1
|
Child Only Kinship Care Cases:The Unintended Consequences of TANF Policies for Families Who Have Health Problems and Disabilities. ACTA ACUST UNITED AC 2016; 22:45-64. [PMID: 17855238 DOI: 10.1300/j045v22n03_04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The passage of the Personal Responsibility Work Opportunities Reconciliation Act (PRWORA) in 1996 changed the way America sought to help its most vulnerable citizens. The Temporary Assistance for Needy Families (TANF) legislation required families to work first. Many families with young children found the stringent requirements of TANF too restrictive for their needs. In this study a number of TANF customers were either physically ill or suffered mental health problems thus preventing them from finding suitable employment. Additionally they may have children who have health problems, which preclude the parent from work activity. Faced with time limits these families may rely on relatives or fictive kin to assume the responsibility of receiving TANF grants for the children so that they may avoid sanctions and possible loss of support for their children. These arrangements are called child-only cases. Given that poverty is related to neglect and neglect may result in out of home placement, these children are at risk for child welfare intervention. Child welfare systems look to kin to assume the responsibility of child rearing to reduce the number of children especially African American children who enter care. However, TANF and informal arrangements for kin to take care of children result in substantially less money for families. An evaluation of TANF is needed to determine if this legislation provides an adequate system for caring for needy families and children. doi:10.1300/J045v22n03_04.
Collapse
|
2
|
Safety, permanency, and well-being revisited. CHILD WELFARE 2010; 89:5-8. [PMID: 20945802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
3
|
Early legislative wins for Obama. HEALTHCARE FINANCIAL MANAGEMENT : JOURNAL OF THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION 2009; 63:32-33. [PMID: 19391561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
4
|
Child Support Enforcement program; medical support. Final regulation. FEDERAL REGISTER 2008; 73:42415-42442. [PMID: 18956489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This regulation revises Federal requirements for establishing and enforcing medical support obligations in Child Support Enforcement (CSE) program cases receiving services under title IV-D of the Social Security Act (the Act). The changes: require that all support orders in the IV-D program address medical support; redefine reasonable-cost health insurance; require health insurance to be accessible, as defined by the State; and make conforming changes to the Federal interstate, substantial compliance audit, and State self-assessment requirements.
Collapse
|
5
|
|
6
|
Industry: lay off Medicaid. Restriction directive 'focused on SCHIP,' exec contends. MODERN HEALTHCARE 2008; 38:12. [PMID: 18260534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
7
|
Let the states innovate. New rules on Medicaid, SCHIP eligibility stifle efforts to expand coverage. MODERN HEALTHCARE 2008; 38:24. [PMID: 18260537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
8
|
New year, old issues. The short-term nature of some fixes for healthcare funding passed in 2007 means many provisions will be revisited. MODERN HEALTHCARE 2008; 38:28-32. [PMID: 18260538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
9
|
State children's health insurance: the canary in the coal mine? HEALTH PROGRESS (SAINT LOUIS, MO.) 2008; 89:14-15. [PMID: 18247003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
10
|
Winners and losers. Bill extends SCHIP to '09; docs decry temporary fix. MODERN HEALTHCARE 2007; 37:8-9. [PMID: 18224741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
11
|
SCHIP stalemate. Impasse will keep kids going to ERs for care: industry. MODERN HEALTHCARE 2007; 37:8-9. [PMID: 18203365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
12
|
SCHIP expansion amount unclear. Congress is in the process of re-authorizing legislation. HEALTHCARE EXECUTIVE 2007; 22:44-49. [PMID: 18019352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
13
|
Experts: SCHIP will come in ... but no one's sure what it will look like when it docks. MODERN HEALTHCARE 2007; 37:8-9. [PMID: 18027473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
14
|
A partisan divide deepens. SCHIP debate presages a bitter fight in 2009 on healthcare reform. MODERN HEALTHCARE 2007; 37:23. [PMID: 17972493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
15
|
Washington memo--a stinker for the GOP. TIME 2007; 170:20. [PMID: 17982838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
16
|
Bush veto was the right move. Congress, special interests doomed expanded coverage for poor children. MODERN HEALTHCARE 2007; 37:22. [PMID: 18018376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
17
|
Industry's outcry: save SCHIP. Many sources decry veto as Leavitt talks compromise. MODERN HEALTHCARE 2007; 37:8-9. [PMID: 18027409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
18
|
The Difference Is In the Details. J Am Coll Radiol 2007; 4:577-8. [PMID: 17845957 DOI: 10.1016/j.jacr.2007.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Indexed: 10/22/2022]
|
19
|
Abstract
We used data from the 1996-2005 Medical Expenditure Panel Survey to track changes in children's public insurance eligibility and coverage. During the 2001-2005 "postexpansion" period, eligibility was approximately constant, while public enrollment increased rapidly and uninsurance declined. Nevertheless, as of 2005, 62 percent of all uninsured children (5.5 million) continued to be eligible but not enrolled. We present detailed estimates of their characteristics by age, income, race/ethnicity, health status, and nativity/citizenship. We also examine the impact of potential changes in SCHIP income thresholds--both an expansion and a rollback--and estimate the number and characteristics of the children potentially affected.
