ( 4 ) p e r c e n t a g e of

p o p u l a t i o n w i t h f a m i l y income below t h e poverty l e v e l . 2/

Benefit Levels

PHS r e g u l a t i o n s 31 l i m i t f r e e s e r v i c e t o t h o s e w i t h f a m i l y income

a t o r below t h e most r e c e n t CSA p o v e r t y income g u i d e l i n e s . The 1984

F e d e r a l p o v e r t y income g u i d e l i n e i s $10,200 f o r a f a m i l y of f o u r ,

p l u s o r minus $1,740 p e r person f o r b i g g e r o r s m a l l e r f a m i l y s i z e s ) .

41 Nominal f e e s may be c o l l e c t e d from such i n d i v i d u a l s and f a m i l i e s ,

under c e r t a i n c i r c u m s t a n c e s . I n d i v i d u a l s and f a m i l i e s w i t h annual

incomes g r e a t e r than t h e p o v e r t y i n d e x b u t below 200 p e r c e n t of i t

a r e r e q u i r e d t o pay f o r s e r v i c e s from a d i s c o u n t f e e s c h e d u l e adj u s t e d on t h e b a s i s of t h e p a t i e n t ' s a b i l i t y t o pay. F u l l payment,

t o c o v e r r e a s o n a b l e c o s t s , i s r e q u i r e d from t h o s e w i t h income t h a t

exceeds t w i c e t h e p o v e r t y l e v e l .

The c e n t e r s p r o v i d e a range o f primary h e a l t h s e r v i c e s on an ambul a t o r y b a s i s , i n c l u d i n g d i a g n o s t i c , t r e a t m e n t , p r e v e n t i v e , emergency,

t r a n s p o r t a t i o n , and p r e v e n t i v e d e n t a l s e r v i c e s and can a r r a n g e and pay

f o r h o s p i t a l and o t h e r supplemental s e r v i c e s i n c e r t a i n c i r c u m s t a n c e s

i f approved by t h e S e c r e t a r y .

FY83 c o s t s t o t a l l e d $360 m i l l i o n , up 11 p e r c e n t from t h e FY81

t o t a l o f $323.6 m i l l i o n . The annual number of r e c i p i e n t s dropped 10

p e r c e n t i n t h i s p e r i o d , from 5 m i l l i o n t o 4.5 m i l l i o n .

-21 42 C.F.R.

-31 42 C.F.R.

51c. 102(e) (1983).

51c. 3 0 3 ( f ) (1983).

4 / The 1984 g u i d e l i n e s were i s s u e d i n February by t h e

~ e ~ a r & e n of

t H e a l t h , Education, and Welfare, u s i n g t h e methodology o f t h e O f f i c e o f Management and Budget (OMB).

MEDICAL ASSISTANCE TO REFUGEES AND CUBAN/HAITIAN ENTRANTS

F u n d i n e Formula

The Refugee Act (P.L. 96-212) a u t h o r i z e s 100 p e r c e n t f e d e r a l l y

funded m e d i c a l a s s i s t a n c e f o r needy r e f u g e e s d u r i n g t h e i r f i r s t 3

y e a r s i n t h e U n i t e d S t a t e s . T i t l e V o f t h e Refugee E d u c a t i o n A s s i s t a n c e Act (P.L. 96-4221, p o p u l a r l y r e f e r r e d t o a s t h e F a s c e l l - S t o n e

amendment, a u t h o r i z e s s i m i l a r a s s i s t a n c e f o r c e r t a i n Cubans and

H a i t i a n s who h a v e r e c e n t l y e n t e r e d t h e U n i t e d S t a t e s . The F e d e r a l

r e f u g e e a s s i s t a n c e program r e i m b u r s e s S t a t e s 100 p e r c e n t f o r t h e nonF e d e r a l s h a r e o f Medicaid payments t o r e f u g e e s and e n t r a n t s who

q u a l i f y f o r t h a t program. I t a l s o p r o v i d e s " r e f u g e e m e d i c a l a s s i s t a n c e " t o needy r e f u g e e s and e n t r a n t s who a r e n o t c a t e g o r i c a l l y e l i g i b l e f o r Medicaid. M e d i c a l a s s i s t a n c e t o r e f u g e e s and e n t r a n t s i s

a u t h o r i z e d t h r o u g h FY 1984.

E l i g i b i l i t y Requirements

-11

A p e r s o n must ( a ) h a v e b e e n a d m i t t e d t o t h e U.S. a s a r e f u g e e

under p r o v i s i o n s o f t h e I m m i g r a t i o n and N a t i o n a l i t y A c t , o r ( b ) be a

Cuban o r H a i t i a n p a r o l e d i n t o t h e U n i t e d S t a t e s between A p r i l 10 and

O c t o b e r 1 0 , 1980, and d e s i g n a t e d " C u b a n l H a i t i a n e n t r a n t , " o r ( c ) b e a

Cuban o r H a i t i a n n a t i o n a l who a r r i v e d i n t h e U.S. a f t e r O c t o b e r 1 0 ,

1980, who h a s an a p p l i c a t i o n f o r asylum pending o r i s s u b j e c t t o e x c l u s i o n o r d e p o r t a t i o n and a g a i n s t whom a f i n a l o r d e r o f d e p o r t a t i o n h a s

n o t been i s s u e d .

I f a needy r e f u g e e o r e n t r a n t i s e l i g i b l e f o r M e d i c a i d , h e may

r e c e i v e a s s i s t a n c e u n d e r t h a t program. I f a r e f u g e e o r e n t r a n t

m e e t s t h e income and a s s e t s t e s t s p r e s c r i b e d by h i s S t a t e o f r e s i dence f o r medicaid e l i g i b i l i t y b u t does not otherwise q u a l i f y f o r

t h a t program b e c a u s e o f i t s c a t e g o r i c a l r e q u i r e m e n t s , t h e r e f u g e e

o r e n t r a n t i s e l i g i b l e f o r "refugee medical assistance."

E f f e c t i v e A p r i l 1, 1981, o n l y r e f u g e e s o r e n t r a n t s i n t h e U.S.

3 years o r l e s s q u a l i f y f o r fully-reimbursed medical a s s i s t a n c e .

E f f e c t i v e A p r i l 1, 1982, t h e s p e c i a l " r e f u g e e m e d i c a l a s s i s t a n c e "

made a v a i l a b l e t o t h o s e r e f u g e e s and e n t r a n t s c a t e g o r i c a l l y i n e l i g i b l e f o r m e d i c a i d e n d s 18 months a f t e r t h e r e f u g e e o r e n t r a n t ' s e n t r y

11 R e g u l a t i o n s g o v e r n i n g t h i s program a r e found i n 45

C.F.R:

400-401.

i n t o t h e U.S.

F o r t h e n e x t 18 months S t a t e s c a n b e r e i m b u r s e d f o r

any m e d i c a l a s s i s t a n c e p r o v i d e d t o a r e f u g e e o r e n t r a n t u n d e r a

S t a t e o r l o c a l g e n e r a l a s s i s t a n c e program. Income l i m i t s f o r GA

a r e g e n e r a l l y lower t h a n f o r m e d i c a i d and s e r v i c e s may b e l e s s

extensive.

Benefit Levels

Medical b e n e f i t s c o n s i s t o f payments made on b e h a l f o f needy

r e f u g e e s t o d o c t o r s , h o s p i t a l s , and p h a r m a c i s t s . F e d e r a l law r e q u i r e s S t a t e Medicaid programs t o o f f e r c e r t a i n b a s i c s e r v i c e s ,

b u t a u t h o r i z e s S t a t e s t o d e t e r m i n e t h e s c o p e o f s e r v i c e s and reimbursement r a t e s , e x c e p t f o r h o s p i t a l c a r e .

MIGRANT HEALTH CENTERS

Funding Formula

The c e n t e r s a r e funded 100 p e r c e n t by t h e F e d e r a l Government.

E l i g i b i l i t y Requirements

S e c t i o n 329 of t h e PHs Act a u t h o r i z e s g r a n t s t o s u p p o r t migrant

h e a l t h c e n t e r s . E l i g i b l e f o r s e r v i c e s a r e b ~ t hm i g r a t o r y farm workers

and t h e i r f a m i l i e s (and former m i g r a t o r y a g r i c u l t u r a l workers who a r e

aged o r d i s a b l e d ) and s e a s o n a l farm workers. The law d e f i n e s "migrat o r y farm worker1' a s a person whose p r i n c i p a l employment i s i n a g r i c u l t u r e on a s e a s o n a l b a s i s , who h a s been s o employed w i t h i n t h e l a s t 2

y e a r s , and who e s t a b l i s h e s a temporary abode f o r t h e purpose of t h i s

work.

"Seasonal farm worker" i s d e f i n e d a s a person whose p r i n c i p a l

employment i s i n a g r i c u l t u r e on a s e a s o n a l b a s i s and who i s n o t a

m i g r a t o r y a g r i c u l t u r e worker.

C e n t e r s a r e t a r g e t e d t o s e r v i c e ''high migrant impact1' a r e a s , which

a r e c o u n t i e s o r o t h e r p o l i t i c a l s u b d i v i s i o n s o f a S t a t e i n which a t

l e a s t 4,000 m i g r a t o r y farm workers and members of t h e i r f a m i l i e s and/

o r s e a s o n a l workers and t h e i r f a m i l i e s l i v e f o r more than 2 months i n

a c a l e n d a r y e a r . I n f i s c a l y e a r 1981 m i g r a n t h e a l t h c e n t e r s s e r v e d

557,000 persons, o f whom 368,000 were m i g r a n t s and 189,000 were seas o n a l farm workers.

