PART I.

PROVISIONS FOR MEDICAL AND REMEDIAL CARE TO RECIPIENTS OF OAA, AB, APTD, (OR AABD), AND AFDC
Explanation of Items and Definitions of Terms

The information presented in Part I covers provisions of
State plans for medical care in the basic public assist-
ance programs which receive Federal financial participa-
tion. They are Old-Age Assistance (OAA), Aid to the
Blind (AB), Aid to the Permanently and Totally Disabled
(APTD) or Aid to the Aged, Blind, or Disabled in a sin-
gle category (AABD) as permitted by a 1962 amendment to
the Social Security Act, and Aid to Families with De-
pendent Children (AFDC). The program of Medical Assist-
ance for the Aged which was authorized by amendment to
the Social Security Act in October 1960 is covered in
Part II of this publication.

Data for each State, contained on a pair of facing pages, should be read in the context of the eligibility requirements presented in the Characteristics of State Public Assistance Plans: General Provisions, which this publication complements. In general, only a person who is eligible for payments to meet subsistence needs from one of the categorical assistance programs, as defined in the State's level of need, is eligible for medical and remedial care. In a few States, eligibility is extended to include a person who meets all the other eligibility requirements of the program category under which he applies and, although he is not in need of aid for subsistence, is in need of aid to meet costs of necessary medical care which his income and resources are not sufficient to pay for.

Definition of Medical and Remedial Care

,

The definition of medical care used in the Handbook of Public Assistance Administration, Part IV, is: "... medical, surgical, dental, and nursing services in the home office, hospital, clinic, or other suitable place, provided or prescribed by persons authorized by State law to give such services; such services to include drugs and medical supplies, appliances, laboratory, diagnostic and therapeutic services, nursing home and convalescent care, and such other medical services and supplies as "Remedial care is may be prescribed by such persons.

described in the Social Security Act as "any type of remedial care recognized by State law."

All medical and remedial goods and services included in the State's public assistance plan are reported, whether the cost is covered in the money payment to the recipient (for subsistence needs as well as such special needs as medical care) or paid in his behalf to the supplier of such services or goods. The report excludes "medicine chest supplies", which usually is a basic item in assistance standards and refers primarily to household remedies sold without prescription.

In addition to the services and goods which the agency recognizes as medical needs or assumes as a public assistance responsibility within one of the assistance categories, information is given about the specific State resources for certain types of medical care and health services which are actually available to meet an area of need of recipients of Federally aided public assistance and which, for this reason, are not included by the State agency in defining the scope and content of the medical care responsibility of a particular public assistance plan. Such information is recorded as a footnote to the related medical service and placed at the end of the State page. Excluded are the services generally available throughout the United States, such as the usual immunization and preventive programs of State Health Departments, State services for mentally ill and mentally deficient, and tuberculosis control programs. Explanation of Individual Items on the State Page

1.

Section A. General Description of Public Assistance Programs

Administration of Federal-State public assistance programs: a brief description of the basic administrative pattern of the State agency and the source of funds (State, local) for financing the program; information as to whether State also has an MAA program.

2. Provision of medical care as a part of public assistance: date of beginning vendor payment provisions, if any; method of handling vendor payments; maximums on the money payment to recipient, if any, where medical care is paid for through the money payment; State's definition of scope of medical and remedial care to be provided; extent to which the full responsibility of the law is implemented in the State plan provisions; general pattern of applicability of medical care provisions in relation to the categories; whether the State makes payment for medical services rendered in any period prior to date of application for any program or makes payment in behalf of a patient (OAA or AABD) in a general medical institution as a result of a diagnosis of tuberculosis or psychosis for any period of time, not to exceed 42 days, after the making of such diagnosis.

Section B. Content and Scope of Medical and Remedial Care

3. Services provided: five major components of medical care services are listed - a. Hospital care (inpatient), b. Nursing home care, c. Practitioners' services, d. Dental care, e. Pharmaceutical services and in sub-item f. "All other care" is grouped the other goods and services enumerated in the State's report.

For each major kind of service and for services under
"other care", the entry includes assistance categories
for which the service is provided, specified limitations
on extent or nature of services, restrictions on cost or
frequency, whether State-wide fee schedules have been
developed and with what collaboration, and method of
making payment together with any limitations inherent in
the money payment if that method is used. No attempt is
made to present here in full the administrative controls
a State uses for a given service, or to give the techni-
cal details of a service.

The following statements explain the terms used in the
different groupings:

a. Hospital care (inpatient)-the term "general services" includes items covered by charges of the hospital, usually room and board, operating room, laboratory services, X-rays, medicines, supplies, and staff services.

b. Nursing home care-nursing or convalescent home (including hospital solely for the chronically ill) licensed as such by the State, which is operated in connection with a hospital or has medical and nursing policies established by professional personnel, including one or more physicians. Entry includes any limitations on conditions for which care is given, degrees of nursing care, limit on length of stay, and any maximums on payments, rates, or amount to be budgeted.

Practitioners' services-the term "all practitioners" includes: medical doctor, osteopath, dentist, optometrist, podiatrist (chiropodist), chiropractor, and Christian Science Practitioner. Specialists are encompassed in the term "medical doctor". Statements are included to indicate location in which service is given (home, office, hospital, and outpatient clinic), applicable usually to medical doctor and osteopath.

d. Dental care-the term "general services" includes: fillings, extractions, X-rays, dentures, denture repair, and orthodontia. Circumstances governing treatment, frequency of service, types of conditions covered, and method of setting rate of payment are briefly mentioned.