Collapse
|
20
|
Dynamics in Medicaid and SCHIP eligibility among children in SCHIP's early years: implications for reauthorization. Health Aff (Millwood) 2007; 26:w598-607. [PMID: 17684031 DOI: 10.1377/hlthaff.26.5.w598] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Two-thirds of children in the United States were income-eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.
Collapse
|
21
|
Two SCHIPs set sail ... but it's rough seas ahead for both bills. MODERN HEALTHCARE 2007; 37:10. [PMID: 17824122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
22
|
Doc-owned hospitals' new hurdle. Fight begins over exclusions, restrictions in SCHIP bill. MODERN HEALTHCARE 2007; 37:8-9. [PMID: 17824121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
23
|
Playing the SCHIP. Bush veto threat has GOP quaking and Dems hoping, but what about the kids? MODERN HEALTHCARE 2007; 37:20. [PMID: 17824148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
24
|
Head to head over SCHIP. Two plans, two chambers--and perhaps one veto. MODERN HEALTHCARE 2007; 37:14. [PMID: 17824003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
25
|
Children And Compartmentalized Coverage. Health Aff (Millwood) 2007; 26:1196-7; author reply 1197. [PMID: 17630464 DOI: 10.1377/hlthaff.26.4.1196-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
26
|
Battle of the estimates. Far fewer kids uninsured, according to HHS study. MODERN HEALTHCARE 2007; 37:40. [PMID: 17622043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
|
27
|
Waiting on SCHIP. Congress mulls array of bills to keep program afloat. MODERN HEALTHCARE 2007; 37:10-1. [PMID: 17612012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
|
28
|
Let's complete the job. SCHIP was meant to end uninsurance among kids, so expansion is needed. MODERN HEALTHCARE 2007; 37:24-5. [PMID: 17479496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
29
|
Return SCHIP to its roots. A program for low-income children should not replace private insurance. MODERN HEALTHCARE 2007; 37:24-5. [PMID: 17477200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
30
|
Building a better SCHIP. Key healthcare leaders back major expansion of a popular program. MODERN HEALTHCARE 2007; 37:22-3. [PMID: 17477199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
31
|
Going to bat for kids. Foundation's request aims at legislature. MODERN HEALTHCARE 2007; 37:7. [PMID: 17477190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
32
|
States hope to build on success. . . while Washington can't agree on what to do with a rare program that works. MODERN HEALTHCARE 2007; 37:20. [PMID: 17477198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
33
|
State Children's Health Insurance Program reauthorization: will it get us closer to universal coverage for America's children? Pediatrics 2007; 119:823-5. [PMID: 17403856 DOI: 10.1542/peds.2007-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
34
|
Congress works to save SCHIP. Hospitals don't want to be targeted to offset new funds. MODERN HEALTHCARE 2007; 37:12. [PMID: 17427626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
|
35
|
Abstract
Before the crucial upcoming debate over reauthorization of the State Children's Health Insurance Program (SCHIP) and all of the 10,000 general health reform questions that this discussion will engender, we should consider one fundamental moral question, for our answer will reveal the kinds of policies we actually want to pursue: Who should be allowed to sit at our health care table of plenty? This essay sketches an answer to this question, drawing on the literature of various faith traditions as well as recent health services research. The short answer is: Everyone, but poor kids have a special place reserved for them.
