D-4740. Federal Financial Participation Assistance Payments.—The State may claim Federal financial participation for medical assistance for any otherwise eligible person who is determined to be blind in accordance with the approved plån for medical assistance. Blindness may be considered as continuing until an examination by a qualified examiner establishes the fact that the recipient's vision has improved beyond the State's definition of blindness. In cases where blindness is being overcome, Federal financial participation may be claimed during a specified temporary recovery and adjustment period, as defined in the State's policies and procedures. Administrative Expenses.—Any expenditures incident to the eye examination necessary to determine who is a blind individual may be considered an administrative expense of the agency. D-4800 PERMANENT AND TOTAL DISABILITY, JUNE 17, 1966 D-4800. Permanent and Total Disability D-4810. Provisions of the Act Section 1902 (a) of the Social Security Act reads as follows: “A State plan for medical assistance must— . “(4) provide such methods of administration . as are found by the Secretary to be necessary for the proper and efficient operation of the plan ;" D-4820. Requirements for State Plan A State plan for medical assistance must: 1. Contain a definition of permanently and totally disabled, showing that: a. Permanently is related to the duration of the impairment or combination of impairments; and b. Totally is related to the degree of disability. 2. Provide for the review of each medical report form and social history by technically competent persons-not less than a physician and a social worker qualified by professional training and pertinent experience acting cooperatively, who are responsible for the agency's decision that the applicant does or does not meet the State's definition of permanent and total disability. D 4830. Criteria for the Administration of the Plan 1. State agency policies and procedures contain a definition of permanently and totally disabled, which is applicable for all categorically needy and medically needy permanently and totally disabled. The Federal definition of permanent and total disability is some permanent physical or mental impairment, disease or loss, or combination thereof, that substantially precludes the individual from engaging in useful occupations within his competence, such as holding a job or homemaking. If the State's definition is not as broad as the recommended Federal definitions, the one used in title XIV or XVI is used for tittle XIX. 2. Uniform procedures, including the following, are used in determining whether an individual is permanently and totally disabled: a. A signed and dated current medical examination report form from an approved examiner is used for each application and reexamination, a copy of which is available in the State agency. The medical findings are adequate to determine whether or not the individual is permanently disabled, according to the State's definition. b. Except for the completely helpless, a corresponding social history is developed, adequate to determine whether or not the individual is totally disabled according to the State's definition. c. The review physician is responsible for setting dates of reexamination and, with other team members, for reviewing reexamination reports in conjunction with social data, to determine whether disabled recipients whose health conditions may improve, continue to meet the State's definition of permanent and total disability. D-4840. Federal Financial Participation Assistant Payments.-The State may claim Federal financial participation for medical assistance for any otherwise eligible person who is determined to be permanently and totally disabled in accordance with the approved plan for medical assistance, and within the Federal definition. Permanent and total disability may be considered as continuing until the review team establishes the fact that the recipient's disability is no longer wihin the State's definition of permanent and total disability. In cases where this disability is being overcome, Federal financial participation may be claimed during a specified temporary recovery and adjustment period, as defined in the State's policies and procedures. Administrative Expenses.