a condition for the approval of the State old-age assistance plan that the State establish or designate a State agency which would be responsible for maintaining standards of health and safety in housing rented to recipients of old-age assistance. This provision, which would become effective in 1966, would provide an essential safeguard for the living arrangements of a highly vulnerable group in the population, the needy aged.

The Federal law providing grants to States for old-age assistance permits the States to have residence requirements as long as 5 years out of the last 9 years before application. In order to alleviate individual hardship, and to help reduce costly administrative procedures, this bill would gradually reduce the maximum residence requirement a State may impose. By January 1, 1968, the maximum would be not more than 3 years out of the last 9, and as of January 1, 1970, not more than 1 year.

Lastly, there are persons receiving old-age assistance who, because of a physical or mental condition, are in need of protection in the use of their payment. While they may not be so handicapped as to be in need of legal guardianship, they require some services in managing their money. Such persons are apt to lose their assistance checks or be subject to exploitation by unscrupulous persons. The bill would permit States, that have made a determination that a needy individual is unable to manage funds because of his physical or mental condition, to make payments with Federal financial participation to a third person concerned with the recipient's welfare. The bill contains safeguards relating to the determination of the need for protective payments, provisions for periodic review of the recipient's circumstances, and a right to appeal the determination that he is unable to handle his money.

Comparable changes would also be made in title XVI of the Social Security Act which authorizes grants to the States for aid to the aged, blind, or disabled (including medical assistance for the aged).

The Bureau of the Budget advises that enactment of this proposed legislation would be in accord with the program of the President. Sincerely,

ANTHONY J. CELEBREZZE,

Secretary.

SPEECH MADE ON APRIL 24, 1963, BY SENATOR GEORGE A. SMATHERS INTRODUCING "THE SENIOR CITIZENS PUBLIC WELFARE AMENDMENTS OF 1963" (S. 1358)

Mr. President, I introduce for appropriate reference a bill entitled "The Senior Citizens Public Welfare Amendments of 1963."

This bill has as its purpose a number of important improvements in provisions in titles I and XVI of the Social Security Act, which deal with our Federal-State programs of old-age assistance.

Section 2 of the bill would require States to provide medical protection for old-age assistance recipients which would be at least equal to that provided those in the new medical category established pursuant to the Kerr-Mills Act.

Section 3 would eliminate the 42-day limitation for medical care in a general hospital for a person suffering from mental illness or tuberculosis.

Section 4 would provide that as a condition for receiving Federal grants for old-age assistance, a State's plan must establish and maintain standards of health and safety for housing rendered to recipients of this program.

Section 5 would provide that the maximum period of residence which may be required for eligibility under old-age assistance programs be gradually reduced to 1 year by 1970.

Section 6 would provide that protective payments under old-age assistance may be made to a third party in behalf of the needy recipient comparable to provisions adopted last year for dependent children.

Of the 172 million persons aged 65 and over in this country today, somewhat less than 1 in 7 or about 214 million receive old-age assistance payments.

These payments are made on the basis of individual need and these 214 million aged are accordingly the neediest among our senior citizens. About half of them are over age 76. About one-third of them are 80 or over. A large majority of them are women. Many of them are widows whose husbands died before they were able to qualify for old-age and survivors insurance benefits.

To a somewhat greater degree than the aged generally, they live in rural areas or small towns.

A considerable number of them, or approximately three-quarters of a million-receive modest social security benefits usually at or near the minimum. Many have high medical expenses which increase their needs. About 30 percent of these individuals are in nursing homes, institutions, confined to their own homes, or need the help of another person in getting about. Nearly 1 in 10 is in a nursing home or institution.

MEDICAL ASSISTANCE TO THE NEEDY

There are a number of specific improvements that can and should be made in the provisions of the Social Security Act concerned with old-age assistance, all of which have been recommended by the President.

Two and one-half years ago, the Congress enacted a new program of medical assistance for the aged, generally referred to as the KerrMills Act. This program is now in operation in just over half of the States. In a few States, six-Tennessee, California, Connecticut, Idaho, Michigan, and South Carolina-medical assistance under the new program is more generous in amount, scope or duration than the assistance that is available for medical care of the very neediest oldage assistance recipients. It seems poor policy for us to provide less in the way of medical care to persons on old-age assistance, who require help with their day-to-day living expenses than we provide to the recipients of medical assistance for the aged, who have enough resources to meet their regular expenses other than their medical bills.

To cure this defect, section 2 of the proposed legislation would require that by July 1, 1965, States have provisions for at least the same scope of medical assistance to the persons eligible to receive oldage assistance as they provide to the persons who receive only medical assistance for the aged. The effective date-2 years hence would give the States that may be in this situation time to work out any existing differences.

AID FOR THE TUBERCULAR AND MENTALLY ILL

Another provision of the bill is directed toward aged persons who are mentally ill or who have tuberculosis. In 1960, recognizing the trend toward more care of mentally ill persons in general hospitals where needed treatment could sometimes be effected in a relatively short time in the individual's home community, the Congress provided that in both old-age assistance and in the new program of medical assistance for the aged, the Federal Government would participate for up to 42 days in public assistance payments for medical care of recipients who are mentally ill or tuberculous in general hospitals.