Benefit Levels

PHs r e g u l a t i o n s 1 1 l i m i t f r e e s e r v i c e t o t h o s e w i t h f a m i l y

income a t o r below t h e most r e c e n t Community S e r v i c e A d m i n i s t r a t i o n

(CSA) poverty income g u i d e l i n e s . 2/ The 1984 F e d e r a l p o v e r t y income

g u i l d e l i n e i s $9,900 f o r a f a m i l y o £ f o u r , p l u s o r minus $1,740 p e r

person f o r b i g g e r o r s m a l l e r f a m i l y s i z e s . Nominal f e e s may be

c o l l e c t e d from such i n d i v i d u a l s and f a m i l i e s . I n d i v i d u a l s and famil i e s w i t h annual incomes g r e a t e r t h a n t h e p o v e r t y i n d e x b u t below 200

p e r c e n t o f i t a r e r e q u i r e d t o pay f o r s e r v i c e s from a d i s c o u n t f e e

-1/ 42 C.F.R. S 56.303(£)(1983).

2/ The 1984 F e d e r a l poverty g u i d e l i n e s were i s s u e d i n

~ e b r u ' ; ; r ~by t h e Department of H e a l t h and Human S e r v i c e s , u s i n g

t h e methodology of t h e O f f i c e of Management and Budget (OMB).

s c h e d u l e a d j u s t e d on t h e b a s i s o f t h e p a t i e n t ' s a b i l i t y t o pay. F u l l

payment, t d c o v e r r e a s o n a b l e c o s t s , i s r e q u i r e d from t h o s e w i t h i n come t h a t e x c e e d s t w i c e t h e p o v e r t y l e v e l .

The c e n t e r s p r o v i d e p r i m a r y h e a l t h c a r e s e r v i c e s , i n c l u d i n g d i a g n o s t i c , t h e r a p e u t i c , p r e v e n t i v e , and emergency s e r v i c e s . The law s t i p u l a t e s t h a t p r e v e n t i v e c a r e i n c l u d e s c h i l d r e n ' s e y e and e a r examinat i o n s and d e n t a l c a r e f o r a l l g r o u p s . The c e n t e r s h a v e a l s o d e v e l o p e d

" l i n k a g e s " w i t h o t h e r programs, s u c h a s t h e Department o f A g r i c u l t u r e ' s

Women, I n f a n t and C h i l d r e n (WIG) n u t r i t i o n program and A l c o h o l , Drug

Abuse, and Mental H e a l t h A d m i n i s t r a t i o n p r o j e c t s .

F i s c a l y e a r 1983 c o s t s t o t a l l e d $38.1 m i l l i o n , down 11.8 perc e n t from t h e f i s c a l y e a r 1981 t o t a l o f $43.2 m i l l i o n . I n f i s c a l

y e a r 1983, a n n u a l r e c i p i e n t s t o t a l l e d 394,000.

MEDICAL ASSISTANCE TO CERTAIN CUBAN REFUGEES

Funding Formula

The Migration and Refugee A s s i s t a n c e Act of 1962 a u t h o r i z e d

F e d e r a l reimbursement f o r t h e c o s t s o f p r o v i d i n g m e d i c a l a s s i s t a n c e

t o needy Cuban r e f u g e e s . The Refugee Act o f 1980 r e p e a l e d t h i s

a u t h o r i t y and phased o u t F e d e r a l c o s t s h a r i n g by s t a g e s , e n d i n g on

September 30, 1981. However, t h e Refugee Act a u t h o r i z e d t h e

i n d e f i n i t e c o n t i n u a t i o n o f 100 p e r c e n t F e d e r a l reimbursement f o r

t h e non-Federal s h a r e o f t h e c o s t s of Medicaid f o r aged, b l i n d , o r

d i s a b l e d Cuban r e f u g e e s whose Medicaid e n t i t l e m e n t i s a r e s u l t o f

t h e i r e n r o l l m e n t i n t h e Supplemental S e c u r i t y Income (SSI) program.

The phased-out reimbursements were f o r t h e non-Federal s h a r e o f

Medicaid b e n e f i t s t o Cuban r e f u g e e s r e c e i v i n g c a s h a s s i s t a n c e

o t h e r than SSI under t h e Cuban r e f u g e e program, and f o r S t a t e

a d m i n i s t r a t i v e c o s t s . The r a t e s of F e d e r a l reimbursements f o r

t h o s e c o s t s were a s f o l l o w s : FY 1979, 85 p e r c e n t ; FY 1980, 75

p e r c e n t ; FY 1981, 60 p e r c e n t .

E l i g i b i l i t y Requirements

C u r r e n t l y , o n l y t h o s e Cuban r e f u g e e s who r e c e i v e d SSI payments a s of September 30, 1978 and c o n t i n u e t o r e c e i v e t h e s e benef i t s a r e e l i g i b l e . Before FY 1982, Cuban r e f u g e e s who were rec e i v i n g o t h e r c a s h a i d under t h e Cuban r e f u g e e program b e f o r e

October 1 , 1978, were a l s o e l i g i b l e .

Benefit Levels

Medical b e n e f i t s c o n s i s t o f payments made on b e h a l f o f needy ref u g e e s t o d o c t o r s , h o s p i t a l s , and p h a r m a c i s t s . F e d e r a l law r e q u i r e s

S t a t e Medicaid programs t o o f f e r c e r t a i n b a s i c s e r v i c e s , b u t author i z e s S t a t e s t o d e t e r m i n e t h e scope o f s e r v i c e s and reimbursement

r a t e s , except f o r h o s p i t a l care.

10.

CRIPPLED CHILDREN'S

SECURITY ACT 11

SERVICES,

TITLE

v OF THE SOCIAT,

Funding Formula

1. P r e v i o u s A u t h o r i t y . F o r FY 1981 and p r e v i o u s f i s c a l

y e a r s , a b o u t 90 p e r c e n t o f t h e t i t l e V a p p r o p r i a t i o n was r e q u i r e d

t o b e made a v a i l a b l e f o r MCH and CC s e r v i c e s , w i t h t h e r e m a i n d e r

d e s i g n a t e d f o r r e s e a r c h and t r a i n i n g a c t i v i t i e s . G r a n t f u n d s f o r CC

s e r v i c e s were d i v i d e d i n t o two h a l v e s , c a l l e d Fund A and Fund B.

Fund A was a p p o r t i o n e d among t h e S t a t e s i n a c c o r d a n c e w i t h c r i t e r i a

i n t h e l a w and r e q u i r e d S t a t e m a t c h i n g , d o l l a r f o r d o l l a r . Each

f i s c a l y e a r a S t a t e r e c e i v e d from Fund A a g r a n t o f $70,000, p l u s

t h a t p o r t i o n o f t h e r e m a i n d e r o f Fund A which e q u a l l e d i t s proport i o n a t e s h a r e o f t h e number o f c h i l d r e n u n d e r 21 i n t h e U n i t e d

S t a t e s . No S t a t e m a t c h i n g was r e q u i r e d f o r Fund B.

I n each f i s c a l

y e a r , $10 m i l l i o n was a l l o c a t e d from Fund B t o S t a t e s and i n s t i t u t i o n s o f h i g h e r l e a r n i n g f o r e s t a b l i s h m e n t o f p r o j e c t s t o s e r v e ment a l l y r e t a r d e d c r i p p l e d c h i l d r e n . Of t h e r e m a i n d e r , a t l e a s t 75

p e r c e n t was a l l o c a t e d t o S t a t e s on t h e b a s i s o f S t a t e p e r c a p i t a

income and t h e number o f c h i l d r e n u n d e r 21, w i t h r u r a l c h i l d r e n

g i v e n t w i c e t h e w e i g h t o f u r b a n c h i l d r e n . These f u n d s were i n t e n d e d

t o a s s i s t S t a t e s i n c a r r y i n g o u t t h e i r S t a t e p l a n s . The r e m a i n i n g

25 p e r c e n t o r l e s s , known g e n e r a l l y a s "Reserve B" o r "RB" f u n d s ,

were r e t a i n e d a t t h e F e d e r a l l e v e l f o r d i s c r e t i o n a r y g r a n t s f o r

special projects of regional o r national significance.

Current Authority

For FY 1982 and l a t e r y e a r s between 85 and 90 p e r c e n t o f t h e

MCH b l o c k g r a n t a p p r o p r i a t i o n i s a l l o t t e d among S t a t e s b a s e d on

1/ P.L. 97-35, t h e Omnibus Budget R e c o n c i l i a t i o n Act o f 1981,

c o n s o i i d a t e d t h e MCH and CC programs i n t o an HCM b l o c k g r a n t w i t h t h e

f o l l o w i n g o t h e r c a t e g o r i c a l programs: s e r v i c e s f o r d i s a b l e d c h i l d r e n

e n r o l l e d i n t h e Supplemental S e c u r i t y Income program, lead-based p a i n t

p o i s o n i n g p r e v e n t i o n , g e n e t i c d i s e a s e s , s u d d e n t i n f a n t d e a t h syndrome,

h e m o p h i l i a t r e a t m e n t c e n t e r s , and t h e a d o l e s c e n t pregnancy program.

