Medicaid State Plan personal care services: trends in programs and policies

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999-2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.     

Medicaid State Plan Personal Care Services

Abstract

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999–2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.     

Using Policy-Relevant Administrative Data in Mixed Methods: A Study of Employment Instability and Parents’ Use of Child Care Subsidies

In the United States, government subsidies help low-income families pay for child care when parents are working, yet policies that tie subsidy eligibility closely to employment may result in frequent disruptions in program participation for families. This paper uses a mixed methods research design that links administrative records on families and children to data collected through surveys and in-depth interviews to examine employment instability and job characteristics of parents using child care subsidies. The results suggest that parents experience substantial employment instability (employment loss and unpredictable schedules) and that exiting the subsidy program is frequently related to employment-related eligibility factors. Overall, the use of administrative data integrated with other methods provides substantial opportunities for researchers to explore complex social phenomenon and provide insights in the evaluation of social programs.     

The potential of the SSI program to reduce poverty among the elderly

Is it more effective to reduce poverty among the elderly by increasing the benefits paid by the Supplemental Security Income (SSI) program or by increasing eligibility for the program? This paper answers that question from a policymaker's perspective. At given program cost levels, we compare the potential reduction in poverty from increasing benefit levels to the potential reduction associated with a variety of policy proposals that would increase eligibility for the program. This paper employs a microsimulation model containing an eligibility and benefits calculator, a participation model, and an optimization algorithm. The data are from the Survey of Income and Program Participation supplemented by the administrative records of the SSI program. The results show that increasing eligibility by relaxing the restrictions of the means tests can be more effective in reducing poverty than raising benefit levels.     

Medicaid Funding for Assisted Living Care: A Five-State Examination

Medicaid waiver programs financing assisted living care are examined in five states to gain insights about program implementation, accomplishments, and challenges. Documents, augmented with stakeholder interviews, are used to describe income eligibility, options for supplementing payments to facilities, risk adjustment payment levels, and participation. Needs determination and waiver-based payments are in place. Eligibility and funding levels are complicated by room and board allocations that are linked to the federal benefit rate for Supplemental Security Income. Provider participation may be diminishing. Many recipients have to accept shared occupancy as program payments are insufficient for single units.     

Options to liberalize Social Security disabled widow(er)s benefits

Each month, 200,000 widows and 6,000 widowers receive Social Security disabled widow(er)s benefits, each benefit averaging about $550. Among the most economically at-risk Social Security beneficiaries, their benefits are permanently reduced. This paper reviews the legislative history of the disabled widow(er)s benefit, identifying key decisions that gave shape to this benefit. Social Security program data and six years of Current Population Survey data (March Annual Demographic Files, 1995-2000) are used to profile the economic status of current and potential disabled widows. The analysis, including comparison with other widows, provides strong evidence of economic need among disabled widows with, for example, 44% of disabled widow beneficiaries, ages 50-59, having below-poverty incomes compared with 15% of like-aged non-disabled widows. We conclude that serious consideration should be given to extending eligibility to all widow(er)s disabled before the normal retirement age; to providing a benefit equal to 100% of the deceased spouse's private insurance amount (PIA); to eliminating the unnecessarily restrictive seven-year rule; and to protecting beneficiaries from losing their eligibility to Medicaid. Even in the context of today's heated Social Security debate, we suggest that a rare opportunity may exist to garner bipartisan support for meaningful, low-cost improvements, in a benefit that primarily targets women.     

