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If a program participant refuses work requirements, states have the option to reduce or eliminate assistance to the whole family. This could include the loss of Medicaid. The exception to this provision is when the participant refuses work because they cannot find or afford child care for a child under six years old. Another important feature of TANF concerns minor parents. In addition, these minors must attend high school or an alternative educational or training program as soon as their child is twelve weeks old.

The program assists poor people aged 65 or older as well as blind people and people with disabilities. Forty-one states and the District of Columbia offer general assistance, although in some states, only certain counties provide assistance. Some states also impose time limits on all or certain categories of their general assistance caseload. That is, under this welfare reform legislation, states can opt to limit aid to vouchers or services.

These features of the new approach to public assistance present a threat to the social work principle of self-determination, because they provide less flexibility to caseworkers and clients in the use of welfare assistance. However, there are potential negative ramifications to this aspect of the law as well. TANF funds spent on other services could result in less basic subsistence support to poor families.

Under the legislation, TANF can be administered and distributed by private nonprofit or for-profit entities.

The Nineteenth Century

What are the possible outcomes if this takes place in certain states? On the positive side, competition for TANF contracts may reduce costs to states. In addition, service delivery by less bureaucratic organizations than government may improve service quality. The former federal law regarding public assistance was very specific in guaranteeing clients the right to appeal decisions against them.

The legislation, however, is more general on this issue. States must submit their own plans, which may vary considerably in the protection of client rights. A final issue regards the ability of states to deny cash assistance and Medicaid to adults who do not meet work requirements. In such cases, which sectors of society are responsible for providing the safety net?

Will we revert to the colonial system of church-administered relief? Welfare reform got its major push from city and state government.

Social problems: Who makes them?

A primary example was New York City. New York experienced a fiscal crisis in As a result, many features of TANF, including time limits and teen parent restrictions, had already been implemented at the state level when the federal legislation was enacted. The federal government supports a number of health services for the poor, including services for war veterans, Native Americans, women and children.

Medicare and Medicaid, however, are the two major public health care programs in the United States. Social security recipients, railroad retirees, federal and state government employees, in addition to some people with kidney disease or a permanent disability are eligible for Medicare. Medicare is the second largest domestic program, second only to the social security program. The program is funded by a payroll tax paid by employers and employees.

Part A is basic hospital insurance.

It covers most costs of hospitalization, post-hospital extended care, and home health services. Part B is an optional supplementary medical insurance. The second major public health program, Medicaid, is basically a federal grant to states. Federal regulations specify the basic health services that must be offered under Medicaid.

Yet, services are primarily administered by individual states including decisions regarding the duration of services and optional services. However, the most Medicaid dollars go to people who are blind or have other disabilities. Furthermore, most Medicaid spending on older Americans is for nursing home care. Millions of Americans, of course, obtain private health insurance through their employer. Unless they are experiencing an emergency, those needing medical attention usually see their primary care physician first.

Social Problems And Social Legislation - Suresh Murugan - Google книги

If needed, the primary care physician will then make a referral for more specialized services. Thus, the primary care physician serves as a gatekeeper in managing health care services and costs.

Social Policy: Crash Course Government and Politics #49

In most managed care models, health care is provided to a defined number of enrollees in the health care plan. The HMO or other managed care entity, therefore, receives a fixed dollar amount per enrollee per month. Consequently, the services of physicians and hospitals participating in the managed care system become cost-centers that need to be managed to stay within the contracted budget. The aim is to create an incentive to keep people well i. The fundamental problem with managed health care is the conflict between the goals of high quality and low costs.

Since the emergence of managed care, many issues related to this fundamental problem have come to the attention of consumers, social workers, and policymakers. In addition, patients were faced with predetermined service cut-off dates. Women giving birth, for example, were given hospital stay limits based on cost considerations. Patients also perceived policies regarding the use of specialists to be arbitrary and not necessarily based on patient need. A more recent issue is the effect that managed care might have on urban community service systems — including public hospitals and public health clinics frequently used by Medicaid patients.

18 - Social status and social legislation

To illustrate, from to, Medicaid managed care enrollment in the U. Underlying this trend is the assumption that competition for managed care contracts will increase the supply of health care providers in low-income communities. Without generous capitation payments, this may never happen. Furthermore, managed care companies may leave out certain community-based organizations that serve the poor from their service provider networks. These organizations often are in poor financial condition, have outdated management information systems, and utilize decaying facilities and equipment.

In short, they are relatively costly to a managed care organization. These organizations historically have provided service with an emphasis on individual need in contrast to other criteria such as ability-to-pay or profit. In any case, they are inexperienced in competing for clients in a managed care system.

For these traditional service providers, the emergence of managed care may result in significant losses of revenue and ability to serve uninsured clients. Added to all of this is the prospect of state government contracting with managed care organizations to administer SSI and TANF programs. Yet, it is a trend with many key issues to be addressed by policy planners, social workers, and other health and human service providers. The federal government provides food to poor Americans through a variety of programs. Public, private nonprofit, and private for-profit organizations all cooperate in the provision of these programs.

For example, child nutrition programs including the school lunch program reach out to poor children in schools, childcare centers, and summer camps. These benefits are adjusted yearly in accordance with changes in food prices generally. Although states administer their food stamp programs, the federal government pays for the direct costs of food stamps and a portion of state administrative expenses. With very few exceptions, all recipients of public assistance are eligible for food stamps.

Exceptions include most postsecondary school students! People participating in the food stamp program receive a monthly allotment of stamps. These stamps can then be used to purchase food at most retail stores. Stamps can not be used to purchase alcohol or tobacco products. In recent years, consistent with the push for welfare reform in general, work requirements have been attached to food stamps. The welfare reform legislation passed by the Clinton Administration limits able-bodied recipients between the ages of 18 and 50 without children to three months of food stamps in a three-year period unless the person is working or engaged in a workfare program for 20 or more hours per week.

The federal government assists many middle- and upper-income families with housing through its tax policies and loan programs. Our national government also collaborates with local public and private entities to provide housing assistance to low-income individuals and families. The public housing program, dating back to the New Deal era, provides federal subsidies for construction costs on housing units built by local public housing authorities.

During the Reagan, Bush, and Clinton Administrations, federal funding for public housing was cut drastically. One reason for this diminishing support is the tendency of public housing projects to concentrate multi-problem families into low-income neighborhoods. Increasingly, this approach has witnessed a high incidence of crime and vandalism, resulting in relatively high operating costs for local public housing authorities and high social costs for victimized families.

These problems, along with rising construction costs, compelled policy planners to look for alternative low-income housing proposals.


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The Section 8 program referring to Section 8 of the Housing and Community Development Act emerged in the s as the major alternative to public housing. To illustrate, in , the U. Section 8 is essentially a rent supplement program. In contrast to public housing, tenants have a choice of using their subsidy in publicly or privately owned housing where available in their community. The Housing Act, passed by the George H.