E f f e c t i v e O c t . 1, 1981, S t a t e s c o u l d b e g i n a d m i n i s t e r i n g MCH b l o c k

g r a n t s . P.L. 97-35 a l s o p r o v i d e d t h a t t h e S e c r e t a r y o f H e a l t h and

Human S e r v i c e s would c o n t i n u e m a t c h i n g g r a n t s u n d e r e x i s t i n g programs

u n t i l a S t a t e assumed a u t h o r i t y f o r t h e MCH b l o c k g r a n t , b u t s t i p u l a t e d

t h a t S t a t e s must d o s o b e f o r e Oct. 1, 1982. A s o f August 1982, e v e r y

S t a t e and t e r r i t o r y had begun implementing t h e b l o c k g r a n t .

t h e S t a t e ' s p r o p o r t i o n o f t o t a l funds a l l o t t e d t o a l l S t a t e s i n

FY 1981 under c e r t a i n c a t e g o r i c a l programs now i n c l u d e d i n t h e

b l o c k . These c a t e g o r i c a l programs i n c l u d e m a t e r n a l and c h i l d

h e a l t h and c r i p p l e d c h i l d r e n ' s s e r v i c e s , s u p p l e m e n t a l s e c u r i t y

income s e r v i c e s f o r d i s a b l e d c h i l d r e n , lead-based p a i n t p o i s o n i n g

p r e v e n t i o n programs, g e n e t i c d i s e a s e , sudden i n f a n t d e a t h syndrone,

hemophilia t r e a t m e n t c e n t e r s , and a d o l e s c e n t pregnancy. S t a t e s

must spend t h r e e S t a t e d o l l a r s f o r e v e r y f o u r F e d e r a l d o l l a r s

r e c e i v e d through t h e b l o c k g r a n t .

Between 10 and 15 p e r c e n t o f t h e b l o c k g r a n t a p p r o p r i a t i o n i s

r e s e r v e d f o r MCH p r o j e c t s o f r e g i o n a l and n a t i o n a l s i g n i f i c a n c e ,

r e s e a r c h and t r a i n i n g , and g e n e t i c d i s e a s e and h e m o p h i l l a programs.

These programs a r e a d m i n i s t e r e d a t t h e F e d e r a a l l e v e l .

E l i g i b i l i t y Requirements

1. P r e v i o u s A u t h o r i t y . For FY 1981 and p r e v i o u s f i s c a l

y e a r s , t i t l e V of t h e S o c i a l S e c u r i t y Act a u t h o r i z e d S t a t e s

t o u s e F e d e r a l funds t o e x t e n d and improve s e r v i c e s t o c r i p p l e d

c h i l d r e n " e s p e c i a l l y i n r u r a l a r e a s and i n a r e a s s u f f e r i n g from

s e v e r e economic d i s t r e s s . "

Regulations defined a c r i p p l e d c h i l d

a s one under 21 y e a r s o f age, "who h a s an o r g a n i c d i s e a s e , d e f e c t ,

o r c o n d i t i o n 21 which may h i n d e r t h e achievement of normal growth

o r development. l1 D i a g n o s t i c s e r v i c e s had t o b e provided w i t h o u t

any e l i g i b i l i t y r e q u i r e m e n t s .

S t a t e s determined who r e c e i v e d a i d .

2. C u r r e n t A u t h o r i t y . For FY 1981 and subsequent f i s c a l

y e a r s , S t a t e s a r e t o u s e F e d e r a l funds t o a s s y r e mothers and c h i l d r e n , p a r t i c u l a r l y t h o s e w i t h low income o r l i m i t e d a v a i l a b i l i t y

of h e a l t h s e r v i c e s , a c c e s s t o q u a l i t y MCH s e r v i c e s . The Act d e f i n e s

low income p e r s o n s a s i n d i v i d u a l s o r f a m i l i e s w i t h an income below

100 p e r c e n t o f t h e p o v e r t y l e v e l .

Benefit Levels

1. P r e v i o u s A u t h o r i t y . F e d e r a l law and DHHS r e g u l a t i o n s

d e s c r i b e d t y p e s o f s e r v i c e s t h a t c o u l d b e provided. G r a n t s were used

f o r l o c a t i n g c r i p p l e d c h i l d r e n and p r o v i d i n g m e d i c a l , s u r g i c n l ,

c o r r e c t i v e , and o t h e r s e r v i c e s f o r d i a g n o s i s , h o s p i t a l i z a t i o n , and

-21 42 C.F.R. 8 51a. 1 0 1 ( f ) (1981).

3/ The 1984 F e d e r a l p o v e r t y g u i d e l i n e s were i s s u e d i n

~ e b r u % by

~ t h e Department of H e a l t h and Human S e r v i c e s , u s i n g

t h e methodology o f t h e O f f i c e of Management and Budget (OMB).

F o r a f a m i l y o f f o u r , t h e g u i d e l i n e i s $10,200 i n 1984.

a f t e r c a r e f o r such c h i l d r e n . S t a t e s d e c i d e d t h e l e v e l o f s e r v i c e s .

R e g u l a t i o n s d e f i n e d c r i p p l e d c h i l d r e n s e r v i c e s a s : (1) t h e e a r l y

l o c a t i o n o f c r i p p l e d c h i l d r e n ; ( 2 ) t h e p r o v i s i o n f o r such c h i l d r e n

of p r e v e n t i v e , d i a g n o s t i c and t r e a t m e n t s e r v i c e s ; ( 3 ) t h e development, s t r e n g t h e n i n g and improvement o f s t a n d a r d s and t e c h n i q u e s

r e l a t i n g t o such c a r e and s e r v i c e s ; ( 4 ) t h e t r a i n i n g o f p e r s o n n e l

engaged i n t h e p r o v i s i o n , development, s t r e n g t h e n i n g , o r improvement

o f such c a r e and s e r v i c e s ; and ( 5 ) a d m i n i s t r a t i v e s e r v i c e s i n conn e c t i o n w i t h such c a r e and s e r v i c e s . 51

2. Current Authority. S t a t e s determine t h e l e v e l of

s e r v i c e s . The law f o r b i d s S t a t e t o c h a r g e f e e s f o r s e r v i c e s

provided t o p e r s o n s whose income i s below t h e poverty g u i d e l i n e .

-41

42 C.F.R.

S 51a. 101(k) (1983).

11.

AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDc)

Funding Formula 11

The F e d e r a l Government pays a t l e a s t 50 p e r c e n t o f e a c h

S t a t e ' s b e n e f i t payments 21 and more t h a n 70 p e r c e n t i n 9

S t a t e s . 31 F e d e r a l matchTng f o r AFDC v a r i e s from S t a t e t o

S t a t e , d y p e n d i n g , w i t h i n l i m i t s , on p e r c a p i t a income.

Under m a t c h i n g f o r m u l a s i n t h e law, about 54 p e r c e n t o f e a c h

AFDC b e n e f i t d o l l a r i s p a i d by t h e F e d e r a l Government and

46 p e r c e n t i s p a i d by t h e S t a t e s , some o f which r e q u i r e

l o c a l governments t o s h a r e c o s t s . The F e d e r a l s h a r e v a r i e s

among S t a t e s , r a n g i n g from 50 p e r c e n t t o 77.63 p e r c e n t , and

i t i s i n v e r s e l y r e l a t e d t o S t a t e p e r c a p i t a income. 4 1 The

F e d e r a l Government pays 50 p e r c e n t o f a d m i n i s t r a t i v e c o s t s

i n a l l S t a t e s ( 9 0 p e r c e n t f o r development and i n s t a l l a t i o n

o f automated s y s t e m s o f management i n f o r m a t i o n ) .

The F e d e r a l s h a r e o f a s t a t e ' s AFDC payments i s d e t e r mined by t h e m a t c h i n g f o r m u l a s p e c i f i e d f o r m e d i c a i d i n

( S t a t e s may c h o o s e

t i t l e X I X o f t h e S o c i a l S e c u r i t y Act.

an a l t e r n a t e f o r m u l a , s p e c i f i e d f o r AFDC o n l y i n t i t l e I V

o f t h e a c t , b u t i n e a r l y f i s c a l y e a r 1984 none d i d s o . )

11 F o r a h i s t o r y o f t h e AFDC m a t c h i n g f o r m u l a s , and f o r a d i s cussi& o f a l t e r n a t i v e formulas, s e e "Analysis of Federal-State

C o s t - S h a r i n g i n t h e Aid t o F a m i l i e s With Dependent C h i l d r e n Program," March 1982 (CRS Report 82-62 EPw).

21 I f a S t a t e ' s p e r c a p i t a income e x c e e d s t h e n a t i o n a l a v e r a g e

by more t h a n 5.4093 p e r c e n t , t h e S t a t e must pay t h e maximum s h a r e

o f 50 p e r c e n t .

I n f i s c a l y e a r s 1984 and 1985, 1 3 S t a t e s and D.C. a r e

i n t h i s p o s i t i o n . The 14 j u r i s d i c t i o n s a r e : A l a s k a , C a l i f o r n i a ,

C o l o r a d o , C o n n e c t i c u t , Delaware, D i s t r i c t o f Columbia, H a w a i i ,

I l l i n o i s , Maryland, Nevada, New J e r s e y , New York, Washington,

and Wyoming.