Collapse
|
36
|
Coping With SCHIP Enrollment Caps: Lessons From Seven States’ Experiences. Health Aff (Millwood) 2007; 26:258-68. [PMID: 17211036 DOI: 10.1377/hlthaff.26.1.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Seven states with separate (as opposed to Medicaid expansion) State Children's Health Insurance Programs (SCHIP) implemented enrollment caps during the 2001-2003 recession. Interviews with SCHIP officials and Covering Kids and Families grantees in these states examined implementation policies and their effects on enrollment, outreach, and public support. Enrollment caps were generally maintained for less than a year and resulted in large spending reductions, but enrollment declined steeply. Most key informants indicated that caps were preferable to reversals of simplified enrollment, comprehensive benefits, and low cost sharing and thus offered policymakers an important tool for controlling costs.
Collapse
|
37
|
SCHIP Reconsidered. Health Aff (Millwood) 2007; 26:w608-17. [PMID: 17698885 DOI: 10.1377/hlthaff.26.5.w608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The reauthorization of the State Children's Health Insurance Program (SCHIP) in Congress offers an opportunity to assess the legislation in light of recent developments in Medicaid and states' health coverage reform efforts. Fundamental child health goals can be achieved while still affording states additional flexibility to invest in populations of all ages.
Collapse
|
38
|
Welfare receipt and substance-abuse treatment among low-income mothers: the impact of welfare reform. Am J Public Health 2006; 96:2024-31. [PMID: 17018836 PMCID: PMC1751816 DOI: 10.2105/ajph.2004.061762] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored changing relations between substance use, welfare receipt, and substance-abuse treatment among low-income mothers before and after welfare reform. METHODS We examined annual data from mothers aged 18 to 49 years in the 1990-2001 National Household Survey of Drug Abuse and the 2002 National Survey of Drug Use and Health. Logistic regression was used to examine determinants of treatment receipt. RESULTS Among low-income, substance-using mothers, the proportion receiving cash assistance declined from 54% in 1996 to 38% in 2001. The decline was much smaller (37% to 31%) among low-income mothers who did not use illicit substances. Low-income, substance-using mothers who received cash assistance were much more likely than other low-income, substance-using mothers to receive treatment services. Among 2002 National Survey of Drug Use and Health respondents deemed "in need" of substance-abuse treatment, welfare recipients were significantly more likely than nonrecipients to receive such services (adjusted odds ratio=2.31; P<.05). Controlling for other factors, welfare receipt was associated with higher prevalence of illicit drug use. Such use declined among both welfare recipients and other mothers between 1990 and 2001. CONCLUSIONS Welfare is a major access point to identify and serve low-income mothers with substance-use disorders, but it reaches a smaller proportion of illicit drug users than it did prereform. Declining welfare receipt among low-income mothers with substance abuse disorders poses a new challenge in serving this population.
Collapse
|
39
|
The impact of state TANF policy decisions on kinship care providers. CHILD WELFARE 2006; 85:715-36. [PMID: 17039826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Based on a survey of public assistance and child welfare agency staff, this article examines how state Temporary Assistance for Needy Families (TANF) policy decisions have affected kinship care providers. Findings indicate that most states have continued using TANF to provide income support to kinship caregivers, and some have used TANF to find related support services. These payments, however, are much lower than rates for licensed providers, and many kinship caregivers are subject to work, training requirements, and time limits.
