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Federal Programs
This booklet is one of a series
Information and Assistance
which describes federal re-
Social Services
Project
sources to assist develop-
mentally disabled people.
Other topics in the series in-
clude: Orientation to the
Governmental Process,
Income Maintenance,
Housing Development
Programs, Intermediate Care
Facilities, Planning for Action,
and Developmental Disabilities
DRAFT
DRAFT
TITLE XX AND THE DEVELOPMENTALLY DISABLED
By: Mark Litvin
A training module to
provide an understanding
of the Title XX - Social
Services program. Impor-
tant issues for the devel-
opmentally disabled are
highlighted.
Federal Programs Information and Assistance Project
1522 K Street, N.W.
Suite 1030
Washington, D.C. 20005
Phone: (202) 785-1507
Mark E. Litvin, Project Director
Funded in part by Developmental Disabilities Office,
Project of National Significance (54-P71180/6-02)
DRAFT
DRAFT
Table of Contents
I.
Statement of Objectives
1
II.
History and Background
2
III.
Goals and Services
3
Clustered Services
13
Purchase of Services
15
Integral and Subordinate Services
16
IV.
Eligibility
21
Low Income Category
21
Need Alone Category
22
Income Maintenance Category
22
Other Considerations
22
V.
Planning
29
State Plan
29
Comprehensive Annual Services Program Plan (CASP)
30
Plan Content
31
Public Participation
32
Time Schedule
33
VI.
Funding
35
VII. Relationship With Other Programs
43
VIII. Answer Sheets
47
SOCIAL SERVICES MODULE
INDEX
I
Statement of Objectives
1
II A Brief History of the Social Security Act and the Development
of Title XX
2
1. Most important sources of federal assistance to programs
serving mentally retarded persons
3
2. Explanation of original federal social services legislation
4
3. Birth and development of Title XX
5
a. revision of national welfare program to emphasize "social
services"
5
b. increase of matching rate of Federal Financial Participa-
tion
5
C. rapid increases of FFP in 1971-72
6
d. Ceiling on FFP initiated by Congress in 1972
6
e. states demanded clearer guidelines for using social
services in 1973-74
6
f. initial proposal for Title XX - 1974
5
g. Enactment of Title XX - 1975
6
III Goals and Services of Title XX
11
1. Universal Services
12
2. Definition - Clustered Services
15
3. Purchase of Services
15
4. Integral and Subordinate Services
16
Worksheet #1
19
IV
Eligibility
1. Low Income Category
21
2. Need Alone Category
22
3. Income Maintenance Category
22
4. Other Considerations
22
a. "fifty percent rule"
22
b. FY 1976 - 77 eligibility changes
24
C. trend in 1977
26
Worksheet #2
28
29
V Planning
1. Requirements for state participation
29
2. State Plan
29
3. Criteria for administration and supervision of Title XX
29
4. Comprehensive Annual Services Program Plan (CASP)
30
a. plan content
30
b. planning cycle
31
C. needs assessment activity
32
35
VI Funding
1. 1975 - new FFP program
35
2. P.L. 94-401
35
3. Sources of state's share of funding
36
4. FFP not available for certain expenditures
37
5. 1976-77 summary of Title XX planned expenditures
39
Worksheet #4
40
41
Summary
Relationship with other programs
43
44
References
47
Worksheet Answers
List of Tables
1. Most Important Sources of Federal Assistance to Programs
Serving Mentally Retarded Persons
3
2. A Sampling of Potential Services
12
3. Potential Target Groups for Clusters of Services
14
Statement of Objectives
The overall objective of this module is to provide the reader with
a basic understanding of Title XX of the Social Security Act. This module
is intended to familiarize the reader with this major federal-state social
service program with a particular emphasis on its potential for providing
services for developmentally disabled persons.
To aid in the accomplishment of the major objectives, this module is
divided into the following sections: History and Background; Goals and
Services; Eligibility and Application Process; Planning; Funding; and Rela-
tionship to Other Programs. Each section contains some questions for review
and guidance. The answers to the questions are found at the end of the module.
2
History and Background
In late 1974, the United States Congress passed its version of a
modern-day social service program for individuals and families. The
program is funded at the Federal level under the public assistance
section of the Social Security Act of 1935 as amended and is matched
by state and local funds. Known as Title XX, it is likely to be the last
fundamental re-ordering of federal social service legislation to be passed
for many years.
The significance of social service funds for developmental disabilities
groups is reflected in a recent study (Nathan, 1976). Specifically, a nationwide
survey was conducted to gather information about current patterns and trends
in state services for mentally retarded children and adults. The insti-
gator and sponsor of this study was the President's Committee on Mental Retar-
dation, and the subjects surveyed were state mental retardation service coordina-
tors. One question these coordinators were asked was to indicate the three most
important sources of Federal assistance in descending order of importance. The
results are summarized in Table I.
One can easily ascertain from this table the significance of Federally
supported social service/public assistance programs for the developmentally
disabled.
3
Table I
Most Important Sources of Federal Assistance to Programs
Serving Mentally Retarded Persons
Ranked by Number of States
Federal Program
First
Second
Third
Unranked
Social Service
22
9
4
15
Medicaid
17
12
6
15
SSI
0
5
6
40
Developmental Disabilities
2
6
11
31
Vocational Rehabilitation
2
3
4
41
Title I, E.S.E.A.
3
9
12
27
Other
1
3
2
44
(From: Nathan, 1976, p. 35)
The original Federal social services legislation was Title IV
(Grants to States for Aid and Services to Children and Families) and
Title VI (Grants to States for Services to the Adult Aged, Blind or
Disabled). Both Titles strongly emphasized social services for public
assistance recipients. They furthermore encouraged states to provide
social services exclusively to this group by requiring that a minimum
4
of 90% of the Federal funds be used for them and only 10% be used for
non-public assistance recipients. However, the law did stipulate that
there were six specific target groups that could be served without
affecting a state's 90/10 ratio. The "mentally retarded" were one of these
six
special
groups
listed.
Congressional floor debate, as recorded
in the Congressional Record of October 12 and 13, 1972, indicated that there was
some strong intent that the term "mental retardation" include the devel-
opmentally disabled (Ross, 1972).
As a result of discovering this and other unique features in the
Titles IV and VI legislation, advocacy groups for the developmentally
disabled took the initiative and approached state public assistance/social
service agencies with proposals for social service programs for the
developmentally disabled. In many instances, these groups were willing and
able to provide the non-Federal matching funds needed, thereby eliminating
any expenditure by the state public assistance/social service agency.
An abrupt change in the social service/public assistance legislation
occurred, however, when advocates for the developmentally disabled were just
becoming aware of how to use these funds. Specifically, Title XX, which
eliminated the feature of special target groups such as the mentally
retarded, replaced the social services provision of Title IV-A (Aid to
Families of Dependent Children) and all of Title VI, both of which had included
the retarded as a special target group. This bill was signed by President
Ford on January 4, 1975 and became Public Law 93-647.
Title XX (Public Law 93-647), which created a new social service program
for public assistance recipients and other low and moderate income families
and individuals, is the focus of this module. This module is intended to
familiarize the reader with this major piece of social service legislation
in terms of its historical background, goals and services, eligibility
5
requirements, and funding and planning considerations.
Title XX, the Federally funded social services program, can be
traced back to 1962 when the national welfare program was revised to
emphasize "social services". In signing the legislation which implemented
this shift in program emphasis, President John F. Kennedy issued the
following statement (cited in Kadushin, 1974)
This measure embodies a new approach stressing services in
addition to support, rehabilitation instead of relief, and
training for useful work instead of prolonged dependency.