Work-site health and fitness programs: Impact on the employee and employer

Physical fitness and health lifestyle habits have been reported to lower the risk of death from disease, foster healthy muscles, joints and bones, and enhance personal function and mental health. Given these benefits, many employers are implementing health and fitness programs into their workplace with the goals of improving and maintaining the health of their employees and increasing worker productivity. However, research is still being conducted to determine if these programs are an effective means of achieving these goals. OBJECTIVE: The purpose of this paper is to investigate the impact of these programs on employee physical and mental health, employee work performance, and the employer. This paper also investigates the effectiveness of the specific program structures and intervention procedures that were used in the employee health and fitness programs that have been implemented. STUDY DESIGN: This paper analyzed 15 previously conducted studies to investigate the impact and design of employee health and fitness programs. RESULTS: The reviewed literature suggests that the incorporation of an employee health and fitness program can have positive effects for both the employee and the employer. Programs that are structured using a variety of physical fitness programs, health education classes, outreach and one on one counseling with follow up contact have proven to be most beneficial in terms of employee and employer satisfaction. CONCLUSION: The implementation of an employee health and fitness program can have positive lasting effects on both the employee and employer. In addition to implementing programs that offer a variety of choices and one on one counseling, employers would benefit from targeting the at-risk population to ensure that the programs benefit the greatest number of employees possible.     

SNAP EXPANSIONS AND PARTICIPATION IN GOVERNMENT SAFETY NET PROGRAMS

This paper investigates the interactions between health and nutritional assistance programs such as Medicaid, SNAP, WIC, and school lunch programs. Exploiting variation in SNAP eligibility across states and over time, I find strong evidence of program interactions: when a state moves from the federal rule to the most extensive SNAP eligibility rule, enrollment in free school lunch and WIC increases by 4.1 and 7.9 percentage points, respectively. I estimate that the federal government spends an additional 74 cents on the school lunch program and WIC for each dollar spent on SNAP due to the expansion. (JEL H53, I38, J22)     

Inclusion of caregiver supports and services in home- and community-based service programs: recent reports from state units on aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services-funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

Inclusion of Caregiver Supports and Services in Home- and Community-Based Service Programs: Recent Reports from State Units on Aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services–funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

Short-Term Home Visiting for Parents

The purpose of this article is to review various aspects of home-visiting programs that have shown to be effective in recent literature to inform policy makers, practitioners, and other involved stakeholders of the current best practices or limitations and to discuss future recommendations based on the literature. Areas of review include intervention design, home-visitor qualifications to fit program design, ongoing staff training and supervision, cultural competency, family-centered approaches, and appropriate intensity and duration through frequent home visiting. Home visiting demonstrates many promising outcomes, as well as challenges, and home-visiting programs would benefit most from more research and more collaboration between programs, service providers, policy makers, and funding sources.     

Welfare Reform and Elderly Immigrants' Naturalization: Access to Public Benefits as an Incentive for Naturalization in the United States

Welfare reform in the United States restricted non‐citizens' eligibility for public assistance programs and strengthened economic benefits from naturalization. We examine the impact of these policy changes on elderly immigrants' naturalization, considering their level of need for public benefits. Using individual data from the Current Population Survey as well as state‐level data, we employ a differences‐in‐differences approach to consider variations in time, state policy, and probability of Medicaid participation. Results show that naturalization significantly increased among elderly immigrants who were likely to participate in Medicaid, suggesting that elderly immigrants in need of Medicaid became naturalized to maintain their eligibility for public benefits after welfare reform.     

A Global Perspective on Social Security Programmes for Disabled People

By the mid-1990s, 163 countries had statutory general disability programmes. Most have adopted social insurance as their primary policy instrument, which restricts coverage to those in paid formal employment, makes benefit eligibility dependent upon the satisfying of specific minimum contribution period requirements and provides earnings-related pensions. Many countries also provide supplementary and special need benefits. Programme funding comes overwhelmingly from employer and employee contributions, with a majority of countries providing government subsidies. Using a methodology that assesses national statutory social security intentions, a ranking of these disability programmes reveals that Australia has the best designed one.     