—Any expenditures incident to the medical examination necessary to determine who is a permanently and totally disabled individual may be considered an administrative expense of the agency. Mrs. GRIFFITHS. Yes. Mr. HAWKINS. It is a fairly detailed description of what a State may do. Now they are not uniform in all States. Mrs. GRIFFITHS. No, they are not uniform. For instance-I believe that Delaware's is visual acuity of 20/200 or less and/or a limitation of the visual field at 20 degrees or less in the better eye with corrections. In the District of Columbia it is central visual acuity of 20/200 or less in the better eye with correcting lenses, or peripheral field loss in which visual field efficiency reduced to 30 percent or less or certain other ocular conditions which constitute severe visual handicaps. Mr. VENEMAN. Do you have also in that document, Mrs. Griffiths, what our basic requirements are? Mrs. GRIFFITHS. No, I don't. Mr. HAWKINS. I believe, Mrs. Griffiths, that all but two States use the 20-over-200 central visual acuity. There are different peripheral visions, and the States of Pennsylvania and Missouri have, or have had until recently at least, lower, more restrictive definitions of central visual acuity. One, I believe, was 5/200ths, and the other was 10/200ths. Mrs. GRIFFITHS. In applying the limitation on how much a family can have in the way of resources and still be eligible for assistance, the bill says that the Secretary is to decide when a family can keep income-producing property and when they have to sell the property. What is your present thinking on how these regulations might work? Mr. VENEMAN. I think that there has to be a certain amount of individual attention given to these kinds of cases where you are involved in income-producing property. For example, if you just said all income-producing property has to be disposed of before you are eligible, then, of course, you could probably take away a very small investment on the part of some aged couple who had a small house in the back of their lot that they were renting out. Mrs. GRIFFITHS. If you let it go individual-case-by-individual-case you are going to end up in the situation of the appeal now to the Supreme Court on murder. Mr. VENEMAN. On what? Mrs. GRIFFITHS. On murder, that is, you pick out the people you want to execute and you let the others off. So you can't really let it go individual-case-by-individual-case. You have to have some guidelines. Mr. VENEMAN. I believe we have some discrepancy in that area at the present time under the present Code, don't we? 36-662 0-70-pt. 1-20 Mr. HAWKINS. Income-producing property is now a matter handled according to State plan, and there are various provisions in the individual State plans on it. Mrs. GRIFFITHS. Which State plan are you going to adopt? Mr. HAWKINS. I am not sure it would be any existing State plan. There are limitations. Here there is a uniform amount of $1,500 of property that one can have plus home, household goods, personal effects, and the items which the Secretary finds actually contribute to employability. Now, certainly there would have to be regulations on that score written. Mrs. GRIFFITHS. Mr. Secretary, as I read the welfare bill, it would be possible for a State to get out of the welfare business. It could put up its share of any supplemental payments to families and its share payments to adult recipients and turn it all over to the Federal Government. It would also be possible for the State to then withdraw from the social-services part of the program for families and thereby avoid having anything to do with the programs, the things which were designed to help people get off welfare or never come on. If this happens, isn't the welfare problem merely going to get worse rather than better with the Federal Government bearing the resulting full burden? of Mr. VENEMAN. No, I think if this should happen-I can't conceive very many states getting out of the social services or the other provisions of the Social Security Act and that includes public assistance. But I think the same thing occurs when a vacuum is created; somebody else moves in, and presumably the next level of government, being the Federal Government would provide for the services that would have to go along with the assistance payments. Mrs. GRIFFITHS. Then you anticipate that, while you suggest today that the cost of this bill is $4 billion, it could grow tremendously because we take over additional services under welfare. Is that right? Mr. VENEMAN. As I say, I don't conceive of that happening. I think Mr. Patricelli has a comment. Mr. LANDRUM. Would you yield? Mrs. GRIFFITHS. Yes. Mr. LANDRUM. At the time the President disclosed this program to the Nation, there followed immediately on national television a group of persons evaluating that program. Among them was Mr. Finch's predecessor, who said at that time that the estimated cost of $4 billion was about one-third of what it would reasonably cost. He thought it would cost about $14 billion. Would you think that that would be more like the cost of the program? Mr. VENEMAN. No; I do not, Mr. Landrum. I am not sure just whom Mr. Cohen uses for his actuaries at this particular point. Mr. LANDRUM. You recall that he said that, though? Mr. VENEMAN. I feel that the basis upon which these figures were developed, and, if you recall from the Secretary's testimony yesterday morning, they were not done solely by Health, Education, and Welfare Mr. LANDRUM. If the gentlewoman would continue to yield for a moment, you do recall that Mr. Cohen, former