This important legislation will assist our state and local
public welfare agencies to redirect the incentives and
services they offer to needy families and children and to
aged disabled people. Our objective is to prevent or
reduce dependency and to encourage self-care and self-
support; to maintain family life where it is adequate and
to restore it where it is deficient
Public welfare, in
short, must be more than a salvage operation picking up the
debris of human life. (p. 160)
One of the significant features of the 1962 amendments was the
mandate to initiate services to prevent or reduce dependency
of former and potential welfare recipients. In addition, these amend-
ments increased the matching rate or Federal financial participation (FFP)
rate from 50% to 75% of the cost of providing those self-care and self-
support services. Finally, there was no limit placed on total amount of
Federal dollars to be made available.
For several years, the information surrounding these funds remained
within the domain of public welfare departments. Program growth was slow
and constrained, and very limited demands were made for the open-ended
75% Federal financial participation. In fact, the major use of the
funds was for salaries of public welfare social services workers. By
1971-72, however, this situation began to change rapidly.
6
Citizens and groups outside of the public welfare agencies began
to recognize several significant features of the social services funds
and programs. For example, services to prevent and reduce dependency
were virtually undefined, and almost any type of program could be con-
strued as preventing or reducing dependency. There was no maintenance
of state fiscal effort provision, and services already being provided
could be refinanced with 75% Federal funds. Services could be purchased from
private providers and did not have to be delivered by public welfare staff;
almost anyone could be construed as a "potential" welfare recipient. The
non-Federal 25% did not have to be state funds appropriated to the public
welfare agency but rather could be provided by private non-profit agencies
or by funds appropriated to other agencies.
The consequence of this recognition by non-public welfare agencies
was that, whereas in 1971 the Federal financial participation (FFP) under
this program was $750 million, by 1972 this amount had increased to
$1.7 billion. It was then estimated that annual Federal expenditures
would next jump to $4.8 billion. This rapid increase in Federal spending
was of such magnitude that many people warned of the most extensive
raid on the Federal treasury in modern times.
As a result of this uncontrolled surge for the Federal dollar and concern
for re-financing of previously state funded programs, Congress, in October
1972, shifted from unlimited Federal matching of state expenditures to a
ceiling of $2.5 billion of FFP. In addition, this legislation required that
90% of a state's service expenditures be spent on current welfare recipients,
with only 10% of the funds allowed for former and potential cash assistance
recipients except for six exempt service categories (foster care, drug abuse,
7
alcoholism, mental retardation, family planning and child care). The
definition of former and potential recipients was also drastically
reduced by sebsequent regulation. At the same time, DHEW began to re-
strict program expansion by promulgating constricting rules and regu-
lations and by unleashing teams of program and fiscal auditors upon the
states.
The years 1973 and 1974 were marked with turmoil and ambiguity.
Relationships between the states and DHEW became extremely strained as
the call for a reform of the national social program came from
all quarters. Most parties agreed that a new law and not just new
regulations was necessary to resolve this issue.
Interested legislators and a coalition, which came to be known
as the Social Service Coalition, began to work on a bill that would give the
states more flexibility and clearer guidelines to use the social services
funds. Proposed legislation evolved from this effort, and many people,
particularly state public welfare administrators, felt that it was the answer
and threw their support behind it. However, primarily because of opposition
from DHEW, this legislation stalled in committee. Work continued, and in the
early spring of 1974, DHEW presented its proposal for a solution to the
social services dilemma to representatives of governors on the Human Resources
Committee on the National Governor's Conference. Out of this Conference grew
the initial proposal of Title XX. Although changed and redrafted several times
before ultimate passage, this original proposal set a new tone and offered
some unique\ alternatives which eventually found their way into Title XX.
A new Title XX social services program within the Social Security
Act had been introduced in the House and the Senate in October of
1974. The House passed its version without amendment on December 9. The
8
Senate Finance Committee reported a Bill out of committee on December 14
after striking all the House-passed language on social services and sub-
stituting three items from which had passed the Senate on November 30, 1973. The
three transferred items included social services amendments (Part D, H.R. 3153),
a child support program, and a work bonus for low income families, The Senate
passed its version of H.R. 17045 on December 17, 1974, adding two floor amend-
ments related to social services. On December 19, 1974, conferees dropped the
work bonus provision, modified the child support program, and agreed to changes
in the social services amendments passed by the House under H.R. 17045.
Although, I have signed H.R. 17045, I am pleased with most of
its provisions, but concerned about others. The provisions
concerning the Federal-State partnership program for social
services successfully concludes many long months of negotia-
tions among the Congress; the Department of Health, Education,
and Welfare; governors; state administrators; and spokesmen
for producers and consumers. Ending a long impasse, the
efforts of all exemplify my call for communication, coopera-
tion, conciliation and compromise when I assumed the office
of President. (White House Press Release, January 4, 1975).
With that statement, President Ford signed into law H.R. 17045
(PL (#-647) on January 4, 1975. This Act amended the Social Security
Act by creating Title XX. It also brought an ena to Title VI (Social
Services to Adults), and the social services provisions of Title IV-A
(Aid to Families of Dependent Children). The enactment of Title XX was
significant to the states in that it theoretically:
--Provides for an expansion of possible services offered and
numbers of individuals to be served;
9
--Places full accountability for planning and administering the
program at the state level;
--Requires the development of new planning, financial management,
and reporting practices at the state level; and
--Provides for accountability to the citizens of states through
a public planning process.
In summary, a flurry of Congressional activities culminated several
years of negotiations and compromise that had surrounded the provision
of social services funded, in part, by the Social Security Act,. Since
its passage, several people and organizations have claimed at least
partial authorship and responsibility for Title XX. Most are valid claims,
for Title XX was born out of a long struggle, and literally hundreds of
people and organizations were directly involved. The four major groups who
participated in its development and shaping were the Human Resources -
Committee of the National Governor's Conference, the National Council of
State Public Welfare Administrators of the American Public Welfare Associa-
tion, the Department of Health, Education and Welfare, and the Social Service
Coalition. The National Association for Retarded Citizens and United Cerebral
Palsy Association, Inc. were active members of the Social Services Coalition and
spent a great deal of time and effort representing the interests of the devel-
opmentally disabled in the Title XX development process.
Before discussing the Title XX program in depth, it may be helpful to
review its philosophical bases. Title XX rests on the premises that (Ross, 1976) :
1) Government has an obligation to assist society's most vulnerable
people to attain the highest possible level of independent living
of which they are capable; Further, that the reduction of dependency
also represents a saving of public funds otherwise required for
institutional and income maintenance support.
10
2) Assistance in improving individual and family functioning involves
a variety of services which can best be provided by a combination
of public and private agencies, all determined at the state and
local levels, and not prescribed federally.
3) The priority for public social services funds should be on those
people with low income and that as an individual's income status
improves he or she should contribute more to the cost of the
services received through the payment fees;
4) Social service funds should not be used to substitute for
established state or federal support in other primary human service
areas, such as, state institutions, public education, basic health
care and cash assistance;
5) Outside of these restricted areas, the choice and scope of services
should be left to the states, with specific encouragement to design
the method of provision so as to complement other service programs;
6) Application for services should be voluntary (except for crisis inter-
vention), and the identification of needs and selection of goals and
appropriate services can should be a joint effort of the consumer
and service provider whereever possible;
7) Accountability for the service program should be directed more to the
public and their elected officials at the state and local level, and
less to the federal government. To accomplish this:
a) Annual Program Plans incorporating goals and objectives should
be developed and made public in a process that includes citizen
participation;
b) Achievement against the goals and objectives should be the subject
of published reports and special evaluations.
