[Mailgram] NEON, INC., South Norwalk, Conn., June 11, 1976. Hon. STEWART B. MCKINNEY, DEAR CONGRESSMAN MCKINNEY: Thank you for your letter of May 28, 1976 which referred to the referenced amendment to Title XX of the Social Security Act. This office reviewed your comments on the proposal and solicited action by the Neon, Inc., board of directors at its regular meeting of June 9, 1976. The Neon, Inc., board voted to endorse H.R. 12175 and to encourage your support of the proposed measure. From what we have seen of the cumbersome regulations which were promulgated at the Federal level we are pleased to see only measure made toward the relaxation of or limiting those criteria which are now in effect. We are concerned however, that this is currently being considered. Another amendment to the bill which would restrict funds earmarked for higher education, tuition reimbursement, and specialized training for social service delivery personnel. We have been informed that the assistance subcommittee may be considering a ceiling on spending in this area. Neon, Inc., and several other social service agencies in Fairfield County have encouraged our personnel to return to college so that we can insure that the quality of service which we provide can be maintained and the Community Action Agencies can someday be considered a "professional" in the human services field. We have encouraged our colleagues to communicate with Mr. Martin of the Ways and Means Committee and expect we can provide some insight into this matter. Thank you once again for your interest in Community Action and for the opportunity to express our concerns regarding this legislation. FREDERICK P. FALCONE, Deputy. [Telegram] JOHN M. MARTIN, Jr., Esq., Chief Counsel, Committee on Ways and Means, UNIVERSITY OF NEW HAVEN, New Haven, Conn., June 11, 1976. We would like to officially register our opposition to bill H.R. 12175 propos ing a ceiling on funds for Title 20 of Social Security Act. Funds as presently available are vital for improvement of training needs of social service employees of Connecticut. PHILLIP KAPLAN, President. STATEMENT OF HAROLD H. PINKNEY, CHAIRMAN, NEW YORK CITY RESIDENT ADVISORY COUNCIL The New York City Resident Advisory Council (RAC) is the official tenant association advising the New York City Public Housing Authority on policies and programs. Some 600,000 persons live in public housing in N.Y.C., of whom more than 50.000 are aged 65 and over. Inflation, particularly the rising costs of energy has led to a reduction in social services provided by the N.Y.C. Housing Authority. The fiscal crisis facing N.Y.C. has led to further reductions in social services funded out of welfare, commu. nity development, aging and related Federal/State/local funds. Social service programs are desperately needed by public housing tenants, particularly the elderly. RAC supports the concept of 100 percent Federal Block grant funds for social service programs funded under Title XX of the Social Security Act. RAC also recommends that: 1. Thirty-three percent of all Title XX funds be earmarked for services for the elderly. The elderly have not received a fair share of existing Title XX funds, and therefore earmarking of elderly funds is necessary. 2. Non-profit organizations, especially community groups and organizations, be given every opportunity to participate in planning and operating Title XX programs. STATEMENT OF PLANNED PARENTHOOD FEDERATION OF AMERICA, INC. The Planned Parenthood Federation appreciates the opportunity to submit, at the request of the Public Assistance Subcommittee, this statement on proposed changes to the Title XX social services program embodied in the Administration's block grant proposal, H.R. 12175, and the House and Senate versions of H.R. 12455. Although we are opposed, generally, to the block grant proposal, and indeed to any major revamping of a program so recently revised by Congress, we believe there are several legislative changes which would facilitate full implementation of the Title XX program. Most of the suggested changes outlined below are contained in various pieces of legislation which have been introduced during the past year to amend Title XX. Legislation to amend Title XX should: (1) Leave unchanged the eligibility provisions of P.L. 93-647 regarding the targeting of social services to lower income groups, but include a provision which would permit services to be provided on a group eligibility basis without requir ing a formal declaration of income in cases where the state may reasonably conclude that most of the persons receiving the services have incomes below the 115 percent of the state's median income. Reinstatement of the legislative authority for group eligibility would provide relief to problems faced by senior citizens centers as well as other groups and greatly simplify and cut down on administrative costs. We believe the states should be allowed to provide services on a group eligibility basis when there is good reason to believe that the group falls within the income guidelines of the program and that the cost of administering individual determinations is prohibitively high in relation to the actual cost of providing services. (2) Include provisions which would assure that family planning services are provided on a strictly confidential basis and that all