31 Alabama, A r k a n s a s , Kentucky, Maine, M i s s i s s i p p i , S o u t h

~ a r o l ' T n a , T e n n e s s e e , Utah, and West V i r g i n i a .

4 1 I n FY 1984-1985 t h e S t a t e s and t h e D i s t r i c t o f Columbia

f a l l T o u g h l y i n t o t h r e e g r o u p s u n d e r t h e Medicaid f o r m u l a : F e d e r a l

s h a r e between 50 and 55 p e r c e n t , 19 S t a t e s ; 55-65 p e r c e n t , 17

S t a t e s ; and 65-77.63 p e r c e n t , 15 S t a t e s .

U n l i k e t h e Medicaid f o r m u l a , t h i s " r e g u l a r " AFDC f o r m u l a

p l a c e s a c e i l i n g on a v e r a g e b e n e f i t s e l i g i b l e f o r F e d e r a l

funds. )

The m e d i c a i d c o s t - s h a r i n g f o r m u l a u s e d t o d e t e r m i n e t h e S t a t e

and F e d e r a l s h a r e s o f AFDC b e n e f i t payments i s a s f o l l o w s :

S t a t e s h a r e = S t a t e p e r c a p i t a income s q u a r e d / n a t i o n a l

p e r c a p i t a income s q u a r e d x 45 p e r c e n t

F e d e r a l s h a r e = 100 p e r c e n t - S t a t e s h a r e ( w i t h a minimum

o f 50 p e r c e n t and a maximum o f 8 3 p e r c e n t )

F o r t h e o u t l y i n g a r e a s , Guam, P u e r t o R i c o , and t h e V i r g i n

I s l a n d s , 75 p e r c e n t F e d e r a l m a t c h i n g i s p r o v i d e d f o r AFDC b e n e f i t s

and a d m i n i s t r a t i o n , b u t t h e law imposes a c e i l i n g on F e d e r a l f u n d s .

S t a t e s d e c i d e w h e t h e r t h e i r l o c a l i t i e s must h e l p pay f o r AFDC.

A t t h e s t a r t o f FY 1982, 1 0 S t a t e s r e q u i r e d t h e i r l o c a l i t i e s t o pay

some p o r t i o n o f b e n e f i t c o s t , 5 1 and 1 3 S t a t e s r e q u i r e d them t o

h e l p pay a d m i n s t r a t i v e c o s t s . 71

I n FY 1983 F e d e r a l f u n d s p a i d $7.3 b i l l i o n o f t h e n a t i o n ' s

$13.6 b i l l i o n b i l l f o r AF'DC b e n e f i t s (53.6 p e r c e n t ) . F o r AFDC

a d m i n i s t r a t i v e c o s t s , which t o t a l e d $1.792 b i l l i o n ( i n c l u d i n g

t r a i n i n g c o s t s ) , t h e F e d e r a l s h a r e was s l i g h t l y above 50 p e r c e n t .

E l i g i b i l i t y Requirements

T i t l e I V o f t h e S o c i a l S e c u r i t y A c t p e r m i t s S t a t e s t o g i v e AFDC

c a s h t o needy c h i l d r e n ( a n d t h e i r m o t h e r s o r o t h e r c a r e t a k e r r e l a t i v e s )

who h a v e been d e p r i v e d o f s u p p o r t o r c a r e o f o n e p a r e n t b e c a u s e :

-- t h e i r f a t h e r s a r e a b s e n t from home c o n t i n u o u s l y (86.9

p e r c e n t o f t h e c h i l d r e n ) , a r e i n c a p a c i t a t e d ( 5 . 3 perc e n t ) , dead ( 2 . 2 p e r c e n t ) , o r unemployed ( 4 . 1 p e r c e n t ) ;

-- t h e i r m o t h e r s a r e i n c a p a c i t a t e d , a b s e n t , d e a d , o r

unemployed ( 1 . 5 p e r c e n t ) .

5 1 T h e s e S t a t e s were C a l i f o r n i a and New York, t h e two l e a d S t a t e s , p l u s Colorado, I n d i a n a , M i n n e s o t a , Montana, New

i n g AFDC

J e r s e y , North C a r o l i n a , North Dakota, and Ohio.

6 1 The 1 3 S t a t e s were t h e 1 0 shown i n f o o t n o t e No. 5 , p l u s

~ i s s i T s i ~Nebraska,

~i,

and V i r g i n i a . F u r t h e r , A r i z o n a r e q u i r e d

l o c a l i t i e s t o c o n t r i b u t e o f f i c e s p a c e and A r k a n s a s r e q u i r e d 27

o f i t s 79 c o u n t i e s t o h e l p pay AFDC a d m i n i s t r a t i v e c o s t s .

7/ These p e r c e n t a g e s a r e from March 1979 AFDC S t u d y , cond u c t e z by t h e U.S. Department of H e a l t h , E d u c a t i o n and W e l f a r e .

B e f o r e O c t o b e r 1, 1982, when P.L. 97-248 t o o k e f f e c t , a needy

c h i l d whose f a t h e r was a b s e n t f o r m i l i t a r y s e r v i c e c o u l d r e c e i v e

AFDC, and 0 . 3 p e r c e n t o f AFDC c h i l d r e n q u a l i f i e d on t h i s b a s i s i n

March 1979.

C h i l d r e n must b e u n d e r t h e a g e o f 1 8 o r , a t S t a t e o p t i o n , u n d e r

19 i f s t i l l i n h i g h s c h o o l o r t e c h n i c a l s c h o o l . B e f o r e P.L. 97-35,

S t a t e s c o u l d e x t e n d e l i g i b i l i t y u n t i l a s t u d e n t ' s 2 1 s t b i r t h d a y and

c o l l e g e s t u d e n t s c o u l d q u a l i f y . A l l S t a t e s a i d needy f a m i l i e s w i t h o u t a b l e - b o d i e d f a t h e r s i n t h e home, b u t a s o f September 1983 o n l y

23 S t a t e s ( p l u s t h e D i s t r i c t o f Columbia and Guam) o f f e r e d AFDC t o

c h i l d r e n w i t h two a b l e - b o d i e d p a r e n t s a t home, one o f whom was

11unemployed."

8 1 These AFDC-UP S t a t e s p a i d r e l a t i v e l y h i g h benef i t s , and h e l d m o r e t h a n t w o - t h i r d s o f t h e N a t i o n ' s AFDC c a s e l o a d .

F e d e r a l r e g u l a t i o n s d e f i n e a n unemployed p a r e n t a s o n e working

fewer t h a n 100 h o u r s a month, b u t r e q u i r e t h a t t h e p a r e n t h a v e a

s p e c i f i e d h i s t o r y o f p r e v i o u s work i n o r d e r t o q u a l i f y f o r AFDC.

Under P.L. 97-35, AFDC on grounds o f a p a r e n t ' s unemployment i s

a l l o w e d o n l y i f t h e unemployed p a r e n t i s t h e f a m i l y ' s " p r i n c i p a l

earner. "

To r e c e i v e AFDC, f a m i l i e s must b e "needyu by S t a t e s t a n d a r d s

and must meet a t e s t o f c o u n t e d r e s o u r c e s , e s t a b l i s h e d by t h e

S t a t e need s t a n d a r d s f o r an

State within outer Federal l i m i t s .

AFDC f a m i l y o f 3 p e r s o n s ranged i n J a n u a r y 1984 from $179 i n

T e n n e s s e e t o $696 i n A l a s k a and $816 i n Vennont.

In a l l States

e x c e p t Vermont and A l a s k a need s t a n d a r d s were below t h e 1983 Cens u s Bureau p o v e r t y t h r e s h o l d f o r a 3-person f a m i l y , $662. I n

j u d g i n g a n a p p l i c a n t f a m i l y ' s e l i g i b i l i t y , a l l o f i t s income i s

counted except f o r a p o r t i o n of earnings:

$75 f l a t a l l o w a n c e

f o r e x p e n s e s and c h i l d c a r e c o s t s , u p t o $160 p e r c h i l d .

AFDC c o u n t a b l e income l i m i t s (payment s t a n d a r d s ) a r e s e t by

S t a t e s . I n 29 j u r i s d i c t i o n s payment s t a n d a r d s i n J a n u a r y 1984

were below n e e d s t a n d a r d s . A s a r e s u l t , i n most S t a t e s a f a m i l y

c o u l d b e d e n i e d a i d on income g r o u n d s , even though i t was deemed

needy by t h e S t a t e . For a f a m i l y o f t h r e e , c o u n t a b l e income

l i m i t s ranged i n J a n u a r y 1984 from $118 monthly i n A l a b a n a t o

$530 i n Vermont, $579 i n S u f f o l k County, New York, and $696 i n

Alaska.