11
Goals and Services
This section of this Title XX module reviews the overall goals of the
Title XX program and the services that are potentially available for devel-
opmentally disabled persons.
Goals
Under Title XX, Federal financial participation (FFP) is available
with respect to expenditures by participating states for the provision of
services directed at five broad goals. These service goals are:
1. achieving or maintaining economic self-support to prevent,
reduce, or eliminate dependency;
2. achieving or maintaining self-sufficiency, including reduction
or prevention of dependency;
3. preventing or remedying neglect, abuse, or exploitation of
children and adults unable to protect their own interests; or
preserving, rehabilitating or reuniting families;
4. preventing or reducing inappropriate institutional care by
providing for community-based care, home-based care, or other
forms of less intensive care; and
5. securing referral or admission for institutional care when other
forms of care are not appropriate, or providing services to
individuals in institutions.
A quick examination of these five basic Title XX goals makes it easy to see
the best potantial of this program for developmentally disabled persons. Goal
Number Four "opens the doors" for use of Title XX funds in the provision of
community-based residential alternatives and for home-based services.
Services
Title XX is basically open ended with respect to the specification of
service for which FFP is allowable, except that it does specify some ser-
vices, i.e., education, medical that do not allow for FFP. In other words,
the Act makes provision for a wide array of services as long as they can be
substantively linked to any one of the five broad service goals.
12
Universal services. Under Title XX there are services known as "universal
services". These are services provided by a state without regard to the
persons' income level. The boundaries of Title XX universal services have
undergone considerable change since the initiation of the program in 1975.
Initially, there were three universal services: Information and Referral,
Protective Services for Adults, and Protective Services for Children. On
April 2, 1976 regulations were issued which broadened the definition of
Protective Services to include any service defined in the state's Title XX
plan which is provided in response to a documented case of abuse or neglect.
Then, on September 7, 1976, P.L. 94-401 was signed into law and family
planning became the fourth Title XX universal service. However, due to the
required publication dates for the fiscal year 1977 plans, only a few final
state plans reflect the changes brought about by P.L. 94-401 relative to
family planning.
A broad spectrum of Title XX services can be directed to the developmentally
disabled. Services to developmentally disabled individuals include, but are not
limited to counseling, casework, employment training, and instructional living
situations. Of the fifty-one Fiscal Year 1977 Title XX state plans, fifty
describe services to the developmentally disabled, and twenty-five provide
separate services to developmentally disabled individuals.
Table 2
A Sampling of Potential Services
home-based services
child care
protective service for children and adults
service for children and adults in foster care
adult day care services
transportation services
training and related services
employment services
counseling services
preparation and delivery of meals
health support services
attendant services
13
It has been estimated that for fiscal year 1976, Title XX expenditures
for home-based services were $380,660,349, or 11 percent of all Title XX
expenditures and that 2,150,000 people received such services. However,
it is also estimated that only a small percentage of these people were
developmentally disabled. Home-based services are of significant importance
for developmentally disabled persons. Published State Title XX plans include
such home-based services as:
a) Homemaker Services - General household management activities
such as meal preparation, child care, and routine household
care. Most often, homemaker services are provided on a temporary
basis, and when appropriate, they include an element of teaching
the client how to do it for him/herself.
b) Chore Services - Most often described as home-maintenance activities such
as repairs, yard work, shopping, house cleaning;
c) Home Health Aide Services - Medical home care activities provided by
nursing aides;
d) Home Management Services - Described as formal or informal instruction
and training in child care, home maintenance, meal preparation, budget
management, and consumer education.
In addition, the Act does list allowable, appropriate combinations of
services designed to meet the special needs of groups such as: developmentally
disabled, children, the aged, the mentally retarded, the blind, the emotionally dis-
turbed, the physically handicapped, alcoholics, and drug addicts.
Each service offered under a service plan must be described as a
separately identifiable service. Also, the method of delivery, and the
service's relationship to one or more program goals and objectives must
be specified. Each service must furthermore be identified with respect
to each of the categories of eligible individuals to whom the service is
to be provided and to each of the geographic areas described in the ser-
vices plan in which the service is to be offered to each category of
individuals.
Clustered services. As previously stated, an additional service feature
14
of the Act is that it allows the state requesting FFP to designate a target
group with special service needs. Appropriate clusters of services are then
designated which are most suitable to that group. Table 3 provides a list
of potential target groups Finally, unlike past legislation and regulations,
Table 3
Potential Target Groups
for Clusters of Services
developmentally disabled
children
aged
mentally retarded
blind
emotionally disturbed
physically handicapped
alcoholics
drug addicts
the secretary of DHEW can no longer deny FFP to a jurisdiction for a
service expenditure on the grounds that it is not a legitimate service
or is not a service directed at one of the five basic goals.
Every service must be defined and described so that it is clear
exactly what activities are included in the provision of the service.
Services are not to be defined only in terms of the recipients to which
they apply or only in terms of the goals which they address. Federal
financial participation is available for expenditures for clustered
services which are defined in terms of groups of activities only if they
are broken down into particular, separately identifiable services. To
the extent that medical/remedial or room/board expenditure is planned for
matching under Title XX, those service components must be described in the
15
services plan as specific components of a particular service.
The purpose of the requirements concerning clustered services are:
(1) to insure that the public will know what services are available;
(2) to identify and distinguish services for reporting purposes; and
(3) to identify expenditures for claiming FFP. A service containing any combination
of particular services is by definition a clustered service, and services which
will be considered clustered require a discrete definition in the services plan.
Residential treatment services for specified groups of clients in specified
facilities are not considered to be clustered services. For example,
"services for emotionally disturbed children" or "residential treatment
services for emotionally disturbed children in specified types of facilities" is
a discrete service. Since the Title XX regulations require all services be
described and identified, a definition of these particular services must include
a description of all the activities, such as counseling and room and board, that
are included.
Purchase of services. In conjunction with its administration of
Title XX, the state agency has the discretion to contract with other
entities for the provision of services for the state's social services
program. All terms of these purchase of services contracts must be in-
cluded in a single contractual instrument that is dated and signed by
each party to the agreement. As a part of the purchase of service con-
tract, a detailed description of the services to be provided is required.
Each particular service within a cluster of services (e.g., services for
the developmentally disabled) must be separately identified and described.
The service components to be offered should be included within this detailed
description. The state agency retains the responsibility to make deter-
minations of Title XX eligibility even under the purchase of service
situation. However, the state agency may delegate this task to providers
16
with active purchase of service contracts. In either case, the state.
agency must retain the responsibility of monitoring and verifying such
determinations by use of some procedure such as sampling.
Contracts for purchase of services in the case of a private provider
may be based on a negotiated rate basis. In the case of a public provider,
contracts may be based on unit cost. A unit of service is determined
relevant to a particular service, depending on the nature of the service,
and could be based on time, task, or the number of clients served. This
provision does not preclude purchase of service contracts in which reim-
bursement varies with utilization rates.
In purchasing services from both private and public sources, FFP
is only available for expenditures where the rates of payment do not exceed
the amounts "reasonable and necessary" to assure the quality of service.
Records must be kept under this provision that describe the methods used
to establish and maintain rates of payment for all purchase of service
contracts.