applicants for and recipients of family planning services be considered eligible for such services on an individual rather than family basis. (3) Provide for the reallotment of unused federal funds for social services, in any fiscal year, to states whose regular allotments of such funds are insufficient to meet their needs. Analysis of Title XX services plans for the first program period indicates that approximately $70 million under the $2.5 billion social services ceiling were not expected to be expended during FY 1976. Under present law, with the exception of $16 million to be reallotted to Puerto Rico, Guam and the Virgin Islands, this $70 million would be lost to the program. (4) Include the day care provisions of the Senate amendments to H.R. 12455 which extend the suspension of day care staffing standards until October 1, 1977 and provide $250 million annually to support improvements in current day care services. (5) Raise the overall ceiling on social services expenditures which has been in effect since 1973 to at least reflect increases in the cost of living. (6) Include the provisions contained in the Senate version of H.R. 12455 which make permanent certain changes in Title XX relating to services for alcoholics and drug addicts including requirements regarding confidentiality, determination of integrality of medical services and funding of seven-day detoxification periods. FAMILY PLANNING UNDER TITLE XX The Social Security Act now requires that family planning services (including medical services and supplies) be "offered" on a voluntary basis, and "provided promptly" to all AFDC recipients and other eligible individuals including "minors who can be considered to be sexually active." The Social Security Amendments of 1972 provided 90 percent federal matching for family planning services, a preferential rate to the 75 percent match available for other services, and established a one percent penalty to be levied upon the states in cases of nonperformance. Congress, in overhauling the social services program in 1974, retained these various provisions. Family planning is thus a major program priority and the only specifically required service under the Title XX program. As a result, all the states are now offering family planning and referring clients for family planning services, as needed. Much more importantly, they are beginning to assume responsibility for purchasing medical family planning services on behalf of eligible individuals. Although progress has been very slow, and very uneven, since 1967, the states have been spurred to action recently by the various Congressional incentives. The first round of Title XX plans indicated that more than 40 states intended to purchase at least some medical family planning services in their initial program year (up from 10 states in 1972 and 27 states in 1975 under Title IV-A). These Title XX funds represent a significant portion of total funds available to family planning providers nationwide, and at the same time they amount to only about two percent of the total Title XX budget. PROBLEMS WITH H.R. 12175 AND H.R. 12455 Because of the progress made to date under Title XX, largely as a result of the 1972 and 1974 amendments, we cannot support the Administration's block grant proposal which would not only remove the family planning incentive now supplied by the preferential 90 percent federal matching rate, but would remove all service priorities from the program and require that no less than 75 percent of federal expenditures be used for services for welfare recipients and other individuals with incomes below the poverty level. This last provision would be especially detrimental to the provision of family planning services under the Social Security Act because of the unique funding arrangement established by the 1972 Social Security Amendments. At that time Congress not only provided a 90 percent matching rate for the provision of family planning services under Title IV-A but also extended the 90 percent matching rate to the provision of family planning under the Medicaid program. This legislative action makes the most appropriate funding arrangement to be one where eligible current welfare recipients receive family planning through Medicaid funding and other individuals with higher incomes receive services through Title IV-A, or now, Title XX. If the major portion of the funds were restricted to current welfare recipients and similarly low income people, the congressional incentive to maximally utilize both Medicaid and IV-A/XX funds for family planning services would be lost. H.R. 12455 as amended by the Senate Finance committee does not, in our opinion, adequately resolve the eligibility problem; it merely hands the problem over to the states. Furthermore, because of the limitation on funds available under Title XX and the social desirability of targeting services to those in our society who need them the most but at the same time have the least access to assistance, the elimination of all federal eligibility standards does not seem appropriate. The Planned Parenthood Federation along with other members of the Social Services Coalition has recommended to the conferees on H.R. 12455 that the Senate withdraw its eligibility amendments and retain the provisions of the current law, which restrict free services to individuals