P.L. 97-35 e s t a b l i s h e d a F e d e r a l g r o s s income l i m i t f o r AFDC

f o r t h e f i r s t t i m e . I t i s 150 p e r c e n t o f t h e S t a t e ' s s t a n d a r d

8 1 Congress a u t h o r i z e d a i d f o r a c h i l d needy b e c a u s e o f a

paren'i's unemployment i n 1961, b u t l i m i t e d i t t o f a m i l i e s o f unemployed f a t h e r s i n 1967. I n 1979 t h e U.S. S u p r e ~ eC o u r t r u l e d t h a t

t h e program must b e open t o c h i l d r e n o f unemployed m o t h e r s on t e r m s

e q u a l t o t h o s e f o r c h i l d r e n o f unemployed f a t h e r s , and s o i t a g a i n

became a n unemployed p a r e n t program. S e e C a l i f a n o v . W e s c o t t . 443

U.S. 76 ( 1 9 7 9 ) . I n 1981, i n t h e Omnibus Budget R e c o n c i l i a t i o n A c t ,

Congress r e s t r i c t e d AFDC-UP t o f a m i l i e s whose p r i n c i p a l e a r n e r was

was unemployed.

o f need; i n more t h a n one-half o f t h e S t a t e s t h i s i s below t h e

p o v e r t y t h r e s h o l d . T h i s law a l s o s e t a c o u n t e d r e s o u r c e l i m i t :

$1,000 ( e q u i t y v a l u e ) p e r f a m i l y . Excluded a r e t h e home ( b y l a w ) ;

an a u t o ( l i m i t e d by r e g u l a t i o n t o $1,500 i n e q u i t y v a l u e , o r a

lower S t a t e l i m i t ) ; and, by r e g u l a t i o n and a t S t a t e o p t i o n , i t e m s

o f p e r s o n a l p r o p e r t y deemed e s s e n t i a l t o d a i l y l i v i n g . 9 1 p r i o r

Federal regulations s e t outer resource l i m i t s e l i g i b l e Tor Federal

m a t c h i n g , namely: home, p e r s o n a l e f f e c t s , a u t o m o b i l e u s e d f o r

t r a n s p o r t a t i o n income-producing p r o p e r t y , p l u s $2,000 per AFDC

r e c i p i e n t i n r e a l and p e r s o n a l p r o p e r t y .

F e d e r a l law r e q u i r e s a l m o s t a l l a b l e - b o d i e d AFDC r e c i p i e n t s

t o r e g i s t e r f o r t r a i n i n g and employment s e r v i c e s (which may i n c l u d e j o b s e a r c h f o r no more t h a n 8 weeks p e r y e a r ) u n l e s s t h e y

a r e s c h o o l c h i l d r e n o r m o t h e r s o f p r e s c h o o l c h i l d r e n . I n March

1979, 4 3 p e r c e n t o f AFDC m o t h e r s had n o p r e s c h o o l c h i l d . P.L. 97-35

a l l o w s 101 S t a t e s t o e s t a b l i s h community work e x p e r i e n c e programs

e cCi p i e n t s a r e r e q u i r e d t o work on p u b l i c p r o j e c t s

i n W ~ ~ C ~ A Fr D

i n exchange f o r t h e i r AFDC b e n e f i t s (known a s work r e l i e f o r workf a r e ) . F o r s u c h programs, S t a t e s a r e p e r m i t t e d t o r e q u i r e p a r t i c i p a t i o n o f m o t h e r s whose y o u n g e s t c h i l d i s t h r e e , p r o v i d e d c h i l d

care i s available.

F e d e r a l law a l s o r e q u i r e s AFDC m o t h e r s t o a s s i g n t h e i r c h i l d

s u p p o r t r i g h t s t o t h e S t a t e and t o c o o p e r a t e w i t h w e l f a r e o f f i c i a l s

i n e s t a b l i s h i n g t h e p a t e r n i t y of a c h i l d born o u t s i d e of marriage

i n o b t a i n i n g s u p p o r t payments from t h e f a t h e r .

P.L. 97-35 r e q u i r e s S t a t e s t o c o n s i d e r a s a v a i l a b l e t o an AFDC

c h i l d p a r t o f t h e income o f a s t e p p a r e n t who l i v e s w i t h him.

Benefit Levels

S t a t e s s e t b e n e f i t l e v e l s . I n J a n u a r y 1984 maximum payments

p e r f a m i l y o f t h r e e w i t h o u t c o u n t a b l e income ( S t a t e AFDC g u a r a n t e e s )

ranged from $96 p e r month i n M i s s i s s i p p i t o $696 i n A l a s k a (and t o

$530 i n Vermont and $579 i n S u f f o l k County, New ~ o r k ) . F o r f a m i l i e s

of f o u r , t h e r a n g e was from $120 i n M i s s i s s i p p i t o $775 i n A l a s k a

(and t o $625 i n C a l i f o r n i a and $676 i n S u f f o l k County, New York).

I n December 1983 b e n e f i t s a v e r a g e d $320 p e r f a m i l y ( 2 . 9 p e r s o n s ) ,

$307 f o r 1 - p a r e n t f a m i l i e s , and $470 f o r AFDC-UP f a m i l i e s . Most

AFDC r e c i p i e n t s a l s o a r e e l i g i b l e , on income and a s s e t g r o u n d s ,

f o r food s t a m p s ; and a l l a u t o m a t i c a l l y a r e e l i g i b l e f o r Medicaid.

4 5 C.F:R.

R e g u l a t i o n s implementing t h e 1981 AFDC law a r e found a t

§ 205, 206, 233, 234, 235, 237, and 238.

101 The P r e s i d e n t ' s b u d g e t f o r FY 1982, 1983, 1984 and 1985,

p r o p o x d t o r e q u i r e S t a t e s t o e s t a b l i s h community work e x p e r i e n c e

programs.

Because maximum food s t a m p b e n e f i t s a r e u n i f o r m f o r t h e 4 8 cont i g u o u s S t a t e s and D . C . and b e c a u s e a c t u a l b e n e f i t s a r e i n v e r s e l y

s c a l e d t o income, t h e y r e d u c e t h e r a n g e among S t a t e s i n p o t e n t i a l i n come b e n e f i t s a v a i l a b l e t o AFDC f a m i l i e s . F o r example, t h e g a p

between M i s s i s s i p p i and C a l i f o r n i a i n maximum b e n e f i t s f o r a 3-person

f a m i l y i s r e d u c e d from $430 ( c a s h o n l y ) t o $336 m o n t h l y when food

stamps a r e added ( J a n u a r y 1984 d a t a ) .

D u r i n g t h e f i r s t 4 months o f a j o b u n d e r t a k e n by an AFDC r e c i p i e n t , F e d e r a l law r e q u i r e s S t a t e s , i n c a l c u l a t i n g t h e f a m i l y ' s AFDC

a flat

grant, t o disregard a portion of the r e c i p i e n t ' s earnings:

e x p e n s e a l l o w a n c e , $75 m o n t h l y , f o r f u l l - t i m e work, p r o r a t e d f o r

p a r t - t i m e work; c h i l d c a r e c o s t s u p t o a c e i l i n g o f $160 monthly

p e r c h i l d ; $30 e a r n e d m o n t h l y , p l u s o n e - t h i r d . 111

The i m p o s i t i o n o f a n o v e r r i d i n g g r o s s income l i m i t a t 150 perc e n t o f t h e S t a t e ' s n e e d s t a n d a r d p r e v e n t s f u l l u s e o f t h e work i n c e n t i v e bonus ( d i s r e g a r d o f $30 p l u s 1/3 i n e a r n i n g s ) i n many S t a t e s .

A f t e r an AFDC r e c i p i e n t s p e n d s 4 months on a j o b , h e r work i n c e n t i v e

d i s r e g a r d e x p i r e s ; then a l l h e r e a r n i n g s e x c e p t t h e f l a t expense

a l l o w a n c e and capped c h i l d c a r e c o s t s a r e s u b t r a c t e d from t h e f a m i l y ' s

w e l f a r e g r a n t . At t h a t p o i n t any i n c r e a s e i n "net" e a r n i n g s ( g r o s s

wages minus f l a t a l l o w a n c e and c h i l d c a r e c o s t s ) c a u s e s a n e q u a l c u t

i n t h e AFDC c h e c k .

P.L. 97-35 p e r m i t s S t a t e s t o t r e a t t h e v a l u e o f food stamps and

h o u s i n g s u b s i d i e s a s income, u p t o t h e v a l u e f o r food o r s h e l t e r t h a t

i s i n c l u d e d i n t h e S t a t e ' s need s t a n d a r d . 121

The Tax E q u i t y and F i s c a l R e s p o n s i b i l i t y Act o f 1982 (P.L. 97248) r e d u c e d AFDC b e n e f i t s f o r most r e c i p i e n t s by r e q u i r i n g S t a t e s

t o round b e n e f i t s down t o t h e n e x t l o w e r d o l l a r . T h a t law a l s o perm i t s S t a t e s t o r e d u c e b e n e f i t s f o r AFDC f a m i l i e s i n s h a r e d h o u s i n g

by p r o - r a t i n g s h e l t e r and u t i l i t y c o s t s .

111 B e f o r e p a s s a g e o f P.L. 97-35, AFDC law r e q u i r e d S t a t e s

t o giGAFDC r e c i p i e n t s a permanent work i n c e n t i v e bonus.