Integral and subordinate serviçes. There are two terms that need
to be understood when discussing Title XX social services. These terms
are integral and subordinate. Understanding of these terms is par-
ticularly crucial when dealing with medical/remedial or room/board service
expenditures. To be eligible for FFP for these two types of expenditures,
medical/remedial and room/board must be an intergal but subordinate part of
a larger social service. The Comprehensive Annual Services Plan (CASP) must
identify each particular social service which has a medical/remedial or room/
board component. For each of these particualr services, the medical/remedial
or room/board component must be by definition essential to effectively providing
the particular social service. If the service could be achieved without the
17
medical/remedial or room/board component, then it is not integral. Aside from
this broad criterion, at least three out of four of the clients receiving the
particular service in the facility must also receive the medical/remedial or
toom/board component at some time during the period as service for the
integral requirement to be met for the facility.
Earlier Title XX regulations required a complicated formula (using
percentages) for determining whether a social service was integral and/or
subordinate. However, this complicated procedure was eliminated by
subsequent regulations published in the Federal Register, Volume 42,
Number 20 on January 31, 1977. These regulations state that medical and
remedial care are deemed to be integral but subordinate components of a
service if: 1) they are necessary to achieve the objective of that service
and not merely to correct a medical condition; and 2) the specific medical
and remedial care are described and included in the service of which
they are an integral but subordinate part. For example, in describing
child day care services, a state could describe (itemize) medical examinations,
dental screening, and immunizations as integral but subordinate parts of the
child day care service. Also, the regulations state that room or board is an in-
tegral but subordinate component of a service if: 1) it is necessary to achieve
the objective of that service and not merely to provide food and shelter; and
2) room or board are included in the state's service plan along with a description of
the services of which it is an integral but subordinate part. Room and board
is not an integral but subordinate part of foster care. However, FFP is avail-
able for. special services provided by a foster family home if a qualified pro-
fessional person other than the placement worker documents the person in foster
care needs special service and that the care-givers are qualified to provide that
service.
18
In addition to the restrictions listed above, the regulations pub-
lished January 31, 1977 list other service restrictions in sections 228.40
through 228.48. One important restriction for developmentally disabled
individuals relates to educational services (223.43). This section specifies
that FFP is not available for any educational service made generally available
for any educational agency to residents of the state without cost and without
regard to their income. In other words, if a school district is providing
special education services to the public at no charge then Title XX funds cannot
be used to pay for that educations1 service. However, "educational" services
per se are not excluded from FFP under Title XX but the expansion of generally
available special education laws such as Public Law 94-142, the Education for
All Handicapped Children Act, will limit the educaitonal services available
for FFP under Title XX.
The only basic restrictions of FFP for service expenditures are:
1) at least one service directed toward at least one of the goals in each
of the five goal categories must be provided; 2) at least three types
of services (selected by the jurisdiction) must be made available to
recipients of Supplementary Security Income, Title XVI; and 3) family
planning services must be made available to AFDC recipients upon request
(90% Federal financial participation).
19
Worksheet #1 - Goals & Services
Use the space following these questions to write in your answers.
Public Law 93-647 authorizes programs for social services to individuals
and families.
1. List the five basic goals of the Title XX program.
a.
b.
C.
d.
e.
2. Write a statement of your interpretation of the ramifications of these goals or
services for developmentally disabled persons.
3. What implications for specific social services are contained in
Public Law 93-647?
4. What is a "clustered service"?
20
5. Explain when and how services can be purchased.
6. What are integral/subordinate services?
21
Eligibility
Under the prior legislation and regulations, program eligibility
focused primarily upon clients who were connected with an income maintenance
program. In addition, this concept of welfare "relatedness" had to be
verified for former, current, and potential welfare clients.
Eligibility represents one of the significant new features of
Title XX in that eligibility is not limited to the notion of income
maintenance. Specifically, the three eligibility categories are: 1) low income;
2) non-income related (need alone) and 3) income mainenance. It is important
to recognize that these three categories represent separate issues and that in
order to be eligible only one of the conditions must be met.
Low Income Category
Unlike the former legislation and regulations, Title XX recognizes the need
for providing services to low income, non-public assistance, individuals and
families. This recognition eliminates the necessity for and practice of "bur-
eaucratic game playing" of attempting to provide services to the low income, yet
non-welfare recipient, individual. By state option, any goal oriented service
may be delivered and matched with Federal funds to individuals and families whose
income is above 80 percent of the state's median income or is below 115% of the
state median income (or 100% of national median income, if lower). In these
cases a fee reasonably related to income must be charged for service provision.
A state may establish an income level lower than 115% of the median income, at
different categories of individuals. The basic criteria for fee schedules state
that a fee may not be designed to discourage utilization of needed services, shall
be positively related to the individual's ability to pay, and shall not exceed
the cost of the service.
22
Need Alone Category
Regarding the eligibility category (need alone) there are three
groups of services which are applicable. These are: 1) information and referral
services; 2) services "directed toward the goal of preventing or remedying neglect,
abuse, or exploitation of children and adults unable to protect their own inter-
ests"; and 3) family planning services.
Income Maintenance Category
For the third eligibility category (income maintenance recipients)
Title XX invokes what is commonly known as the "fifty percent rule". This
rule states that a minimum of one-half of the Federal funds (37.5 percent
of the total matchable program) must be spent on persons in the following
groups:
--those who are receiving aid under the Title IV-A Aid to Families
of Dependent Children program (A.F.D.C.) or those who are eligible
to receive such aid; or
--those whose needs are taken into account in determining the needs
of an individual who is receiving aid from the A.F.D.C. program or
who are eligible to have their needs taken into account in
determining the needs of an A.F.D.C. recipient or eligible person; or
--those persons who are eligible to receive or are receiving Title
XVI (S.S.I.) benefits; or
--those persons who are eligible for Title XIX (Medicaid) assistance.
Other Considerations
In conjunction with Title XX eligibility, the term "fifty percent rule"
has become a common element of the jargon. The intention of the fifty
percent rule is to encourage the provision of services under Title XX
23
to specified categories applicable to these specified categories under
the Title XX program is less than half the total Federal funds claimed
by the state for the entire Title XX program, the amount of FFP will be
adjusted downward.
The testing of conformity against the requirement of the fifty
percent rule must be conducted by each state on a statewide basis at
least once every Federal fiscal year. The basis against which the fifty
percent test is measured is the total amount expended under the services
plan during a Federal fiscal year.
States may utilize acceptable sampling procedures to determine the
level of allowable FFP under the fifty percent rule. Scientific statistical
sampling procedures which will measure expenditures with a statistical
error of + 10 percent at the 95 percent confidence level may be used to
collect data for the test. If statistical sampling procedures are not
utilized, states must collect data on an individual service recipient
basis to verify whether or not the recipient would be included among the
group of prescribed individuals included under the rule and accumulate
sufficient expenditure data on an individual basis to meet the fifty
percent rule.
However, these eligibility standards have been somewhat relaxed,
a provision of Public Law 94-401. Under related regulations, states have
the right to waive individual eligibility determinations when there is
reason to believe that a substantial portion, at least 75%, of a particular group
of clients have family incomes below 90% of the state's median income. This authority
does not apply to day care services except for children of migrant workers. In
addition, the existing requirement that at least 50% of Title XX funds be
targeted on welfare, Medicaid, and SSI recipients is retained, and states
24
are required to validate the income status of persons determined elig-
ible on a group basis with the use of sampling procedures.