Two problems have arisen in relation to this 1960 provision. One is that the 42-day period is a short one in relation to certain individuals.

The second is that the administrative burden of keeping track of individuals to determine exactly when the 42d day ends and the 43d day begins is unduly time consuming and has acted as a deterrent to States taking advantage of this provision. The Congress can at very small cost eliminate the 42-day time limitation on such care in general hospitals. This would be done by section 3 of the proposed legislation. Since no State is required to take any legislative action under this provision, it would become effective July 1, 1963, as an additional resource to State public welfare programs. The provision would be applicable to medical assistance for the aged as well as oldage assistance. This section would amend the old-age assistance provisions by deleting, as of July 1, 1963, the existing limitation which precludes Federal participation in cash payments to individuals who are tuberculous or mentally ill in general hospitals.

BETTER HOUSING FOR THE AGED

The studies and hearings of our Special Committee on Aging have shown that many aged persons are especially subject to various types of exploitation. One aspect of this problem is that many old-age assistance recipients live in housing that does not meet even the barest minimum of health and safety.

Studies have shown that the needy aged frequently must pay exorbitant rentals for grossly substandard quarters. Census data indicate that among households headed by a person age 65 or older who live in rental housing nearly 40 percent are in quarters that are classified as substandard.

The rental costs represent a major segment of our payments of oldage assistance despite the fact that, a large proportion of our aged own their own homes, including many of the needy aged who receive oldage assistance.

It is estimated that one-half billion dollars a year-about onefourth of the $2 billion total expenditure for old-age assistancegoes to pay rent.

Clearly the time has come when States and localities must come to grips with this basic problem. The bill does not propose to tell States how to set standards or who in the State government should administer those standards.

The bill would simply require that by July 1, 1966, the States establish or designate some agency to establish and maintain standards of health and safety for the quarters which recipients of old-age assistance rent. This would give the States very broad latitude in providing realistic protection for aged renters and sufficient time in which to get their provisions into operation.

LIBERALIZING RESIDENCE REQUIREMENTS

It is estimated that one person in five in the United States moves each year. Substantial numbers move across State lines. Aged persons almost certainly do not move as often as younger workers. However, many aged persons may need to change their State residence in order to be near relatives who can offer care and companionship.

At present a State may impose a residence requirement for old-age assistance as long as 5 years out of the preceding 9. Today there are 20 States that impose this maximum requirement permitted under the Federal law. They are: Alaska, Arizona, California, Colorado, District of Columbia, Florida, Indiana, Iowa, Kansas, Louisiana, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, Oklahoma, Oregon, Texas, and Washington. The Governor's conference several years ago recommended that this be reduced to 1 year. The proposed legislation would reduce the present 5-year limitation to 3 years, beginning in 1968, and to 1 year immediately preceding application, beginning in 1970. This time span would permit States to make any necessary adjustments. With the continued decline in the oldage assistance caseload the cost of this humanitarian step would be minimal.

PROTECTIVE PAYMENTS FOR THE AGED

As I indicated earlier, there are among our aged on old-age assistance substantial numbers of persons who are very old and feeble. These persons, while not mentally ill, are often forgetful. Some tend to lose things, some are subject to exploitation by unscrupulous persons. Some of these individuals live with children or relatives. Ôthers live in nursing homes or institutions. By and large they do not need formal legal guardianship. However, they do frequently need help in managing money.

Under existing law we can make money payments to a recipient or his legal guardian. We can make payments directly to doctors, hospitals, or other suppliers of medical care, but we cannot make payments to a third person to help a feeble senior citizen.

Section 6 of the bill would make provision, with appropriate safeguards, for protective payments made to a third person in behalf of an old-age assistance recipient.

Last year the Congress enacted a provision for protective payments in aid to families with dependent children. While the need among the aged arises for somewhat different reasons, I am convinced that this provision will serve a highly useful and humane purpose.

Throughout the bill corresponding changes have been made in the new title XVI of the Social Security Act which the Congress enacted last year permitting those States that choose to, to have combined program for the aged, blind, and disabled so that aged persons under the combined program would receive the advantages of the provisions of the bill.

Mr. President, I consider that this bill would make possible a number of modest, positive noncontroversial steps which would improve the situation of some of our neediest senior citizens. I believe that it is worthy of prompt consideration and early enactment by the Congress.

The cost of the amendments which I have proposed here is negligible.

[S. 1358, 88th Cong., 1st sess.]

Mr. SMATHERS introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL To improve the public assistance provisions of titles I and XVI of the Social Security Act, relating to aged individuals, and for other purposes

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Senior Citizens Public Welfare Amendments of 1963".

MEDICAL CARE UNDER OLD-AGE ASSISTANCE AND MEDICAL ASSISTANCE FOR THE AGED

SEC. 2. (a) Section 2(a) (11) of the Social Security Act is amended by striking out "and" at the end of clause (D), by striking out the period at the end of clause (E) and inserting in lieu thereof "; and", and by adding after clause (E) the following new clause:

"(F) (i) provide that the services and care for which payment may be made as medical assistance for the aged under the plan shall not be greater in amount, duration, or scope than the old-age assistance