Prior

law r e q u i r e d S t a t e s t o d i s r e g a r d t h e f i r s t $30 e a r n e d m o n t h l y , p l u s

o n e - t h i r d o f t h e r e m a i n d e r , p l u s a l l r e a s o n a b l e work e x p e n s e s , i n

t h a t o r d e r . Because o f t h e s e d e d u c t i o n s , AFDC f a m i l i e s remained

e l i g i b l e f o r a d e c l i n i n g c a s h w e l f a r e payment and f u l l Medicaid

b e n e f i t s u n t i l g r o s s e a r n i n g s e q u a l l e d 150 p e r c e n t o f t h e i r S t a t e ' s

payment s t a n d a r d , p l u s 1 5 0 p e r c e n t o f work e x p e n s e s , p l u s $30

monthly. Under t h e r u l e s , most m o t h e r s i n t h e AFDC program c o u l d

n o t e x p e c t t o e a r n t h e i r way o f f w e l f a r e , a l t h o u g h t h e y c o u l d l e s s e n

t h e i r dependence on i t . Average m o n t h l y e a r n i n g s o f AFDC m o t h e r s

were f a r below AFDC e x i t p o i n t s i n most S t a t e s f o r 3- and 4-person

families.

121 The P r e s i d e n t ' s FY 1983 b u d g e t proposed t o r e q u i r e S t a t e s

t o c o G t F e d e r a l e n e r g y a s s i s t a n c e a s income f o r AFDC, u p t o t h e

v a l u e f o r u t i l i t i e s i n t h e s t a n d a r d o f n e e d . Congress r e j e c t e d

t h i s recommendation.

12.

SUPPLEMENTAL SECURITY INCOME (SSI)

Funding Formula

S i n c e i t s J a n u a r y 1974 b e g i n n i n g , S S I h a s p r o v i d e d a minimum i n come f l o o r , f i n a n c e d by U.S. g e n e r a l r e v e n u e and a d m i n i s t e r e d by t h e

S o c i a l S e c u r i t y A d m i n i s t r a t i o n (SSA), t o p e r s o n s e l i g i b l e u n d e r

Federal rules.

S t a t e s may p r o v i d e a d d i t i o n a l payments t o SSI r e c i p i e n t s a t t h e i r own e x p e n s e . I n a d d i t i o n , a " g r a n d f a t h e r " c l a u s e

r e q u i r e s S t a t e s t o p r o v i d e s u p p l e m e n t s t o a s m a l l number o f p e r s o n s ,

p r e v i o u s l y e n r o l l e d i n t h e pre-SSI programs o f F e d e r a l - S t a t e c a s h a i d

f o r needy a d u l t s , whose income o t h e r w i s e would f a l l s h o r t o f i t s

December 1973 l e v e l . 11

I f a S t a t e c h o o s e s t o have t h e F e d e r a l Government a d m i n i s t e r

i t s s u p p l e m e n t s , i t must a g r e e t o p r o v i d e supplements f o r a l l Fede r a l S S I r e c i p i e n t s o f t h e same c l a s s . I f SSA a d m i n i s t e r s S t a t e

supplements t o S S I , F e d e r a l f u n d s pay a l l a d m i n i s t r a t i v e c o s t s ,

p l u s , u n t i l 1985, a s h a r e o f t h e c o s t o f s u p p l e m e n t a r y b e n e f i t s o f

Wisconsin and Hawaii. 21 I f S t a t e s a d m i n i s t e r t h e i r own s u p p l e ments, t h e y must pay a i l t h e i r c o s t s b u t a r e g e n e r a l l y f r e e t o

d e s i g n t h e i r own s u p p l e m e n t a r y programs and may a d o p t more r e s t r i c t i v e e l i g i b i l i t y r u l e s t h a n t h o s e o f S S I . I n December 1983 t h e

F e d e r a l Government a d m i n i s t e r e d s u p p l e m e n t s f o r 27 j u r i s d i c t i o n s .

11 The Department o f H e a l t h and Human S e r v i c e s e s t i m a t e d t h e

number o f r e c i p i e n t s o f mandatory S t a t e s u p p l e m e n t a r y payments a t

10,188 i n May 1984.

21 These S t a t e s a r e e l i g i b l e f o r F e d e r a l f u n d i n g o f t h e

c o s t s o f p a s s i n g t h r o u g h t o r e c i p i e n t s o f SSI S t a t e s u p p l e m e n t s t h e

a n n u a l c o s t - o f - l i v i n g r i s e i n t h e b a s i c F e d e r a l SSI g r a n t , p r o v i d e d

t h e i r own s p e n d i n g f o r s u p p l e m e n t s ( t o p r o v i d e b e n e f i t s e q u a l t o

" a d j u s t e d payment l e v e l s " o f t h e pre-SSI program p l u s t h e c o s t - o f l i v i n g i n c r e a s e s i n t h e F e d e r a l b e n e f i t s i n c e 1977) e x c e e d s t h e i r

CY 1972 s p e n d i n g on c a s h a i d t o t h e a g e d , b l i n d , and d i s a b l e d . T h i s

i s b e c a u s e t h e y had "hold-harmless" s t a t u s , q u a l i f y i n g them f o r

F e d e r a l reimbursement o f a d d i t i o n a l SSI e x p e n d i t u r e s c a u s e d by c a s e l o a d g r o w t h , a s o f J c l y 1, 1977. E f f e c t i v e on t h a t d a t e , two pro( 1 ) r e q u i r e m e n t t h a t S t a t e s mainv i s i o n s o f P . L . 94-585 took e f f e c t :

t a i n t h e i r a g g r e g a t e s p e n d i n g on SSI s u p p l e m e n t s a f t e r a r i s e i n t h e

b a s i c F e d e r a l b e n e f i t and ( 2 ) p r o v i s i o n o f F e d e r a l f u n d s f o r t h i s p a s s through r u l e i n S t a t e s t h a t then possessed hold-harmless p r o t e c t i o n .

The 9 8 t h Congress v o t e d t o p h a s e o u t t h e s e "hold-harmless" payments,

and t h e y a r e s c h e d u l e d t o end i n 1985 ( P . L . 97-248).

I n FY83, F e d e r a l f u n d s p a i d 78.5 p e r c e n t o f t o t a l SSI b e n e f i t s

o f $9.2 b i l l i o n . 31 The F e d e r a l s h a r e ranged from 46 p e r c e n t i n

C a l i f o r n i a and 5aVpercent i n M a s s a c h u s e t t s , S t a t e s w i t h l a r g e

s u p p l e m e n t s , t o 100 p e r c e n t i n G e o r g i a , T e n n e s s e e , Texas, and West

V i r g i n i a , where no r e c i p i e n t r e c e i v e d a supplement.

E l i g i b i l i t y Requirements

T i t l e X V I o f t h e S o c i a l S e c u r i t y Act e n t i t l e s t o F e d e r a l payments

p e r s o n s who a r e ( 1 ) aged 65 and o v e r , b l i n d , o r d i s a b l e d ; ( 2 ) whose

c o u n t e d income and r e s o u r c e s f a l l w i t h i n l i m i t s s e t by law and r e g u l a t i o n s , and ( 3 ) who l i v e i n one o f t h e f i f t y S t a t e s , t h e D i s t r i c t o f

Columbia, o r t h e N o r t h e r n Mariana I s l a n d s .

F o r b a s i c F e d e r a l b e n e f i t s , c o u n t a b l e income l i m i t s ( c a l e n d a r

y e a r 1984) a r e $942 q u a r t e r l y p e r i n d i v i d u a l and $1,416 p e r c o u p l e .

These income c e i l i n g s e q u a l maximum F e d e r a l b e n e f i t s o f t h e program

( s e e below f o r b e n e f i t d e t a i l s ) . F o r S t a t e s u p p l e m e n t a r y SSI benef i t s , c o u n t a b l e income l i m i t s a r e h i g h e r , r a n g i n g u p t o $1,698 quart e r l y per i n d i v i d u a l i n Alaska.

C o u n t a b l e r e s o u r c e s may n o t exceed $1,500 p e r i n d i v i d u a l and

$2,250 p e r c o u p l e . Excluded a s s e t s i n c l u d e a home; t h e f i r s t $2,000

i n e q u i t y v a l u e o f h o u s e h o l d goods and p e r s o n a l e f f e c t s ; t h e f u l l

v a l u e o f a n a u t o i f needed f o r employment o r m e d i c a l t r e a t m e n t , o r i f

m o d i f i e d f o r u s e by a h a n d i c a p p e d p e r s o n , o t h e r w i s e , t h e f i r s t $4,500

i n m a r k e t v a l u e o f t h e a u t o ; and a l i f e i n s u r a n c e p o l i c y n o t exceedi n g $1,500 i n c a s h s u r r e n d e r v a l u e and, under t e r m s o f P.L. 97-248,

b u r i a l p l o t s and f u n d s , s u b j e c t t o a l i m i t . 4 /

P . L . 98-21 r e q u i r e s t h e S o c i a l S e c u r i t y A d m i n i s t r a t i o n (sSA),

when n o t i f y i n g s o c i a l s e c u r i t y b e n e f i c i a r i e s aged 64 a b o u t t h e i r

a p p r o a c h i n g e l i g i b i l i t y f o r Medicare, t o i n f o r m them a l s o a b o u t SSI.

The law a l s o r e q u i r e d SSA, b e f o r e J u l y 1984, t o n o t i f y a l l e l d e r l y

s o c i a l s e c u r i t y b e n e f i c i a r i e s w i t h low b e n e f i t s a b o u t t h e a v a i l a b i l i t y o f SSI.