States may establish standards and methods for determining eligibility.
Two common methods for determining eligibility are: 1) a declaration method
and 2) a documentation method. The declaration method implies acceptance
of an, individual's statements regarding his/her status. The documentation
method means that the state will seek and obtain verification of information
provided by the person applying for services. The states may use one
method for determining eligibility for all services, categories of individuals
and geographic areas, or they may use different eligibility determination
methods for different services, different categories of individuals, and
different geographic areas.
Eligibility for Title XX social services underwent considerable change
between fiscal years 1976 and 1977. In large part, the changes were a direct
result of revisions in the federal regulations regarding Title XX. Key
changes in the regulations were:
The April 2, 1976 regulations eliminated the specific list
of services which could be provided as Protective Services
to children and adults. Now, states may provide whatever
services, included in their services plan, which they deem
appropriate to prevent or remedy abuse, neglect, or exploi-
tation.
A review of the fiscal year 1977 Title XX states plans shows that most states
plan to provide services other than those designated universal without
regard to income in documented cases of abuse, neglect or exploitation.
The August 26, 1976 Proposed January 31, 1977 final
regulations permit states to delegate, to their des-
ignated geographic areas the authority to set eligibility
levels for services.
To date, six states have taken advantage of this change and now provide
services at different eligibility levels in different geographic areas.
25
In Arizona, Minnesota, and New York, the eligibility levels are almost entirely
determined by local geographic units (i.e., counties), while in California,
Colorado, and Washington, the geographic variance is limited predominently
to one county or planning area.
On September 7, 1976, P.L. 94-401 was signed into law. This new
law amended several provisions of Title XX. One significant pro-
vision was the designation of family planning as the fourth uni-
versal service. However, due to the required publication date
of most Title XX plans (either July 1 or October 1, 1976) this
new provision will have almost no impact on fiscal year 1977 plans.
The summary/comparison below indicates changes in eligibility for services
for the program years 1976-1977.
Summary
FY 76
FY 77
States which do not vary income
eligibility by category of individ-
ual or services
12
8
States which vary income eligibility
levels by category of individual only
7
6
States which vary income eligibility
levels by service only
13
8
States which vary income eligibility
levels by category of individual
and service
19
23
States which vary income eligibility
levels by geographic areas
NA
6
States offering some or all services
to 80%
22
22
States offering some or all services
to 115%
17
17
26
In summary, states have made fairly extensive changes in their eligibility
criteria for services in the fiscal year 1977. Although the number of
states providing some services to 80% or 115% has not changed, an additional
ten states vary eligibility by category of individual and service. This of
course includes the six states which vary service not only by geographic area
but also by service and category of individual.
Generally, the trend in fiscal year 1977 is for states to lower eligibitity
levels and/or include additional criteria for service eligibility. For
example, of the six states which provide all services to a certain percent of median
income in fiscal years 1976 and 1977, three have lowered the income level for
services. Other states, like Colorado and Michigan have maintained eligibility
levels but now only provide services to these levels when the individual meets
certain criteria, i.e., has a disabling condition, receives services because
of protective intervention, etc.
Of the fifty states that describe services to the developmentally disabled,
(Wyoming is the exception) the following twenty-five states provide separate
services for the developmentally disabled.
Alabama
Maine
New Mexico
Arizona
Maryland
North Carolina
California
Minnesota
Rhode Island
Colorado
Mississippi
South Carolina
Delaware
Montana
South Dakota
Georgia
Nebraska
Tennessee
Indiana
Nevada
Utah
Kentucky
New Jersey
Virginia
Washington
All fifty states providing services to the developmentally disabled make the
services available to income maintenance recipients. In all states except
Delaware, which limits services to income maintenance recipients, services are
27
available to income eligibles.
The developmentally disabled have expanded access for services in seven
states. These states which have established higher levels of median income
for eligibility standards include:
D.D.
Others
Colorado
80%
AFDC/SSI
Except for day care (55%)
Hawaii
79%
60%
New Mexico
115%
80%
Ohio
80% (MR)
54%
Tennessee
80%/115%
70%
Utah
115%
80%
Virginia
70%
50%
The District of Columbia, Hawaii and North Dakota make all services provided
in their fiscal year 1977 CASP plans available to the developmentally disabled.
Colorado, Missouri, Ohio, Pennsylvania, Utah and Virginia make most of their
services available to the developmentally disabled.
28
Worksheet #2 - Eligibility
Eligibility is no longer limited to the notion of income maintenance.
1. List the three eligibility categories:
a.
b.
C.
2. Who qualifies for FFP under the "need alone" category?
3. Write a brief interpretation of the "50% rule".
4. The term "50% rule" insures that people in the income maintenance
category receive one-half of available federal funds.
True
False
29
Planning
In order to participate in Title XX, a state must develop both a
state administrative plan and a Comprehensive Annual Services Program
plan (CASP). The state administrative plan is a "preprint" prepared by
the Department of Health, Education and Welfare. One of the most
innovative and important components of Title XX is the requirement for
a Comprehensive Annual Services Program plan (CASP). The CASP moves
the service agency from the standard "preprint" planning process to a
more genuine planning process.
State Plan
The governor of the state is responsible for designating the state
agency authorized to administer or supervise the administration of the
state's Title XX program if existing law does not provide for or require
this designation to be made by another source. The designating official
has considerable latitude in determining what is the appropriate state
agency to designate. The administration and supervision of Title XX could
be placed under the state public assistance agency, an umbrella agency,
or any other state agency as long as it meets the following minimum criteria:
(1) it is the only agency designated to administer Title XX; (2) it has
statewide jurisdiction; and (3) it is capable of carrying out the authority
and responsibilities of Title XX. The one exception to these criteria is
if, on December 1, 1974, a separate agency administered or supervised the
service program for the blind under Title VI, that agency may continue
to do so for Title XX. If a state uses this two-agency option, both agencies
must use the same program year. In addition, the services plan for the agency
for the blind may be developed in conjunction with the services plan for the
primary Title XX agency as a joint effort. When this is done, services to
the blind must be clearly identified including separate identification of
30
expenditures, services, and geographic areas served. In addition to these
requirements regarding designation of appropriate state agency, the state
plan also covers administrative requirements in the following areas:
--Fair hearings for persons whose services request has been denied;
--Observance of proper confidentiality;
--Personnel and merit system standards;
--No durational residence requirements allowed;
If the state provides services to persons in institutions or
foster homes, there must be one or more state authorities
responsible fpr establishing and maintaining standards for such
institutions or homes. These standards must be reasonably in
accord with recommended standards of appropriate national
organizations, and must cover admission policies, safety, sani-
tation, and civil rights;
The state's program for services must be in effect in all political
subdivisions of the state. However, not all services are required
to be available in every political subdivision if the planning
process shows them to be unnecessary;
If the state provides day care for children, there must be one or
more state authorities responsible for establishing and maintaining
standards for such services which are reasonably in accord with
recommended standards of appropriate national organizations. Such
standards must cover admissions policies, safety sanitation, and
protection of civil rights;
Some state money must be used to meet the cost of services.
The state plan must be approved by the Secretary of DHEW, and no FFP
can be allowed until the state plan has been approved. If the Secretary
of DHEW, after reasonable notice and hearing, finds that an approved plan
no longer complies or fails to follow any of its provisions, he may with-
hold all FFP until compliance is achieved or reduce FFP by three percent
for each plan requirement not in compliance.