Collapse
|
40
|
With minimal federal help, community safety nets are straining to care for uninsured immigrants. HOSPITALS & HEALTH NETWORKS 2006; 80:90. [PMID: 16703838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
|
41
|
|
42
|
Governor signs Omnibus Healthcare Bill (HB 4021). THE WEST VIRGINIA MEDICAL JOURNAL 2006; 102:322-9. [PMID: 16706325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
|
43
|
Welfare reform and substance abuse treatment for welfare recipients. ALCOHOL RESEARCH & HEALTH : THE JOURNAL OF THE NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM 2006; 29:63-7. [PMID: 16767856 PMCID: PMC6470907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Abstract
OBJECTIVES We sought to determine if the recent expansions in Medicaid and the State Children's Health Insurance Program (SCHIP) have resulted in a narrowing of income disparities over time with the use of dental care in children 2 to 17 years of age. METHODS Six years of data from the National Health Interview Survey were utilized. A trend analysis was conducted using 1983 as a baseline, which predates the expansions, and 2001-2002, the endpoint, which postdates implementation of the expansions. In addition, we examined two intermediate time points (1989 and 1997-1998). We conducted unadjusted and adjusted analyses using logistic regression. RESULTS Overall, use of ambulatory dental care has increased dramatically for children over the past two decades. In 1983, more than one in three children (38.5%) had no dental care within the previous 12 months. By 2001-2002, about one-quarter of children (26.3%) were reported to have no dental care within the year, a reduction of 12.2% from 1983 (p<0.001). Frequency of unmet dental care remained unchanged between 1997-1998 (the first year this measure was available) and 2001-2002. A reduction in income disparities for use of dental care was found in our unadjusted analysis but this difference became statistically insignificant in the adjusted analysis. No changes in income disparities occurred for unmet dental needs in either the unadjusted or adjusted analyses. CONCLUSIONS A substantial overall improvement in dental care use has occurred among all income groups, including poor and near poor children. This "keeping up" with their higher-income counterparts represents an important public health accomplishment for children in low-income families. Nevertheless, additional efforts are needed to close remaining disparities in access to dental care.
Collapse
|
45
|
"Leavers" from TANF and AFDC: how do they fare economically? SOCIAL WORK 2005; 50:239-49. [PMID: 16152746 DOI: 10.1093/sw/50.3.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Temporary Assistance for Needy Families (TANF), a part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, changed the philosophical ground and rules and regulations that apply to low-income families with children who seek federal income support. TANF recipients have less flexibility in charting their life courses than AFDC recipients had. This article presents the findings of a study that investigated how TANF leavers, in comparison with AFDC leavers, fared economically after they left the cash assistance rolls. The major finding is that the income status of AFDC leavers increased considerably, but that of TANF leavers declined. The authors argue that TANF leavers fared less well economically because their decisions about whether to work, to engage in work-related activities, and to leave cash assistance rolls were under stricter control. The data sources for this study were the 1993 and 1996 Survey of Income and Program Participation.
Collapse
|
46
|
The effect of the State Children's Health Insurance Program on health insurance coverage. JOURNAL OF HEALTH ECONOMICS 2004; 23:1059-1082. [PMID: 15353193 DOI: 10.1016/j.jhealeco.2004.03.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2002] [Accepted: 03/24/2004] [Indexed: 05/24/2023]
Abstract
This paper presents the first national estimates of the effects of the SCHIP expansions on insurance coverage. Using CPS data on insurance coverage during the years 1996-2000, we estimate instrumental variables regressions of insurance coverage. Our regression results imply that 9% of children meeting income eligibility standards for SCHIP gained public insurance. While low, our estimates indicate that states were more successful in enrolling children in SCHIP than they were with prior Medicaid expansions that were focused on children just above the poverty line. Crowd-out of private health insurance was estimated to be nearly 50%, which is in line with estimates for the Medicaid expansions of the early 1990s. In addition, state anti-crowd-out provisions in the form of waiting periods were found to significantly affect both take-up and crowd-out.
