Sidebilder
PDF
ePub

CHART B

GENERAL ASSISTANCE:

DISTRIBUTION OF EXPENDITURES FOR ASSISTANCE BY
SOURCE OF FUNDS, FISCAL YEAR 1946-47

[blocks in formation]

The Council believes that Federal financial participation in general ssistance, even in the limited manner recommended herein-whereby he State and local unit of government would have to expend $2 for ssistance payments to receive $1 in Federal funds- -will, in most tates, result in better provision for needy individuals. Federal nancial help is especially important for the low-income States. urthermore, the establishment of minimum Federal requirements or the operation of a State-Federal general assistance program as a ondition of Federal aid would improve the administration of general ssistance in all parts of the country. These requirements should be milar to those for the existing State-Federal public assistance rograms, and should create a State-Federal partnership in general ssistance like that in the other programs. The proposed program ould continue to be essentially a State and local responsibility, but ederal participation would result in more nearly equitable and dequate treatment for persons in need of general assistance. The ocial Security Administration would be charged with the duty of scertaining that each State receiving Federal funds had a State-wide eneral assistance plan in effect which was administered in a proper nd efficient manner, with the selection of personnel on a merit basis. eneral assistance would be available to needy persons regardless of here they happened to live in a State, and objective methods of termining eligibility for and the amount of assistance would be quired of all units of government administering the program. Because the proposed general assistance program should provide bsistence to persons who cannot be self-supporting and for whom her provision is lacking, we believe that, as a condition of Federal ancial participation, a State should be precluded from denying any erson general assistance on the basis of his residence or citizenship. ithout such a safeguard, it cannot be expected that all persons in eed of assistance would receive aid. Today, although the Statecal general assistance programs are widely assumed to assist all edy persons not covered by the State-Federal programs, State ws, as well as interpretations by local autonomous units of governent administering the programs, generally provide continuing assistice only to those who meet State and local residence requirements. See recommendation 5 for discussion of residence requirements.) In order to help persons who need assistance because of unemploytent to obtain jobs and to avoid paying public funds to employable ersons when suitable employment is available, the States should be quired to assure registration and clearance of employable applicants or assistance with the public employment service. The States should so be required to refer all persons likely to benefit from the Stateederal vocational rehabilitation program to the agency administerg that program.

Although we recommend that the Federal Government finance nly one-third of the cost of general assistance payments made by le States within the maximums specified, we believe it is desirable to atch the administrative costs incurred by the States on a 50-50 asis. Then the Federal Government will share uniformly in the dministrative costs for all State-Federal public assistance programs. his uniformity will simplify recording for purposes of reimbursement 1 the States that integrate general assistance with one or more of ne existing State-Federal assistance programs.

In recommending Federal grants-in-aid to the States for general assistance, we do not intend that a general assistance program should be considered as a preferred method of dealing with large-scale unemployment if it should again occur. Neither should gener assistance be a substitute for unemployment insurance. These subjects will be discussed in a subsequent report by the Counc General assistance would serve the purpose of providing an under pinning for the other social measures by aiding those for whom n other means of support is available.

It is difficult to estimate with accuracy the long-range costs of State-Federal general assistance program. General assistance more sensitive to changes in economic conditions than are any of the other public-assistance programs. In the last 12 years, expenditures for general assistance have ranged from a high of $472,000,000 m the fiscal year 1938-39 to a low of $85,500,000 in 1944-45 (see appendi A, table 13). Expenditures for general assistance payments from State and local funds in 1947 amounted to $164,000,000.

It is estimated that under a continuation of current economie conditions, the annual cost to the Federal Government under the proposed general assistance program would range from a low of $65,000,000 to a high of $75,000,000 for assistance payments, and from $13,000,000 to $15,000,000 for administrative expenses. This estimate is based on the assumption that the October 1947 case loads represent an average annual case load. This assumption, of course would be invalid if current economic conditions changed materially 3. To help meet the medical needs of recipients of old-age assistance aid to the blind, and aid to dependent children, the Federal b ernment should participate in payments made directly to agenci and individuals providing medical care, as well as in money por ments to recipients as at present. The Federal Government sho pay one-half the medical care costs incurred by the States above th regular maximums of $50 a month for a recipient ($15 for the third and succeeding persons in a family receiving aid to depende children) but should not participate in the medical costs ab the regular maximums which exceed a monthly average of $6 person receiving old-age assistance or aid to the blind and a monthly average of $3 per person receiving aid to dependent children State public-assistance agencies should be required to submit plans the Social Security Administration for its approval, setting forth the conditions under which medical needs will be met, the scope standards of care, the methods of payment, and the amount compensation for such care

The present Social Security Act limits Federal financial participa tion in assistance payments to those which are paid to the recipients in money. Consequently, if the cost of medical care furnished to recipients of assistance is met by the State or local agency through direct payments to physicians or other suppliers of medical care, the expenditures must now be borne entirely by the State and loca governments. Under our recommendations, total money payments in which the Federal Government will be able to participate will limited to $50 monthly ($15 for the third and succeeding persons a family receiving aid to dependent children). In most cases the amounts or more will be needed to meet living costs other than

medical care. Consequently, Federal funds will be available as they are now to only a very limited extent for money payments to recipients to enable them to arrange for their own medical care.