Comprehensive Annual Services Program Plan (CASP)
The responsibility for the preparation of the proposed and final
Comprehensive Annual Services Program (CASP) is with the agency
designated as the Title XX agency by the state administrative plan.
31
This CASP process has the potential of significantly altering the
scenario of public assistance/social service expenditures. The CASP
provides a mechanism for real planning to replace the "squeaky wheel"
approach.
Plan content. The state's proposed and final CASP must include
the following information:
--program objectives
--services to be provided (mandatory and optional), their definition
and relationship to objectives and goals
--categories of individuals to be served (including income categories)
--geographic areas for service provision and nature and amount of
services for each area
--a description of Title XX planning, evaluation, and reporting
activities
--sources of the program funding
--a description of organizational structure, including use of public
and private agencies and volunteers
--a description of Title XX coordination with and utilization of
AFDC, CWS, SSI, Medicaid, and other related human services programs
--estimated expenditures by services, categories served, geographic
areas and a comparison of estimated non-Federal expenditures for
the planning year and the preceding program year
--a description of steps taken to assure that needs of all residents
and geographic areas of the state were considered in plan devel-
opment
The Title XX planning cycle is a 12-month period excluding the
first cycle which can be up to 24 months. During the planning cycle, the
following critical activities must occur: 1) needs assessment; and 2) services
inventory; 3) analysis of services and needs; 4) policy/priority setting
and development of goals and objectives; 5) selection of the array of
services to be provided and balancing of related costs within resource
constraints; and 6) evaluation of services including monitoring and
32
and reporting of services as delivered during current plan prior to developing
the next services plan.
The needs assessment activity is of crucial importance. By being able
to to respond and demonstrate the need for services for developmentally
disabled persons, the Developmental Disabilities Councils and volunteer agencies
can help open the door to Title XX funds. Each Title XX plan must describe
how the needs of all residents of the state were taken into account in
developing the plan. The description of the needs assessment must include
(Ross, 1975):
1) data sources used or to be used;
2) Public or private organizations consulted or to be consulted;
3) The manner in which the results of the needs assessment were
utilized in development of the services plan.
Public Participation. The proposed Comprehensive Annual Service
Program plan must be published or made generally available to the public
at least 90 days prior to the beginning date of the program year (July 3, 1975
for the initial year). The proposed plan must be prepared by the designated
service agency and approved by the governor (unless state law otherwise provides).
A period of at least 45 days must then be allowed for public comment on
the proposed plan. The final Comprehensive Annual Services Program plan
must then be published at least 45 days after publication of the proposed
plan and prior to the beginning of the program year. The final plan must
contain the same information as is required for the proposed plan plus
an explanation of the differences between the two and the reasons for the
differences.
Any amendment after plan approval must be published and made avail-
able for public comment for 30 days. When published as a final amendment,
it must include an explanation of any differences between the proposed
and final amendment.
33
Time schedule. In order to assure public participation in develop-
ing its program, a state's program planning must meet some basic condi-
tions. First, a state service program planning year must be established
at the beginning of the fiscal year of either the state or Federal govern-
ment. Since the initial start-up date in all jurisdictions is October 1,
1975, this means that initial program years will vary in length. An
initial program year of a maximum of 24 months is allowable if a state
chooses to follow the new Federal fiscal year may have an initial
program year of only 12 months. States using a state fiscal year which
does not coincide with the Federal fiscal year may have an initial
program year of less than 12 months or more than 12 months but less than
24 months, e.g., October 1, 1974 to June 30, 1975 or October 1, 1975 to
June 30, 1977.
34
Worksheet #3 - Planning
1. What does "C.A.S.P." mean?
2. What is the timeline for C.A.S.P. development?
3. Who is responsible for C.A.S.P. development?
4. What six basic activities should take place during C.A.S.P. development?
a.
b.
C.
d.
e.
f.
35
Funding
Effective October 1975, Title XX established a new consolidated
program for Federal financial participation (FFP) in the provision of
services by the 50 states and the District of Columbia. First, the
provisions of Title I, IV, X, XIV, XVI, and Section 1130 of the Social
Security Act under which FFP for social services was provided were repealed.
Second, the total funds available ($2.7 billion in Fiscal Year 1977)
are to be divided among the states and the District of Columbia on a popu-
lation ratio formula. Federal financial participation for services directed
at the goals enumerated are at the rate of 75% except for family planning
services at 90%. These matching rates apply not only to expenditures for
services but also to expenditures for administration including planning and
evaluation, In addition, personnel training and retraining directly related to
the provision of the services (including both short and long term training
at educational institutions) is at 75% FFP. However, these funds may be
provided through a different appropriation than the $2.7 billion of service
funds. That is, they are not subject to a ceiling on Federal matching.
In addition, on September 7, 1976, when President Ford signed into law
a compromise social services bill (P.L. 94-401) it authorized an additional,
one time, $240 million in Title XX funds specially for day care to be used
during the transition quarter between Fiscal Years 1976-77 and during
Fiscal Year 1977. The current Title XX allocation formula will be used
to distribute these additional funds; however, a state's allotment of the
additional funds may not exceed its actual Title XX expenditures for
day care services. The Federal matching rate for these funds is 75%
during the transitional quarter and 100% during Fiscal Year 1977.
36
Third, Federal payments to a state in any fiscal year cannot exceed
its share of $2.7 billion alloted among the states on the basis of
population. Also, general reallotment of unused funds to the states is
not authorized. However, if there are unused funds, up to $15 million
are made available to Puerto Rico and up to $.5 million are made available
to both Guam and the Virgin Islands as Federal matching for expenditures
for the provision of services.
The state's share of funding is derived from two basic sources:
public funds, and funds from private sources. In order for public funds,
other than those appropriated directly to the state Title XX agency
(including local units thereof), to be considered in computing the state's
matching share, they must meet the following criteria:
--Transferred funds must be cash sums transferred by the chief
financial officer of the contributing agency or designee, and/or
through the Treasurer of the State. To qualify as transferred
funds, the control over such funds must be placed with the
Title XX agency;
--For expenditures made by other public agencies for Title XX
activities, there need not be an actual transfer of funds between
the public agency and the Title XX agency. This provision applies
in cases where the state Title XX agency has an agreement for
support services or a purchase of service contract in effect with
other public agencies.
An organization is considered public only if it was created by public
law.
Funds are considered to be donated from private sources if the
funds are not required by law. Funds from private sources must be re-
ceived in cash by the Title XX agency and must be under its administra-
tive control. To receive Federal financial participation for expenditures
of funds donated to a state or local Title XX agency, a state must retain
sole discretion for how the donated funds are expended. However, private
sources of donated funds are permitted to apply two types of restrictions on
37
their donations. These are: (1) designation of the geographical area
in which a service is to be provided; and (2) designation of the type of
service to be provided so long as the donor is not a sponsor or operator
of the designated service. These provisions do not preclude the donor
agency from reserving the right as part of the donation agreement to audit
the application of the donation to assure that the donation was
applied as intended.
Funds contributed by federated organizations such as United Way or
Community Chests are acceptable for FFP as long as the funds are donated
without restriction and the organizations are not operators of service
programs or participants in the management or direction of the provider
agency. No federal financial participation is available under any circum-
stances for the expenditures of funds from a private profit-making donor
to purchase services from that donor.
Therefore, Federal financial participation is not available for
certain kinds of expenditures.