When self-interest and age sterotypes collide: elders opposing increased funds for programs benefiting themselves

Elders tend to be portrayed by the media as selfishly promoting programs that benefit the old. We predicted, however, that older individuals who choose positive stereotypes about the young over positive stereotypes about the old would oppose an increase in spending on these programs. By analyzing the responses of 1656 individuals, we found: (1) older participants were more likely than younger participants to oppose increased funding of Social Security, Meals on Wheels, and Medicare; and (2) this opposition to increased funding for Social Security and Meals on Wheels was predicted by a stereotype of aging based on a more favorable perception of the capabilities of the young than of the old. Our findings suggest that elders' evaluation of programs that benefit their age group may be more influenced by stereotypes internalized decades earlier than by their current group interests.     

The public library system. Social services resource for the geriatric population

The public library system is targeting the geriatric population and instituting programs to meet informational and recreational needs. From retirement planning, visual aids, and screening, to accessing library material to the elderly, the public library system attempts to meet the challenge of providing service to this special population. Although not a formal group, the library has inherent therapeutic effects that benefit the elderly who participate in their programs. The clinician would be advised to take advantage of these various programs. Because each local and regional center will offer different programs, calling a local library is the most effective way to find out what a specific public library system has to offer. Nurses may also consider joint efforts to initiate programs in their library systems to better meet the population's needs.     

Using Relationship Education Programs with Same-Sex Couples: A Preliminary Evaluation of Program Utility and Needed Modifications

Same-sex couples represent a group likely to benefit from relationship education, given the many unique challenges they face. However, it is unclear whether existing programs, predominantly designed for married heterosexual couples, are appropriate for use with same-sex couples. In this article we highlight the need for quality relationship education programs for same-sex couples and review the literature to identify unique needs of same-sex couples that may not be met by existing programs. We then describe a small survey of couple therapists and researchers conducted to provide preliminary information about whether same-sex couples are perceived to benefit from existing relationship education programs and whether modifications to program content are needed. Twenty respondents indicated that a core set of relationship education components were useful when working with same-sex couples, although the presentation of these components generally required modifications to remove heterosexist bias and to improve applicability to same-sex couples. In addition, several novel program foci were suggested (e.g., stigma management). Implications for the design and delivery of relationship education to same-sex couples are discussed.     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

Recent Developments in Welfare to Work in Hong Kong

Summary

The Asian financial crisis (1997) has created a social care crisis resulting in rising unemployment, poverty, income inequalities and homelessness. Although faced with dwindling public finances, the Hong Kong Special Administrative Region (SAR) government had been compelled to tackle these problems. However, it has been attracted to the neo-liberal recipe: changing the subvention system to a block grant, curbing social spending, and tightening eligibility for social assistance. Notably, the introduction of the Intensive Employment Assistance Projects (IEAPs), which are the first welfare to work programs in East Asia, has become a major policy tool. This paper reports on a study of the impact of the projects, one of the key pillars for welfare to work programs. The IEAPs were found to have brought about positive changes in welfare clients' motivation to work and sense of self-reliance. Social workers from both traditional and progressive NGOs have etched, in various ways, their place in the welfare to work programs and contributed to the debate on welfare reform in Hong Kong.     

Income Mobility and the Earned Income Tax Credit

Households who work full-time at minimum wage jobs earn more than the phasein range of the Earned Income Tax Credit (EITC). This means that the EITC mainly acts as a negative income tax. However, most families are eligible to receive the EITC for a relatively short time. Seventy-four percent of new EITC families will lose their eligibility in two years or less. Sixty-one percent of families already on the EITC will lose their eligibility in three years or less. EITC families are much more mobile than AFDC families. The main reason that families gain or lose EITC eligibility is changes in earnings.     

“There Was No Money Left to Save”: Financial Literacy and the Lives of Low-Income People

Despite the popularity of financial literacy programs intended to benefit low-income families, little research explores how families experience and interpret their own participation in these programs. In-depth interviews with participants in one such program revealed participants’ complex analyses of financial literacy and their own poverty. Their analyses simultaneously affirm and challenge hegemonic ideologies and neoliberal practices and, as such, provide an opportunity for social workers to respond in ways that address not only the immediate financial needs of low-income families but also the structures and ideologies that contribute to those needs.