The public assistance and social services programs studied by the Commission serve specific client populations. Each program operates within organizational and funding structures defined by Federal statute and regulations and, in some cases, by State and local statutes and regulations. Administrative responsibilities are delegated to Federal, State, and local government units as the laws require. The following sections briefly identify the clients served and the basic administrative characteristics of the programs studied.
Aid to Families with Dependent Children
Title IV-A of the Social Security Act authorizes payments to States for the provision of financial assistance to needy families with dependent children. The Act defines dependent children as those children under 18 (or in the case of children attending school, under 21) who have been deprived of parental support or care by reason of the death, continued absence from home, physical or mental incapacity, or, under certain conditions, the unemployment of a parent. Within the broad requirements of the Social Security Act, a State has considerable latitude in defining the categories of the needy who will be served by the program in that State (e.g., whether or not to include families with an unemployed parent), in applying the eligibility criteria, and in determining what level of assistance will be provided to those eligible.
Aid to Families with Dependent Children (AFDC) provides financial assistance to help cover the costs of food, shelter, clothing, and other basic living costs. Emergency assistance and funds to support certain children in foster homes and institutions may also be provided. To supplement this assistance, an AFDC recipient is also eligible for assistance under the Medicaid, Food Stamp, and Title XX Social Services programs, and may also qualify for other forms of public assistance and social services.
Administrative and funding responsibilities for AFDC are shared by the Federal government and State and local governments. Program administration is overseen by the Social Security Administration of the Department of Health, Education, and Welfare (DHEW).6 A State may either administer the program or supervise its administration by local governments. Federal funds (ranging from 50 percent to 65 percent of the total cost) help to finance assistance payments to recipients and may also be used to help cover administrative costs at the State and local level. States must share in the cost of the program and, in some but not all cases, local governments also contribute.
The Medicaid program authorized by Title XIX of the Social Security Act provides Federal funds to States for use in paying for medical services rendered to both the categorically needy and the medically needy. The categorically needy are those receiving assistance under the AFDC or Supplemental Security Income programs. The medically needy are those who meet all criteria for federally funded cash assistance, except the income criterion, and who lack the income and resources to meet the costs of necessary medical care and services. Their income may not exceed 133-1/3 percent of the State's cash assistance standard.
At minimum, a State must provide categorically needy individuals with:
- inpatient hospital services;
- outpatient hospital services;
- other laboratory and x-ray services;
- skilled nursing facility services for individuals 21 years of age or older;
- early and periodic screening and diagnosis of individuals under 21 to discover and treat mental and physical defects;
- family planning services and supplies; and
- physician's services.
The State may use the Federal funds in providing the medically needy with the above services or with other services which qualify for Federal funding under the Act. The services are rendered to recipients by qualified medical-care providers who are then reimbursed by the State.
The Health Care Financing Administration of the Department of Health, Education, and Welfare7 oversees the administration of the Medicaid program. A State agency is responsible for either the administra tion of the program or the supervision of its administration by local government units. The designated State agency may, however, contract with other State agencies for performance of specified functions such as utilization review. States may also contract with private organizations to process claims, to act as the State's fiscal agent, or to develop and operate its Medicaid Management Information System, a mechanized claims-process-ing system for which special Federal funding is available.
The Federal share of Medicaid program costs is calculated according to a formula based on the State's per capita income in relation to national per capita income. The Federal share ranges from a low of 50 percent in many States to a high of 78 percent in one. States or localities, or both, provide the remaining funds.
Title XX of the Social Security Act authorizes Federal grants to States for the provision of social services to recipients of public assistance under the AFDC or Supplemental Security Income programs and to other low income persons who do not qualify for public assistance but whose income does not exceed 115 percent of the median income of a family of four in the State. The grants provided under Title XX are to be used for five specified purposes:
- achieving or maintaining economic self-support to prevent, reduce, or eliminate dependency [of eligible clients];
- achieving or maintaining self-sufficiency, including reduction or prevention of dependency;
- preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests, or preserving, rehabilitating, or reuniting families;
- preventing or reducing inappropriate institutional care by providing for community-based care, home-based care, or other less intensive forms of care; and
- securing referral or admission for institutional care when other forms of care are not appropriate, or providing services to individuals in institutions.