Secretary, said that following the program? Mr. VENEMAN. What Mr. Cohen said was that he was talking about a reasonable program which would be an all-inclusive guaranteed annual income program, and that is about the figure that we talk about when we talk about putting a guaranteed annual income up to the poverty level. It is about $14 billion. Mr. LANDRUM. A very substantial part of this proposal Mr. VENEMAN. We are not suggesting that. Mr. LANDRUM (continuing). Has been advocated by Mr. Cohen. Isn't that true? Mr. VENEMAN. The concept, I think, has been advocated by previous administrations. Mrs. GRIFFITHS. What percentage of the money that is paid out now for child care goes to babysitters? Mr. VENEMAN. What percentage of the child care money goes to babysitters? Mrs. GRIFFITHS. Yes. Mr. VENEMAN. Mr. Sugarman, I think, can answer that. Mrs. GRIFFITHS. And how much is it actually? How much money is being paid for babysitters? Mr. VENEMAN. Mr. Jule Sugarman, the Acting Chief of the Children's Bureau and Office of Child Development, will answer that. Mr. SUGARMAN. I believe, Mrs. Griffiths, that the most relevant figures would be those under the work-incentive program. During fiscal 1969, when that program was just beginning, there were about $4.7 million spent for child care. Of that amount we believe that about 60 percent was spent for child care outside the home and about 40 percent for inhome care. Inhome care would largely be babysitting care. Mrs. GRIFFITHS. How much has it gone up? Mr. SUGARMAN. Well, that would all be net additional expenditures over the prior fiscal year, because WIN was a new program in that year. Mrs. GRIFFITHS. Can you pick out any one State and show this committee month-by-month how the baby care cost has gone up? Mr. SUGARMAN. Yes; we could. Mrs. GRIFFITHS. Will you supply it for the record? Mr. SUGARMAN. I would be happy to. I would say that as a general picture that most States began their child care programs with inhome or babysitting care and have only recently begun to move toward group care or family day care. (The information to be supplied follows:) MONTH-BY-MONTH EXPENDITURE FOR CHILD CARE UNDER THE WIN PROGRAM IN THE STATE OF MARYLAND Month Total expenditure Total children served $12,238 (85 percent Federal-15 percent State). (The following information was also supplied for the record:) STANDARDS AND COSTS FOR DAY CARE NOTES A. This analysis is divided into three parts representing distinct types of day care situations: (1) Care in a center for the full day; (2) Care in a foster home for the full day; and (3) Care in a center before and after school and during the summer. There are many possible variations in the use of those three types, but most commonly, group one is used for children 3-6, group two for children under three and group three for children of school age (up to 14). B. Costs can vary enormously depending on the areas of the country being served. For example, Federal agencies report a range of $1,000 to $1,900 for the same type of program in various parts of the nation. These variations reflect difference in salary and cost levels as well as differences in the kinds of services generally available to a child (e.g., the existence or non-existence of a Medicaid program). In the analysis most of the costs are based on Head Start experience with day care programs of the group one type. It should be remembered that Head Start programs generally have 10-20% of their costs covered by nonFederal contributions which may or may not be available to Social Security Day Care programs. C. The analysis projects standards at three different levels of quality: (1) minimum, (2) acceptable and (3) desirable. "Minimum" is defined as the level essential to maintaining the health and safety of the child, but with relatively little attention to his developmental needs. "Acceptable" is defined to include a basic program of developmental activities as well as providing minimum custodial care. "Desirable" is defined to include the full range of general and specialized developmental activities suitable to individualized development. Individual experts will differ as to the elements required for each level of quality. Most experts feel that the disadvantages to children of a "minimum" level program far outweigh the advantages of having the mother work. Some will feel that for children from "disadvantaged" homes only the "desirable" level is appropriate. The figures shown represent a consensus among a number of experts of what would be required at each level of quality. D. The costs shown are potentially reducible by the availability of free space or transportation and by the availability of services such as medical care through other funding sources. Fees paid by the parents will also reduce costs. Under the Social Security legislation, 25% of the cost is provided through state funds so the Federal cost in net may be 60-70% of the totals shown. |