--Matching is not available for expenditures for the provision of
services to individuals not receiving AFDC or SSI who are members
of families with an income in excess of 115 percent of the median
income of a family of four in the state (adjusted to take account
of family size);
--Matching is not available for expenditures for most services
unless certain requirements concerning fees for those services are
met. In the case of services provided to individuals receiving
AFDC or SSI or who are members, of families with incomes below
the median income of a family of four in the United States
(adjusted to take account of family size), or 80 percent of
the median income of a family of four in the state (adjusted to
take account of family size), the secretary must prescribe
requirements concerning the imposition of fees. In the case of
services provided to all other individuals, fees reasonably
related to income must be imposed;
--Matching is not available for medical services except in certain
limited circumstances; for the purchase, construction, or major
modification of buildings, facilities, or equipment, or for the
provision of room and board except in certain limited circumstances;
38
--Matching is not available for expenditures in the form of goods or
services provided in kind by a private entity, and is available
for expenditures of donated private funds only if the funds are
transferred to the state and under its control, are donated with-
out restrictions as to use with certain limited exceptions, and
do not revert to the donor's use unless the donor was a non-profit
organization;
--Matching is not available for expenditures for child care unless
the care meets certain standards. In-home care must meet standards
of national standards-setting organizations. Out-of-home care
must comply with the requirements of Title IV B of the Social
Security Act and the Federal Interagency Day Care Requirements
of 1968 except that in the case of day care for children of
school age or older in a day care center, the maximum permissable
number of children per adult is somewhat higher than that
authorized by the 1968 Requirements;
--Matching is not available for expenditures for the general
educational program of the state;
--Matching is not available for expenditures for the provision of
services to individuals in hospitals, skilled nursing facilities,
intermediate care facilities, prisons, and foster family homes if
the services are provided by the institution or home in which the
individual is living, except in certain limited circumstances;
-Matching is not available for expenditures for the provision of
cash for income maintenance purposes.
Beyond these specific prohibitions, each state is free to develop
the services program it considers appropriate except that family planning
services must be provided to AFDC recipients and at least three different
services must be provided for SSI recipients. States are also required
to expend, in each year, out of state and local appropriated funds, at
least as much as was expended out of state and local appropriated funds
for the provision of services during fiscal year 1973 or fiscal year 1974,
whichever was less.
39
The following data represent a summary of Title XX planned expenditures
for fiscal years 1976 and 1977, based on information available in the state
final Comprehensive Annual Services Program (CASP) plans.
Total Title XX
Federal
Federal Shares
Expenditure
Share
@ % of the
Estimates
Estimates
2.5 Billion Allotment
(in millions)
(in millions)
%
FY 76
$3.354
2.429
97.2
FY 77
3.409
2.444
97.8
The estimated total expenditures for Title XX social services reflect a
$55 million increase (or + 1.7%) in fiscal year 1977. Roughly 70 percent
of the increase represents state monies above those required for federal match.
These additional nonmatched monies are used to supplement the Title XX program.
Some provide for an increase in services and others are merely keeping up with
inflation. States which plan to provide Title XX services with state funds
above that necessary for the federal match include:
California
Minnesota
Connecticut
New York
District of Columbia
Oregon
Florida
Pennsylvania
Illinois
Vermont
Massachusetts
A review of 1976 fiscal date indicates that:
--There was a 14% differential between planned (97.2%) and actual
(83.2%) use of the federal allotment.
--Forty-one state plans estimated full use of all federal funds
while actual reports indicate that only seventeen spent their total
allotment.
For fiscal year 1977 forty-four states estimate full use of their allotment.
Given the history, it is unlikely they will all make it.
40
Worksheet #4 - Funding
1. The federal financial participation available for Title XX is
an open-ended appropriation.
True
False
2. Explain the allowable funding exemption for personnel training.
3. When are funds from private sources considered "donated"?
4. Title XX funds cannot be used to pay for educational services.
True
False
5. The usual federal/state matching ratio is:
a. 50/50
C. 90/10
b. 25/75
d. 75/25
41
Summary
One of the key implications of Title XX is related to the funding
available. The $2.7 billion FFP available is not "new" money. This is
the same $2.5 billion FFP that has been available for social service
programs, per fiscal year, since 1972. The program is different, but the
dollars are the same. With the rapid escalation and inflation of program
costs, those states which have already reached their FFP ceiling will be
facing a proportional shrinking of Federal assistance. This is true even
if these programs remain at a status quo level. More and more non-Federal
dollars, that won't be matched, will have to be used to keep programs
from sliding backward. For varied reasons, several states are not using
their alloted share of the $2.5 billion FFP. However, a provision to
allow for the reallocation of unused funds among states which could use
them did not become a part of the final version of Title XX.
Another very key issue of Title XX is the potential for public
participation in the planning process. Interested citizens and consumer
advocates will have a chance to become involved if the state agencies
abide by the intent and spirit of the Act. Advocacy groups should not
overlook the potential significance of participating in the formal process
as set forth by Public Law 93-647. Coupled with their participation in
the political arena, they must learn to use effectively the formal
procedures if they wish to capitalize upon the social service funds for
the developmentally disabled.
In very simplified terms, then, Title XX allows for provision of
services to a large group of people; the funds available are limited; and
citizens can have input into the Title XX plan. Therefore, citizens
need to get together and work with the state agencies to help assure that
42
proper priorities are set for these limited funds.
43
Relationship With Other Programs
Because of the broad nature of the goals of the Title XX program,
the flexibility of designating services and the income eligibility structure,
Title XX has significant potential for working in combination with other
state-federal programs.
Title XX does require that states must provide at least three services
to recipients of Supplemental Security Income. Therefore, it becomes criti-
cally important for Supplemental Security Income recipients and/or their
advocates to become actively involved in the Title XX planning process to
insure that the services provided are useful and meaningful for developmentally
disabled persons. Many community living arrangements for developmentally dis-
abled individuals are being funded by the S.S.I. recipients using their monthly
allotments to pay for basic room and board costs and using Title XX to pay
for supplemental/supportive services.
A basic activity of the state Developmental Disabilities program
is to review and comment on other state program plans and to point out the
deficiencies of those plans in regard to serving developmentally disabled per-
sons. Based upon the open public planning process and the scope of the
Title XX program the Developmental Disabilities Council/Agency should be
actively involved in monitoring the expenditures of Title XX dollars.
44,
SPECIAL NOTE
A primary source of current data for this module was:
Technical Notes
Summaries and characteristics of States'
Title XX Social Services Plans for Fiscal
Year 1977 prepared by Eileen Wolff, Barbara
E. Bird, and Patricia L. Sullivan.
This document is prepared annually by the Department of Health,
Education and Welfare, Office of the Assistant Secretary for
Planning and Evaluation. It is an excellent analysis of State
Title XX Plans and national trends in the delivery of Title XX
social services.
45
References
Conference Report on H.R. 17045, House Report Number 93-1643, December
19, 1974.
Congressional Record, October 12, House Discussion of P.L. 92-912.
Congressional Record, October 13, 1972, Senate discussion of P.L. 92-912.
Congressional Record, December 9, 1974, House Passage of H.R. 17045, Pages
HII412-HII417.
Congressional Record, December 17, 1974, Senate Passage, Conference Report,
Pages H12584-H12591.
Congressional Record, December 20, 1975, Senate Passage Conference Report,
Pages S22522-S22526.
Federal Register, Monday, April 14, 1975, Vol. 40, No. 72, Part II.
Federal Register, Friday, June 27, 1975, Vol. 40, No. 125, Part II.
Federal Register, Thursday, August 26, 1976, Vol. 41, No. 167, Part II.