with incomes below 80 percent of the median, partially subsidized services to individuals with incomes below 115 percent of the median, and require that 50 percent of federal funds be used for services to AFDC, SSI or Medicaid recipients. CONFIDENTIAL DELIVERY OF FAMILY PLANNING SERVICES We recognize that two major problems, eligibility requirements and day care staffing standards, have plagued the Title XX program during its implementation, and we appreciate the attempts being made legislatively to correct them. The eligibility determination crisis, which has had a devastating impact on the provision of family planing services, was created by a requirement in DHEW's Title XX regulations that documentation of family income be obtained for individual eligibility determinations. Although regulation changes published on April 2, which allow the states to use a self-declaration of family income instead of documentation if they so choose, have eased the crisis somewhat, the discreet delivery of confidential services such as family planning is still not guaranteed. Even when states elect a simple declaration of income as the basis for eligibility, the problems with the provision of confidential services to teenagers and certain other individuals, who do not know or cannot obtain family income information, still remain. In order to avoid violation of patient confidentiality in the delivery of family planning services, we recommend that Section 402 (a) (15) of Title IV-A be amended to state that "all persons voluntarily requesting family planning services will receive them on a strictly confidential basis, and no sampling or auditing procedures which would violate this strict confidence will be applied to the delivery of family planning services." Although DHEW revised the definition of "family" in the April 2 regulations, most minors and virtually all married women are still not recognized as onemember families. This, in turn, means that they must either declare or demonstrate the income of other members of the family thereby facing the disclosure to others of private activities and the "consent" in effect of other family members, be they parents or husbands. This policy is clearly invalid legally, in the light of a May 24, 1976 Supreme Court decision affirming a three-judge U.S. district court which ruled that Utah welfare regulations which required parental consent for family planning services were unlawful under the Social Security Act. The Court held that by imposing a special condition (parental consent) on the provision of services to "minors who can be considered to be sexually active," Utah had acted "impermissibly" and in conflict with Titles IV-A, XIX and XX of the Act. The Court noted that "by requiring the furnishing of services to individuals, rather than to families, the Act evinces a congressional intention that the services be furnished to the individual at his or her own request, without regard to the possibility conflicting desires of a parent or spouse." It would therefore appear that obtaining family income information from a parent in order to receive family planning services would constitute a request for consent to obtain those services and thus would violate the intent of the Act. We would urge, therefore, that a provision be added to the law (perhaps to Section 402 (a) (15) of Title IV-A) clarifying this issue so that, with regard to family planning services, all applicants and/or recipients shall be considered as onemember families. In summary, we urge the Public Assistance Subcommittee to reject the Administration's block grant proposal but to adopt provisions aimed at simplifying eligibility determination and lowering administrative costs, and increasing funding available to States in line with demand, needs and inflation. Lastly, we urge the committee to clarify certain sections of the law so as to best carry out the intent of Congress in regard to family planning services. PLANNED PARENTHOOD LEAGUE OF CONNECTICUT, INC., STEWART B. MCKINNEY, M.C., SOUTHERN FAIRFIELD CHAPTER, South Norwalk, Conn., June 10, 1976. DEAR STEWART: Thank you very much for alerting me to the hearings on the Administration's Block Grant proposal for Title XX of the Social Security Act (H.R. 12175). Find enclosed a reprint of the Planned Parenthood Washington memo concerning the Administration's Block Grant proposal, which I assume you have probably already read. The Planned Parenthood League of Ct. and myself as the Southern Fairfield Chapter Director supports the enclosed and could add very little to it. Again, I appreciate your soliciting my comments, and also forwarding same to John M. Martin, Jr., Esq., Chief Counsel, Committee on Ways and Means. Sincerely, RUTH NEALE, [From Planned Parenthood Washington Memo, May 7, 1976] FAMILY PLANNING FORUM OPPOSES BLOCK GRANT PROPOSAL FOR HEALTH FUNDING Over 300 representatives of family planning agencies and programs met in Washington on April 26 to 28 for the fourth annual meeting of the National Family Planning Forum. The Forum heard meetings from Rep. Yvonne Brathwaite Burke (D-Calif.) and a briefing on congressional processes from a member of her staff a presentation by Dr. Louis M. Hellman, the new Administrator of the Health Services Administration who still retain his post as Deputy Assistant Secretary for Population