Benefit Levels

The S o c i a l S e c u r i t y Act e s t a b l i s h e s b e n e f i t l e v e l s and r e q u i r e s

t h a t whenever s o c i a l s e c u r i t y b e n e f i t s a r e i n c r e a s e d b e c a u s e o f a n

a u t o m a t i c c o s t - o f - l i v i n g a d j u s t m e n t (COLA), S S I b e n e f i t s b e i n c r e a s e d

a t t h e same t i m e and by t h e same p e r c e n t a g e .

3/ These d a t a r e p r e s e n t 12 monthly payments.

shows-13 payments f o r 1983 and 11 f o r 1984.

The U.S.

(19837.

§ 416.

SSI r e s o u r c e r u l e s a r e found i n 20 C.F.R.

Budget

Subpart L

SSI b a s i c monthly g u a r a n t e e s : 51

1984

1985

(estimate) 61

Individual

Coup 1e

From 1975 t h r o u g h 1982, c o s t - o f - l i v i n g a d j u s t m e n t s (COLA) were

p a i d e a c h J u l y . Zn p a s s i n g t h e S o c i a l S e c u r i t y Amendments o f 1983,

Congress a c c e p t e d P r e s i d e n t ~ e a g a n ' sp r o p o s a l t o d e l a y t h e 1983

COLA f o r 6 months, t o J a n u a r y 1984, and t h e r e a f t e r t o a d j u s t b e n e f i t s

e a c h J a n u a r y . A t t h e same t i m e i t v o t e d a n i n c r e a s e o f $20 monthly

i n SSI b e n e f i t s ($30 p e r c o u p l e ) , p a y a b l e i n J u l y 1983.

S t a t e s t h a t supplement SSI b e n e f i t s a r e r e q u i r e d t o " p a s s

through" t o r e c i p i e n t s an i n c r e a s e i n t h e F e d e r a l b a s i c b e n e f i t . 71

However, when Congress d e f e r r e d t h e 1983 COLA and i n s t e a d enactedt h e $20 b e n e f i t i n c r e a s e ( a b o u t 7 p e r c e n t ) , i t r e q u i r e d S t a t e s

t o p a s s t h r o u g h o n l y a b o u t h a l f t h i s amount ( t h e 3.5 p e r c e n t

i n c r e a s e t h a t t h e r e g u l a r COLA would h a v e y i e l d e d ) .

S t a t e supplements f o r aged p e r s o n s l i v i n g i n d e p e n d e n t l y were

o f f e r e d i n 26 S t a t e s p l u s t h e D i s t r i c t o f Columbia and ranged from

$2 i n Oregon t o $252 i n A l a s k a and $163 i n C a l i f o r n i a , a s o f

J a n u a r y 1984.

To a s s u r e some g a i n from work, SSI d i s r e g a r d s a p o r t i o n o f

r e c i p i e n t s ' e a r n i n g s , namely, $65 p e r month, p l u s 50 p e r c e n t o f

5/ The law r e q u i r e s a o n e - t h i r d SSI b e n e f i t r e d u c t i o n f o r t h o s e

who 1 7 v e i n a n o t h e r p e r s o n ' s h o u s e h o l d and r e c e i v e s u p p o r t and maint e n a n c e i n k i n d from him.

6 / F e b r u a r y 1, 1884 e s t i m a t e o f t h e S o c i a l S e c u r i t y Administ r a t i T n , which assumed a 4 . 3 p e r c e n t r i s e i n t h e Consumer P r i c e

I n d e x f o r u r b a n wage e a r n e r s (CPI-W) from t h e t h i r d q u a r t e r o f 1983

t o t h e same q u a r t e r o f 1983 t o t h e same q u a r t e r of 1984. However,

the law r e q u i r e s t h e CPI-W t o r i s e a t l e a s t 3 p e r c e n t i n t h i s p e r i o d

f o r a n a u t o m a t i c COLA t o b e p a i d . As o f e a r l y J u n e , 1984, i t

appeared t h a t t h i s t r i g g e r l e v e l of i n f l a t i o n might n o t be reached.

7/ The r e q u i r e m e n t f o r p a s s - t h r o u g h i s s a t i s f i e d i f a S t a t e ' s

t o t a l - s p e n d i n g f o r SSI s u p p l e m e n t s d u r i n g t h e r e l e v a n t 12-month p e r i o d

i s n o t below t h a t f o r t h e p r e c e d i n g 12 months ( P . L . 94-585).

t h e b a l a n c e . 8 1 Because o f t h i s r u l e , aged SSI r e c i p i e n t s w i t h o u t

s o c i a l s e c u r i F y b e n e f i t s o r o t h e r u n e a r n e d income who work remain

e l i g i b l e f o r a d e c l i n i n g SSI payment u n t i l g r o s s e a r n i n g s e q u a l

d o u b l e t h e i r b a s i c b e n e f i t p l u s $85 monthly. 91 I n a S t a t e t h a t

d o e s n o t supplement t h e b a s i c F e d e r a l b e n e f i t , t h e g r o s s income

l i m i t i n 1984 f o r an aged S S I r e c i p i e n t i s $713 monthly i n e a r n i n g s . I n A l a s k a t h e l i m i t i s $1,217 m o n t h l y i n e a r n i n g s .

I n a l l b u t 14 S t a t e s 101 SSI r e c i p i e n t s a u t o m a t i c a l l y a r e

14 S t a t e s w i t h more r e s t r i c t i v e

e l i g i b l e f o r M e d i c a i d . he1n:

e l i g i b i l i t y r u l e s , S t a t e s must d e d u c t m e d i c a l e x p e n s e s o f SSI

r e c i p i e n t s i n d e t e r m i n i n g t h e i r c o u n t a b l e income.

D i s a b l e d SSI r e c i p i e n t s whose c o u n t e d e a r n i n g s exceed t h e

"substantial gainful a c t i v i t y " t e s t t h a t determines d i s a b i l i t y

s t a t u s ($300 m o n t h l y ) a r e e l i g i b l e f o r s p e c i a l c a s h b e n e f i t s

( c a l c u l a t e d a s though t h e y s t i l l had d i s a b i l i t y s t a t u s ) , a s

l o n g a s t h e i r g r o s s e a r n i n g s a r e below t h e r e g u l a r S S I c e i l i n g

($713 i n a S t a t e w i t h o u t s u p p l e m e n t a t i o n ) . The s p e c i a l c a s h

b e n e f i t p r e s e r v e s m e d i c a i d e l i g i b i l i t y f o r t h e d i s a b l e d worker.

I n J a n u a r y 1984 f e d e r a l l y a d m i n i s t e r e d SSI b e n e f i t s a v e r a g e d

$162 t o aged r e c i p i e n t s , $264 t o t h e b l i n d , and $253 t o t h e d i s a b l e d .

H a l f o f t h e N a t i o n ' s 3.9 m i l l i o n SSI r e c i p i e n t s a l s o r e c e i v e s o c i a l

s e c u r i t y , and a b o u t 3 p e r c e n t a l s o h a v e e a r n i n g s . A s o f December

1982, S S I c h e c k s w e r e s u p p l e m e n t a r y t o s o c i a l s e c u r i t y b e n e f i t s f o r

70 p e r c e n t o f aged S S I r e c i p i e n t s , 3 8 p e r c e n t o f b l i n d r e c i p i e n t s ,

and 36 p e r c e n t o f d i s a b l e d r e c i p i e n t s .

I n t h a t month income was

e a r n e d by 1 . 4 p e r c e n t o f aged r e c i p i e n t s and by 6.5 and 4 . 4 perc e n t , r e s p e c t i v e l y , of t h e b l i n d and d i s a b l e d . S o c i a l s e c u r i t y

b e n e f i t s o f d u a l r e c i p i e n t s a v e r a g e d $231. E a r n i n g s o f SSI r e c i p i e n t s w i t h j o b s a v e r a g e d $108. 111

8 1 F o r b l i n d o r d i s a b l e d r e c i p i e n t s , t h e law p r o v i d e s a d d i t i o n a l

deducFions from e a r n i n g s . B l i n d : d i s r e g a r d t h e f i r s t $65 e a r n e d , p l u s

o n e - h a l f o f t h e r e s t , p l u s r e a s o n a b l e work e x p e n s e s . D i s a b l e d : d i s r e g a r d t h e f i r s t $65 e a r n e d , work and l i v i n g e x p e n s e s c a u s e d by t h e

d i s a b i l i t y , p l u s o n e - h a l f o f t h e r e s t . F o r b o t h b l i n d and d i s a b l e d

SSI r e c i p i e n t s , income needed f o r t h e f u l f i l l m e n t o f a s e l f - s u p p o r t

p l a n approved by t h e HHS S e c r e t a r y a l s o i s d i s r e g a r d e d .

(The s p e c i a l

e x p e n s e d e d u c t i o n f o r t h e d i s a b l e d was e n a c t e d i n J u n e 1980 a s a

p r o v i s i o n o f P.L. 96-265.)

9 1 The $85 d i s r e g a r d c o n s i s t s o f t h e f i r s t $20 o f any i n come p l u s $65 i n e a r n i n g s .

101 C o n n e c t i c u t , H a w a i i , I l l i n o i s , I n d i a n a , M i n n e s o t a ,

~ i s s G r i ,Nebraska, New Hampshire, North C a r o l i n a , N o r t h

Dakota, Ohio, Oklahoma, Utah, and V i r g i n i a .