Federal Register, Monday, January 31, 1977, Vol. 42, No. 20, Part III.
Finance Committee Report, Senate Report Number 93-1356, December 14, 1974.
Haaser, T.C. Suggested improvements to the state planning system under
Title XX. Human Services Institute for Children and Families, Inc.
Kadushin, A. Child welfare services. Macmillan Publishing Company, Inc. 1974.
46
Litvin, M. Public assistance/social services and the mentally retarded.
Unpublished doctoral dissertation, University of Oregon, December, 1976.
Nathan, R. (Ed.). Mental retardation: Trends in state services. Wash-
ington, D.C.: President's Committee on Mental Retardation, 1976.
Public Law 93-647. Social Service Amendments of 1974. January 4, 1975.
Public Law 94-120. Natural Graphite Duty Suspension; Social Security Act
Amendments. October 21, 1975.
Public Law 94-401. Social Security Act Amendments. September 7, 1976.
Ross, E. Clarke. (Ed) Word from Washington. United Cerebral Palsy Associations,
Inc. Vol. 3, No. 10. November 1972.
Ross, E. Clarke (Ed) The Social Services Program: Historical Background,
Current Situation, Pending Legislation - Impact on U.C.P.A. Affiliates.
In Word from Wasnington. Vol. 3, No. 6, October, 1974.
Ross, E. Clarke. The Title XX Social Services Program: Impact on Services
for the Severely Disabled from the Perspective of the HEW Proposed
Regulations. Paper presented to the UCP of Ohio local executive work-
shop on Title XX. May 7, 1975.
Ross, E. Clarke. Title XX Social Services Programs: the Conflict of
Philosophy - Public Assistance vs. Human Development. Paper prepared
for the UCPA District Governmental Activities Workshops. March 24, 1976.
Title XX: Boon or Boondogle? Speech given by Charles R. Hall, Assoc.
Reg. Commis. for Community Service Region IX, 102nd Annual Forum,
National Conference on Social Welfare, May 15, 1975.
47
Twiname, J.D., Miller, J.H. 11 Mott, P.E. How to use Title XX to
promote permanence for children. The Child Wolfare League of
America, Inc., 1975.
U.S. Department of Health, Education and Welfare. A description of
Title XX of the Social Security Act, P.L. 93-647, The Social
Service Amendments of 1974, January 15, 1975.
U.S. Department of Health, Education and Welfare. Title XX - Regulation
issues. January, 1975.
U.S. Department of Health, Education and Welfare. H.R. 17045 - P.L. 93-647,
Social Service Amendments of 1974, February 5, 1975.
U.S. Department of Health, Education and Welfare. General information,
P.L. 93-647 - Title XX of the Social Security Act (undated).
Ways and Means Committee Report on H.R. 17045 House Report Number 93-149-C,
November 22, 1974.
In addition to the specific references cited above, the four voluntary
agencies (E.F.A., N.A.R.C., N.S.A.C., U.C.P.A.) have and continue to provide
extensive and periodic review and updates about Title XX. N.A.R.C. publishes
Government Report and N.S.A.C., U.C.P.A. jointly publish Word from Washington.
Also, the National Association of Coordinators of State Montal Retardation
Programs (NACSPMR) produces a sories of publications that are an excellent
source of information about Title XX and developmentally disabled persons.
48
Answer Sheet
Worksheet #1
1. Under Title XX, Federal financial participation (FFP) is available
with respect to expenditures by participating states for the provision
of services directed at five broad goals. These service goals are:
1. achieving or maintaining economic self-support to prevent,
reduce, or eliminate dependency;
2. achieving or maintaining self-sufficiency, including reduction
or prevention of dependency;
3. preventing or remedying neglect, abuse, or exploitation of
children and adults unable to protect their own interests; or
preserving, rehabilitating or reuniting families;
4. preventing or reducing inappropriate institutional care by
providing for community-based care, home-based care, or other
forms of less intensive care; and
5. securing referral or admission fox institutional care when other
forms of care are not appropriate, or providing services to
individuals in institutions.
3. Title XX is basically open-ended with respect to the specification of
service for which FFP is allowable, except that it does specify some ser-
vices, i.e., education, medical that do not allow for FFP. In other words,
the Act makes provision for a wide array of services as long as they can be
substantively linked to any one of the five broad service goals.
4. Title XX allows the state requesting FFP to designate a target
group with special service needs. Appropriate clusters of services are
then designated which are most suitable to that group.
5. In conjunction with its administration of Title XX, the state agency
has the discretion to contract with other entities for the provision
of services for the state's social services program. (See page 15)
49
6. These are services that are part of a larger social service. To be
integral/subordinate a service must be essential to effectively
providing the larger social service. (See page 16)
50
Answer Sheet
Worksheet #2
1. Income Maintenance
Low Income
Need Alone
2. Anyone who is provided one of the universal services. (See page 22)
3. A minimum of 50% of the federal funds must be spent on persons
receiving AFDC, SSI, or Medicaid or others whose needs are taken
into account when computing these payments. (See page 22)
4. True
51
Answer Sheet
Worksheet #3
1. Comprehensive Annual Services Program Plan.
2. Basically it is a 12 month cycle. A proposed plan must be made
available to the public 90 days prior to the beginning of the program
year. Forty-five days must be allowed for comment. (See page 32)
3. The designated Title XX agency and the public.
4. a) needs assessment
b) services inventory
c) analysis of services and needs
d) policy/priority setting and development of goals and objectives
e) selection of the array of services to be provided and balancing
of related costs within constraints
f) evaluation of services including monitoring and reporting
of services as delivered during current plan years prior
to developing the next services plan
52
Answer Sheet
Worksheet #4
1. False
2. There are federal matching funds available for personnel training
outside of a states formula share of Title XX funds.
3. Funds are considered to be donated from private sources if the
funds are not required by law. Funds from private sources must be re-
ceived in cash by Title XX agency and must be under its administra-
tive control. To receive Federal financial participation for expenditures
of funds donated to a state or local Title XX agency, a state must retain
sole discretion for how the donated funds are expended. However, private
sources of donated funds are permitted to apply two types of restrictions on
their donations. These are: (1) designation of the geographical
area in which a service is to be provided; and (2) designation of the type of
service to be provided so long as the donor is not a sponsor or operator
of the designated service. These provisions do not preclude the donor
agency from reserving the right as part of the donation agreement to audit
the application of the donation to assure that the donation was
applied as intended.
Funds contributed by federated organizations such as United Way or
Community Chests are acceptable for FFP as long as the funds are donated
without restriction and the organizations are not operators of service
programs or participants in the management or direction of the provider
agency. No federal financial participation is available under any circum-
stances for the expenditures of funds from a private profit-making donor
to purchase services from that donor.
4. False
5. d. 75/25
The Federal Programs Infor-
Epilepsy
mation and Assistance Project
Foundation
is a consolidation of two grants
of America
of national significance
awarded by the Develop-
mental Disabilities Office of
National
the Department of Health,
Association
Education and Welfare. The
for Retarded
grants were developed
Citizens
through the efforts of the four
national voluntary agencies
National Society
representing each of the
for Autistic
developmental disabilities.
Children
These four agencies, Epilepsy
Foundation of America, Na-
tional Association for Retarded
United
Citizens, National Society for
Cerebral Palsy
Autistic Children and United
Associations, Inc.
Cerebral Palsy Associations,
Inc., are jointly participating in
the Project. The National
Association for Retarded
Citizens has responsibility for
administering the grants.