Most States are now financing the medical care they provide in large part from State and local funds. Since States with comparatively meager resources cannot afford to spend funds for which they cannot get Federal matching, they provide little or nothing for medical care, while in almost all States the medical care provided is inadequate.

It would seem desirable for the Federal Government to participate in the cost of necessary medical care for assistance recipients under arrangements that afford the assistance agency flexibility in establishing its policies and procedures. It is frequently desirable to let recipients make their own arrangements for medical services. On the other hand, there are many circumstances in which the assistance agency finds it preferable to pay the doctor or other supplier of medical care directly. People who are sick or old often need help in arranging and paying for medical services. Furthermore, care is sometimes not available unless arrangement is made in advance for payment to the doctor or hospital for the services to be supplied. The cost of the last illness of a recipient who leaves no insurance or other assets can be met only through direct payments. If the Federal Governmentwithin specified maximums should share one-half the payments to suppliers of medical care and one-half the money payments to recipients which exceed the maximums because of the need for medical attention, the State agency would have no financial inducement to provide medical care in one way rather than the other. Choice could be made of the best way to make medical care available to a recipient in his particular situation.

Illness and disability occur more often among recipients of public assistance than among persons in the general population. Recipients of old-age assistance have an average age of 75 years and have great need of medical services. Like other people of advanced age, they are particularly subject to chronic ailments requiring diagnosis, continuing treatment, and sometimes hospitalization or nursing care.

Evidence of the substantial need of dependent blind persons for medical care has been supplied by a study of the causes of blindness of recipients of aid to the blind. It is estimated that about one-third of the recipients are 65 years of age and over. Many of these aged, blind persons are handicapped by other infirmities as well as by blindness. About one-fifth of the recipients are blind as a result of cataract, a condition which in a substantial proportion of cases might have been corrected by surgery. More than one-tenth of the recipients suffer from glaucoma, which requires early detection and continuing medical treatment to prevent progressive and irremediable loss of vision. Medical assistance could do much to alleviate suffering and prevent or reduce visual loss among persons who are blind or in danger of becoming so.

Children on the aid to dependent children rolls, like all children, need medical services for acute illnesses, correction of defects, dentistry, and immunization against infectious diseases. To the extent that other community programs do not provide such services, the assistance agency should be able to help children obtain them.

It would be very difficult to meet medical needs with a ceiling imposed on individual payments. When medical bills are incurred, they are often large, particularly when the recipient receives hospital or nursing-home care. We recommend, however, the control of Federal expenditures by limiting Federal contributions for medical care to one-half the amounts which average not more than $6 per month per person receiving old-age assistance and aid to the blind, and not more than $3 per month per person receiving aid to dependent children. Analysis of the characteristics of the case loads and of the costs of medical care indicate that adequate medical care for recipients of assistance can be provided on an average basis within these maximums. In addition to these maximums, the requirement of State financial participation in expenditures for medical care would act as a safeguard against extravagant expenditures. A further control would result from having each State set forth, in the plan which it submits to the Social Security Administration for approval, the conditions under which medical needs of recipients would be met, the scope and standards of care, the methods of payment, and the amount of compensation for such care.

The estimated additional annual cost to the Federal Government for providing medical care to recipients of old-age assistance ranges from a low of $45,000,000 to a high of $72,000,000. These amounts include the estimated annual cost to the Federal Government for recipients residing in public medical institutions under recommendation 4. For aid to dependent children the annual cost to the Federal Government would range from $10,000,000 to $15,000,000 and for aid to the blind from $1,000,000 to $2,000,000. Thus the estimated additional annual cost to the Federal Government under recommendations 3 and 4 would range from $56,000,000 to $89,000,000. These estimates are based on March 1948 case loads, the latest month for which data are available.

4. The Federal Government should participate in payments made to or for the care of old-age-assistance recipients living in public medical institutions other than mental hospitals. Payments in excess of the regular $50 maximum made to recipients living in public or private institutions or made by the public-assistance agency directly to these institutions for the care of aged recipients should be included as a part of medical-care expenditures under recommendation 3. To receive Federal funds to assist aged persons in medical institutions under either public or private auspices, a State should be required to establish and maintain adequate minimum standards for the facilities and for the care of persons living in these facilities. These standards should be subject to approval by the Social Security Administration

Many recipients of old-age assistance suffer from chronic ailments and some of these conditions require prolonged treatment in medical

The Social Security Act now authorizes the Federal Government to share in money payments to aged individuals living in private institutions, but it does not permit sharing in aid to persons who are living in public institutions, unless they are receiving only temporary medical care. Persons in public mental hospitals would not generally be competent to handle their own payments and are therefore excluded from this recommendation.

« ForrigeFortsett »