111 DHHS. S o c i a l S e c u r i t y A d m i n i s t r a t i o n . O f f i c e o f P o l i c y .

O f f i c e o f R e s e a r c h , S t a t i s t i c s , and I n t e r n a t i o n a l P o l i c y . Program

and Demographic C h a r a c t e r i s t i c s o f Supplemental S e c u r i t y B e n e f i c i a r i e s . December 1982.

13.

PENSIONS FOR NEEDY VETERANS, THEIR DEPENDENTS, AND SURVIVORS

Funding Formula

The F e d e r a l Government p r o v i d e s 100 p e r c e n t f u n d i n g f o r v e t e r a n s '

pensions.

E l i g i b i l i t y Requirements

Under T i t l e 38 o f t h e U n i t e d S t a t e s Code, c h a p t e r 5 , v e t e r a n s a r e

e l i g i b l e f o r p e n s i o n s p r o v i d e d : t h e y s e r v e d h o n o r a b l y f o r a t l e a s t 90

d a y s , i n c l u d i n g a t l e a s t 1 day o f w a r t i m e s e r v i c e , t h e y a r e t o t a l l y

and p e r m a n e n t l y d i s a b l e d f o r r e a s o n s n o t r e l a t e d t o t h e i r m i l i t a r y serv i c e 11 and n o t c a u s e d by " w i l l f u l m i s c o n d u c t o r v i c i o u s h a b i t s , " and

h a v e yncome below p r e s c r i b e d l i m i t s ( l i s t e d i n s e c t i o n below on benef i t l e v e l s ) . At a g e 65 v e t e r a n s a r e deemed t o b e d i s a b l e d , r e g a r d l e s s

o f p h y s i c a l c o n d i t i o n . S u r v i v o r s o f v e t e r a n s who w e r e d i s a b l e d by a

n o n - s e r v i c e c a u s e a l s o a r e e l i g i b l e f o r p e n s i o n s i f t h e y meet t h e

income t e s t .

V i r t u a l l y a l l p r i v a t e income o f a v e t e r a n and h i s f a m i l y , i n c l u d i n g S o c i a l S e c u r i t y b e n e f i t s and a d u l t e a r n i n g s , i s c o u n t e d a s a v a i l a b l e . Excluded from c o u n t a b l e income a r e c u r r e n t e a r n i n g s o f a c h i l d

t h a t a r e below t h e c h i l d ' s F e d e r a l income t a x t h r e s h o l d ($3,300 y e a r l y

i n 19841, amounts p a i d by a c h i l d f o r p o s t s e c o n d a r y e d u c a t i o n o r vocat i o n a l r e h a b i l i t a t i o n t r a i n i n g e x p e n s e s , and c a s h w e l f a r e a i d . A l s o

e x c l u d e d a r e p r o c e e d s from t h e s a l e o f non-business p r o p e r t y and

amounts o f f a m i l y income e q u a l t o unreimbursed m e d i c a l e x p e n s e s t h a t

exceed 5 percent of t h e b a s i c annual b e n e f i t r a t e ( t h o s e exceeding

$276 i n January-December 1984 f o r a s i n g l e v e t e r a n , f o r example). 2 1

Benefit Levels

The V e t e r a n s ' and S u r v i v o r s ' P e n s i o n Improvement Act o f 1978

(P.L. 95-588) i n c r e a s e d maximum p e n s i o n r a t e s , e f f e c t i v e J a n u a r y 1,

1979. The law p r o v i d e d t h a t t h e r e a f t e r , whenever s o c i a l s e c u r i t y

b e n e f i t s were i n c r e a s e d b e c a u s e o f a n a u t o m a t i c c o s t o f l i v i n g a d j u s t ment (COLA), v e t e r a n s ' p e n s i o n s would b e i n c r e a s e d a t t h e same t i m e

Thus, b e n e f i t s were i n c r e a s e d 14.3 p e r c e n t

and by t h e same p e r c e n t a g e .

11 V e t e r a n s d i s a b l e d b e c a u s e o f m i l i t a r y s e r v i c e a r e e l i g i b l e

f o r c G p e n s a t i o n payments, f o r which t h e r e i s n o income t e s t .

-2/

E l i g i b i l i t y r u l e s o f t h i s program a r e found i n 3 8 C.F.R

P a r t 3.

e f f e c t i v e June 1980, 11.2 p e r c e n t e f f e c t i v e June 1981, and 7.4

p e r c e n t e f f e c t i v e June 1982 ( p a i d i n J u l y e a c h y e a r ) . However,

i n p a s s i n g t h e S o c i a l S e c u r i t y Amendments of 1983, Congress

a c c e p t e d P r e s i d e n t Reagan's r e c o r n e n d a t i o n t o d e l a y t h e 1983 COLA

i n s o c i a l s e c u r i t y b e n e f i t s , u n t i l J a n u a r y 1984, and t h e r e a f t e r t o

a d j u s t b e n e f i t s each J a n u a r y . S i n c e COLAs f o r v e t e r a n s ' p e n s i o n s

a r e t i e d t o t h o s e f o r s o c i a l s e c u r i t y , COLAs f o r v e t e r a n s ' pens i o n s a l s o have been s h i f t e d t o J a n u a r y f o r t h e f u t u r e . The

J a n u a r y 1984 COLA was 3.5 p e r c e n t .

The maximum b e n e f i t s c h e d u l e :

June 1982

Veteran

Family S i z e a /

- Dec. 1983

Widow(er)

Jan. 1984

Veteran

- Dec. 1984

~idow(er)

a / T h i s column r e f e r s t o t h e v e t e r a n p l u s dependents, and t o

t h e wTdow(er) p l u s c h i l d r e n .

b/ For each a d d i t i o n a l c h i l d , add $903 f o r June 1982~ e c e m z e r1983 and $935 f o r c a l e n d a r y e a r 1984.

V e t e r a n s who s e r v e d b e f o r e World War I r e c e i v e an e x t r a $1,245

payment a n n u a l l y .

The v e t e r a n s ' pension s c h e d u l e g u a r a n t e e s a 1984 income above

t h e Census ~ u r e a u ' s 1983 poverty t h r e s h o l d s f o r v e t e r a n s w i t h no

more than two dependents. For widows and widowers, and f o r v e t e r a n s

with t h r e e o r more dependents, t h e program's maximum b e n e f i t s a r e

below t h e p o v e r t y t h r e s h o l d . 31

I n f i s c a l y e a r 1983 pensions averaged $3,157 p e r c a s e t o v e t e r a n s ,

$1,494 p e r c a s e t o v e t e r a n s ' s u r v i v o r s ($263 and $125 monthly, r e s p e c t t i v e l y ) . FY 1983 pension b e n e f i t s t o t a l l e d $3.9 b i l l i o n , up 3 p e r c e n t

from t h e FY 1981 t o t a l o f $3.8 b i l l i o n . I n t h e same p e r i o d t h e number

o f r e c i p i e n t s d e c l i n e d by 17.5 p e r c e n t .

31 Estimated a v e r a g e p o v e r t y t h r e s h o l d s of t h e Census Bureau i n

1983 T i s s u e d J a n . 1984): s i n g l e non-aged person $5,180; s i n g l e aged

person, $4,770; f a m i l y o f two, $6,480, f a m i l y o f t h r e e , $7,940; f a m i l y

of f o u r , $10,180; f a m i l y of f i v e , $12,080.

14.

GENERAL ASSISTANCE (NoN-MEDICAL CARE COMPONENT) 1/

Funding Formula

No F e d e r a l funds a r e p r o v i d e d f o r G e n e r a l A s s i s t a n c e (GA).

GA i s a g e n e r a l name f o r S t a t e and l o c a l programs t h a t h e l p

p e r s o n s who d o n o t q u a l i f y f o r Aid t o F a m i l i e s w i t h Dependent

C h i l d r e n , Supplemental S e c u r i t y Income, o r Emergency Assista n c e t o Needy F a m i l i e s w i t h C h i l d r e n . I n many S t a t e s GA i s

known a s "General R e l i e f . " 2 /

As o f l a t e 1982, 2 5 j u r s i s d i c t i o n s , i n c l u d i n g D.C. and t h e

t h r e e o u t l a y i n g a r e a s , o p e r a t e d S t a t e w i d e GA programs, f u l l y

funded by t h e S t a t e . 3 / N i n e t e e n S t a t e s p r o v i d e d no f u n d s f o r

local relief

although four of these S t a t e s required

t h e i r l o c a l i t i e s t o o f f e r GA. 4 / One S t a t e (West V i r g i n i a ) had

no c a s h GA program, h a v i n g endTd S t a t e f u n d i n g f o r i t i n 1980.

The r e m a i n i n g n i n e S t a t e s g e n e r a l l y s h a r e d GA c o s t s w i t h

localities.

1 / S t a t e d a t a r e p o r t e d h e r e a r e drawn frm a s t u d y

e n t i t i e d " C h a r a c t e r i s t i c s of G e n e r a l A s s i s t a n c e Programs,

1982," p r e p a r e d by Urban Systems R e s e a r c h and E n g i n e e r i n g ,

I n c . , Cambridge, M a s s a c h u s e t t s , f o r U.S. Department of H e a l t h

and Human S e r v i c e s . C o n t r a c t No. HHS-100-82-0038.

2 1 Seven S t a t e s u s e t h e term, G e n e r a l R e l i e f : A l a s k a ,

~ r k a n s a s , C a l i f o r n i a , Iowa, M i s

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