Among the many services Title XX cites as appropriate to these five purposes are: child care services; services related to the management and maintenance of the home; day care services for adults; employment services; information, referral, and counseling services; health support services; appropriate combinations of services designed to meet the special needs of. (1) children; (2) aged, mentally retarded, blind, emotionally disturbed and physically handicapped individuals; and (3) alcoholics and drug addicts.
A single agency of each State administers or supervises the administra-tion of the services programs of Title XX under the oversight of the Office of Human Development, DHEW.8 In providing services to those eligible, a State may elect to use State facilities and personnel, to purchase services from private providers, or to use a combination of these alternatives. The State may also delegate certain administrative responsibilities to providers. For example, responsibility for determining an applicant's eligibility for a Title XX service may be delegated to the provider.
Federal funds totaling approximately $2.7 billion a year are available under Title XX. They can be used to reimburse States for 75 percent of the cost of social services, and in the case of family planning services, for 90 percent of the cost.
The Food Stamp Program permits low-income households to buy coupons for less than the coupons are worth in exchange for food at federally certified food stores. Families receiving cash assistance under the AFDC or SSI programs are eligible for food stamps, as are those whose income falls below levels established by the Federal government.
State or local welfare offices administer the program under the supervision of the Food and Nutrition Service of the Department of Agriculture. The Department of Agriculture pays 100 percent of the cost of the food stamp coupons and 50 percent of the administrative costs incurred by States and localities.
Programs Not Studied by the Commission
As noted above, the Commission could not make a detailed study of all the public assistance and social services programs funded by Federal, State, and local governments, and it made no attempt to study social services programs administered by private organizations that do not receive any government funding. Examples of the different types of government programs the Commission did not study are cited here to lend perspective on the universe of public assistance and social services programs.
Besides the four major programs studied by the Commission, the Federal government funds a great many categorical grant programs that provide assistance and services to the needy. Illustrative of these are:
- nutrition programs administered under Department of Agriculture supervision, such as the School Breakfast and School Lunch Programs, the Special Supplemental Food Program for Women, Infants and Children, and the Summer Food Service Program;
- health programs administered under the supervision of the Department of Health, Education, and Welfare, such as Family Planning Projects, Maternal and Child Health Servic-es, Drug and Alcohol Abuse Community Services Programs, and Community Mental Health Programs;
- education programs under the auspices of DREW, including Follow Through and Vocational Education;
- human development programs administered under the super-vision of DHEW, including Head Start, Runaway Youth, Vocational Rehabilitation, and Special Programs for the Aging;
- housing programs funded by the Department of Housing and Urban Development, such as public housing and rent supplement programs; and
- employment programs of the Department of Labor, such as the Work Incentive Program, Job Corps, and Comprehensive Employment and Training Programs.
States also fund cash assistance and social services programs, especially to meet needs in areas where Federal financial assistance has not been made available. The most common of these State programs, usually called "general assistance," makes cash available to the needy who are not eligible for Federal cash assistance under AFDC or SSI, such as young, single individuals and young couples with no children. States may also fund special purpose programs to supplement Federal programs. Examples of these in California are the State's Emergency Loan Programs and Special Circumstances Program.
Obviously, the record-keeping issues inherent in administering the AFDC, Medicaid, Social Services, and Food Stamp programs also arise in these other programs. Eligibility for these programs is generally based on financial need. Those seeking assistance under any of the programs must apply for it and submit to the prescribed methods of verifying the information they supply. Inevitably, a record is created to document the relationship between the client and the agency administering the program. Therefore, as explained in more detail below, the Commission believes that the information safeguards recommended for the four major programs which the Commission studied in detail should be required of the other programs as well.