Collapse
|
47
|
Abstract
Federal income maintenance programs for people with mental retardation in the United States were described. Combined SSI and DI spending in fiscal year 2000 totaled an estimated $20.6 billion for people with mental retardation. This population is particularly vulnerable to the vagaries of changing public policy and are particularly reliant upon public support. The relative importance of income programs in the lives of people with mental retardation is discussed and the changing role of federal social welfare policy with regard to these programs analyzed.
Collapse
|
48
|
Abstract
PURPOSE To examine the effect of recent federal and state policy changes on adolescents' eligibility and enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP). METHODS By analyzing relevant provisions in federal and state laws, approved state plans and amendments, annual reports and evaluations, and enrollment data provided by states, this article explores the extent to which states have taken full advantage of opportunities to expand Medicaid and SCHIP eligibility for adolescents. RESULTS Between March 1997 and September 2001, states made significant progress toward expanding Medicaid and SCHIP coverage for adolescents. During that time, the number of states that provided Medicaid coverage to all poor adolescents aged younger than 19 years doubled, most states eliminated the disparities that previously existed in Medicaid eligibility levels for younger children and adolescents, and virtually every state raised the income level at which adolescents are eligible for public coverage in either Medicaid or SCHIP. These changes resulted in an increase in the number of adolescents who are enrolled in Medicaid and SCHIP. Nevertheless, many states implemented other policies that create barriers to adolescents' eligibility and enrollment. CONCLUSIONS Despite recent expansions of public insurance eligibility, millions of adolescents remain uninsured. Much work remains to address eligibility gaps and to ensure that eligible adolescents are actually enrolled and use services. The current political and economic environment threatens to undermine the ability of adolescents to access services through these important programs.
Collapse
|
49
|
Abstract
PURPOSE To examine how Medicaid and the State Children's Health Insurance Program (SCHIP) could improve health care access for youth aging out of foster care, a vulnerable population with multiple health concerns. METHODS On the basis of an analysis of state and federal laws, state plans and amendments, and a telephone survey of state officials, this article identifies options in Medicaid and SCHIP for states to provide health insurance coverage for these youth, examines states' use of available options, and highlights other relevant federal health care programs. RESULTS Numerous Medicaid and SCHIP eligibility categories could provide coverage for older adolescents leaving foster care. The federal Foster Care Independence Act of 1999 (FCIA) created a new Medicaid expansion option for this group and other opportunities for states to address their health care needs. Numerous other federal programs also finance health care that could serve this population. CONCLUSIONS The potential exists through Medicaid or SCHIP to ensure that nearly all former foster youth have health insurance as they leave state custody, but Medicaid and SCHIP cannot alone meet all health care needs of these youth. Financing available through other public programs is essential. A few states have adopted the new FCIA Medicaid expansion option for former foster youth, and a larger number have implemented other relevant Medicaid options. Additional states have used other innovative approaches to facilitate health care access. Most states could do much more. A major challenge is to find approaches that can be implemented during times of severe budgetary limitations.
Collapse
|
50
|
Abstract
PURPOSE To assess the availability of public and private financing sources to support comprehensive school mental health programs. The paper focuses on "expanded school mental health" (ESMH) programs, which provide a full array of mental health promotion and intervention services to youth in general and special education through school-community partnerships. METHODS A range of strategies to fund ESMH services are reviewed, including fee-for-service funding, as well as grants, contracts, and other mechanisms from federal, state, local, and private sources. RESULTS An objective national study of the characteristics and financing of ESMH programs has yet to be conducted. Existing evidence suggests that funding for these programs is patchy and tenuous. Many programs are being funded through fee-for-service programs, which generally only support the provision of more intensive services (e.g., assessment, therapy) and are associated with significant bureaucracy and other concerns (e.g., the need to diagnose students). As programs move to enhance funding for preventive and mental health-promoting activities and services, there is an increasing need for grants, contracts, and other sources of support. CONCLUSION Progress in the national movement toward ESMH will be promoted through an interconnected agenda of quality improvement, evaluation of program effectiveness, and the advancement of advocacy. These developments will facilitate policy improvements and increased funding for the full continuum of mental health promotion and intervention in the schools.
Collapse
|