Affairs; remarks from Carol T. Foreman. Executive Director of the Consumer Federation of America: and a major address at the close of the meeting by the Under Secretary of DHEW, Marjorie Lynch. Ms. Lynch discussed the President's viewpoint on the "present collection of narrow, categorical funding programs" and his new (or old) proposals for block grant programs. She argued that they "will provide flexible dollar grants to help states. cities and local agencies to do the job more effectively and close to home," and "the block grant program will enable states to design programs which truly fit the needs and the priorities of their people." The Forum membership appeared to believe otherwise, however. Among the resolutions adopted on the last day was a statement strongly opposing the President's proposal: "The National Family Planning Forum, as an organization representing providers of family planning services across the country, is alarmed by the proposals made by the President and DHEW to convert a number of categorical programs into block grants to the states. The block grant proposal would result in a decrease in the federal funds available to all categorical programs involved. By eliminating state matching requirements, it would almost certainly lower the commitment of state funds as well. It would eliminate most federal controls over the direction of expenditures by the states, in spite of the fact that, at least in the case of family planning, such direction has proved both fruitful and necessary. With a few conspicuous exceptions, the states have put little priority on family planning on their own, as demonstrated by the level (or the absence) of specific appropriations for these services or the general inadequacy of planning and administrative mechanisms. As individuals and organizations, we believe that the proposal would be injurious to the health and welfare of American families, detrimental to the rights of women and counterproductive to the interests of the taxpayers. "It has been amply demonstrated that there are substantial benefits to be derived from the provision of family planning services for the health of women and children, and indeed the whole family. Family spacing and planning is instrumental in the reduction of infant mortality and morbidity, material mortality and morbidity, the birth of low-weight infants. mental retardation and birth defects. These benefits are universal, regardless of place of residence, and, therefore, should be equally available in all states under federal mandate. In addition, the constitutional right of parents to "bear or beget a child" is universal and should not be conditioned by the accident of one's temporary or permanent geographical location in the United States. Parenthood creates special demands on women, and the ability to control fertility is so central to their health, well-being and capacity for achievement that the provision of the services essential to fertility control cannot be left to the discretion of the individual states. It cannot be argued, furthermore, that allowing states to set their individual priorities results in benefits to society at large. Certainly, if states were to place inadequate prority on the provision of family planning services, unwanted births would occur as a result to women who would have to resort to public assistance. The increased cost of their support, and that of their children, would have to be assumed not only by the taxpayers of these states but by the rest of the nation as well. "Our intimate experience in planning and programming at the local level does not lead us to believe, as the Administration insists, that block grants would bring about an improved process of decision-making more reflective of local needs. A recent study by the Government Accounting Office (GAO) on 'How States Plan For and Use Federal Formula Grant Funds to Provide Health Services' noted that 'the idea behind Federal formula grant programs . . is that State and local governments are more aware of their needs than the Federal Government and should be permitted to decide, broadly, how to spend the Federal funds.' But, GAO noted, the states studied 'had not established adequate plans to provide for health services nor accumulated data needed to establish priority funding areas and to measure program results. . . . As a result, the extent to which the grants were used to accomplish the . . . formula grant program objectives was not known.' GAO continued, 'For the most part, States had allocated funds to specific health programs based primarily on tradition and administrative convenience. The same programs were continued yearly with little management review. As a result, health services programs were fragmented and poorly managed.' "The National Family Planning Forum urges the President, the Secretary of DHEW and all appropriate officials to review and abandon a proposal which we believe to be well intentioned but which would result in a lesser availability of family planning services than is now the case and would sharpen the geographical differences in distribution of services. We believe that our government should view, as its goal, the universal availability of family planning services to all who need or want them without regard to creed, race, religion, age, marital status-and place of residence." |