Pharmaceutical services "The preparation and dispensing of drugs as prescribed by legally authorized medical practitioners and the furnishing of drugs which may be supplied lawfully without a prescription." Includes limitations such as drugs specifically provided, drugs excluded, stipulations about illnesses for which medicines will be provided, or any maximums on cost.

f. All other care-areas of service included under this heading are sick-room supplies (such as bedpans, urinals, unusual supplies of bandages); special nursing services (1) "in medical institutions" such as special duty nurse in addition to regular staff of hospital or nursing home; (2) "not in medical institution" using individual registered nurse, licensed practical nurse, home health aide services in support of a continuing medical treatment plan provided under the direction of a physician or a medical agency, or using organized services such as visiting nurse associations and public health nurses; "home health care" as a coordinated home care program

offering in a single package, under direction of a physician, "all the services needed for restoring the patient in his own home to a level of self-care or selfsupport, and for maintaining him at the highest possible level of health"; restorative services including physical therapy, occupational therapy, and speech therapy; preventive medical services such as diagnostic "screening" examinations and immunizations not otherwise available; X-rays for diagnosis and treatment; prosthetic appliances, including hearing aids, eyeglasses, artificial limbs, and braces; transportation to secure medical or remedial care by ambulance or other means; and equipment such as wheel chairs, hospital-type beds, and "walkers". The entry includes any amount the State may allow as a standard budgetary allowance in the money payment for "medical care" (not related to a specific kind of medical service) and any provision for an allowance in the money payment for the cost of premiums for an individually held policy of health or hospital insur

ance.

4.

Section C.

Eligibility for Medical and Remedial Care

5. Application of income: State's policy on application of income and available resources of applicant/recipient to the needs to be met through the money payment and the needs to be met through the vendor payment, or any special treatment given certain resources such as contributions of relatives or friends for the specific purpose of medical care.

Section D.

Administration of Medical

and Remedial Care

6. Medical direction: medical and medical-social work
staff directly involved in administration and direction
of medical care, identifying also the presence of a sep-
arate "medical services" division or unit. (Does not in-
clude staff serving solely on State Review Team for
eligibility determination in the APTD program.)

7. State and local advisory groups: whether such groups
exist; components, function, frequency of meetings; ex-
tent to which local medical advisory groups are used.
8. Inter-organizational agreements and relationships:
agencies or organizations furnishing medical or remedial
care to public assistance recipients without payment
from public assistance funds; whether formal or informal
interagency agreements have been made with such agencies
or working relationships established.

9. Method of making payments to suppliers of medical goods and services: which of the following methods is used by the State "pooled fund", payments to fiscal agents of suppliers, payment to individual suppliers or to organizations of suppliers, group prepayment arrangements with insurance companies or organizations of suppliers; and whether payment is made by the local or by the State agency. The entry also includes the basis for determining the amount of any premium paid into a "pooled fund" or to an organization of suppliers on a group prepayment basis.

10.

sources of revenue for non-Federal share of assistance and administrative costs; proportion between State and local funds, if any, according to programs; significant differences between funds for money payment and funds for vendor payments; flexibility in transfer of funds between programs or between money payment funds and vendor payment funds; expedients which could or would be used by a State if funds were found to be insufficient to meet State's share of vendor payment costs.

State-local financing of costs:

MEDICAL AND REMEDIAL CARE FOR RECIPIENTS OF OLD-AGE ASSISTANCE, AID TO THE BLIND, AID TO THE PERMANENTLY AND TOTALLY DISABLED, AND AID TO FAMILIES WITH DEPENDENT CHILDREN

State Department of Pensions and Security

April 30, 1964

A. General Description of Public Assistance Programs

ALABAMA

OAA, AB, APTD, and AFDC are administered by the 67 county departments of pensions and security under the supervision of the State Department of Pensions and Security. State pays all the non-Federal share of assistance and administrative costs. (Medical Assistance for the Aged is also administered by this agency. See Part II.)

Federal financial participation in vendor payments for nursing home care in OAA began in late 1960 and in 1961 was extended to AB, APTD, and AFDC. Also in 1961, hospital care for OAA was added. The State law (1951) is broadly permissive of payments in behalf of a recipient for needed medical care; limitation of the present program is the result of lack of funds. No provisions for vendor payment in AFDC except nursing home care for adults.* In OAA, payments may be made for a patient in a medical institution after a diagnosis of tuberculosis or psychosis for a maximum of 30 days within a fiscal year.

QAA: Acute illness, acute complications of chronic conditions, and major injury; elective cataract surgery or diagnosed cancer if treatment unavailable from other source; all necessary services; up to 30 days per fiscal year. Rates based on per diem cost developed with participating hospitals by State Health Department. Vendor payment.

OAA, AB, APTD, AFDC adults: Only when needed care cannot be secured in own home or home of another person. Maximum vendor payment in licensed nursing home $125, licensed skilled nursing home, $175. Maximum rates budgeted are $200 and $250 respectively.

OAA: Medical doctor or osteopath; post-hospital care of conditions related to hospitalization, within 30 days following hospitalization; office, home, or nursing home visits. Includes X-rays, electrocardiograms, and blood examinations. Vendor payment.

Not provided. Not provided.

OAA, AB, APTD, AFDC: Nursing care in own home; money payment, budgeting up to $100 a month for such service within the State maximums on total payment (OAA, APTD, $75; AB, $70; AFDC, $32 for 1 child plus $23 for each additional child up to $124 family maximum).