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This file contains materials relating to Cleonice Tavani, Arthur S. Flemming, and Bertha Adkins.
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352356389
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Aging - Federal Council on Aging (4)
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Aging - Federal Council on Aging (4)
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This file contains materials relating to Cleonice Tavani, Arthur S. Flemming, and Bertha Adkins.
citationUrl
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Sarah C. Massengale Files (Ford Administration)
Sarah Massengale's Health, Social Security and Welfare Files
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Old age
Federal aid
Pensions
Taxation
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1976-10-31
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10
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1976
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1975-03-01
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1975
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The original documents are located in Box 3, folder "Aging - Federal Council on Aging (4)"
of the Sarah C. Massengale Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the
United States of America her copyrights in all of her husband's unpublished writings in National
Archives collections. Works prepared by U.S. Government employees as part of their official
duties are in the public domain. The copyrights to materials written by other individuals or
organizations are presumed to remain with them. If you think any of the information displayed
in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential
Library.
The
Interrelationships
of Benefit Programs
for the Elderly
FORD & GERALD LIBRARY
Programs for Older
Appendix II
Americans in Four States:
A Case Study of Federal,
State and Local Benefit Programs
Federal Council on the Aging
The
Interrelationships
of Benefit Programs
for the Elderly
Appendix II
Programs for Older Americans in Four States.
A Case Study of Federal,
State and Local Benefit Programs
Prepared for
The Federal Council on the Aging
by
The Human Resources and Income Security Project
The Urban Institute
December 29, 1975
FEDERAL COUNCIL ON THE AGING
WASHINGTON, D.C. 20201
For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402
TABLE OF CONTENTS
Wisconsin
2
eqidenoitsl9m9tal
CASE
Georgia
25
emsigor9 tilensEl to
Massachusetts
36
vhsbl3
impact
Washington.
55
four Summary Statement
68 bene-
fit programs for also alderly which would be illusrrative, although not
necessarily statistically representative, of elaterlevel activities nation-
wide. The intent was to gain an understanding of several spectra of pro-
II xibasqqA
grams which wight be available to individual recipients around the country.
ni emsigor9
It 18 important to stress that the emphasis is 00 "might ⑉⑈ since there is
to A
vide variation in the extent and types of programs offered 1n different
thens8 [soo] bns sisie
states.
Visconsin, Georgia, Massachusetts and Washington were selected as
representative of certain geographic and demographic characteristics as
TOT benefits
will - having fairly high levels of program activity. These states reprem
00
want Vensie regions of the continental United States - Northeast, North
vd
Central South and West and have on the average similar proportions of
persons 65 years of age and over, incidence of poverty, and percent of
bns
total state population who are both over 65 and poor. An important cod-
sideration in salecting the states vas the availability of date and the
es
willingness of the state program people to cooperate in the study, The
schedule for the project, of which this report constitutes one task,
necossitated il time limit of one week in each state, including travel
time. For this reason visits, for the most parr, were limited to the
State Conitals where most of the departments are located. Consequently
there is a pareity of data on Local, private programs which have
been obtained by corns of a statewide survey with visits to of the
- 1 -
PROGRAMS FOR OLDER AMERICANS IN FOUR STATES:
A CASE STUDY OF FEDERAL, STATE AND LOCAL BENEFIT PROGRAMS
The Federal Council on Aging, as part of a study of the combined
impact of various benefit programs on older Americans, requested that
four states be visited for the purpose of identifying and describing bene-.
fit programs for the elderly which would be illustrative, although not
necessarily statistically representative, of state-level activities nation-
wide. The intent was to gain an understanding of several spectra of pro-
grams which might be available to individual recipients around the country.
It is important to stress that the emphasis is on "might," since there is
wide variation in the extent and types of programs offered in different
states.
Wisconsin, Georgia, Massachusetts and Washington were selected as
representative of certain geographic and demographic characteristics as
well as having fairly high levels of program activity. These states repre-
sent four regions of the continental United States - Northeast, North
Central, South and West - and have on the average similar proportions of
persons 65 years of age and over, incidence of poverty, and percent of
total state population who are both over 65 and poor. An important con-
sideration in selecting the states was the availability of data and the
willingness of the state program people to cooperate in the study. The
schedule for the project, of which this report constitutes one task,
necessitated a time limit of one week in each state, including travel
time. For this reason visits, for the most part, were limited to the
State Capitals where most of the departments are located. Consequently,
there is a paucity of data on local, private programs which might have
been obtained by means of a statewide survey with visits to each of the
- 3
- 2 -
Area Agencies on Aging within a state, or to selected localities. There
the state's total population respectively. Approximately, 24% of those
is no central corpus in the state which gathers data on local programs offered
65 and over had incomes below the poverty level, resulting in 3% of
throughout the state. State and Area Agencies on Aging are making a continuing
Wisconsin's total population being both 65+ and poor. 36% of the 65+
effort to learn of such programs and to include them in their information and
population reside in rural areas.
referrel services, but so far it has not been possible to obtain an inclusive
Since 1968, the Wisconsin Division on Aging has been located within the
listing and description of them.
Wisconsin Department of Health and Social Services (DHSS). The Division does
The initial contacts in each state were with the Stage Agency on Aging
not have statutory authority and operates primarily as an administrative office.
(or its equivalent, since the position of this office in the hierarchy of state
Its present budget is $9 million, $240,000 of which are state funds. The
government varies from state to state) and the state department responsible for
Department of Health and Social Services is an umbrella agency committed
social services. These offices, in turn, supplied referrals to specific program
to a comprehensive human services approach to the planning and delivery of
people. The timing of the state visits presented some problem to the program
services to people in need. Services to older adults are part of the
people in that they were engaged in meeting October deadlines for formulating
broad context of providing services to persons of all ages. Some debate
State Plans required under Title XX of the Social Service Admendments and State
exists within the state on the question of whether the aged would be best
Plans required under the Older Americans Comprehensive Services Amendments.
served by a separate agency, but for the present the "umbrella" concept
A minimum of problems were encountered in arranging appointments with appropriate
prevails.
The Division on Aging, the Governor's Office, the State Legislature
persons. Some follow-up by phone was necessary where appointments could not
be arranged at the time of the state visit. Where data were not readily available,
and various divisions within DHSS are strongly committed to providing
systems and services as alternatives to the institutionalization of the
such data were, in most cases, sent following the visit. In many cases the data
elderly. In keeping with this commitment, an adult Protective Services
were simply not available, or, in the case of programs not specifically aimed at
Act was passed effective June 1974. Guidelines for local agencies admin-
the elderly, data were not always broken out by age.
It was not possible to establish a uniform period for cost information
istering the act were published in July of 1975. In terms of the elderly,
it is estimated that 15% (about 75,000 persons) of those aged 60 through
because of reporting variations among the program offices. An effort was
74 need protective services, if not protective placement, while an esti-
made to obtain the most recent annual data, but in many instances only
mated 75% (150,000 persons) aged 75 and over require such services.
monthly, quarterly, or semi-annual data were available.
Many of these people are presently residing in protected residential
WISCONSIN
settings either with families or in institutions, nursing homes and other
In 1974, an estimated 692,500 persons in Wisconsin were age 60 and over;
493,680 were age 65 and over. They represented 14.9% and 10.8% of
- 4
- 5
care facilities. The act is directed at protecting these people from
Security Act, at least for the first year beginning October 1, 1975, there
self-neglect and neglect by others, from hazardous situations and from
is little likelihood that the Protective Services Act will have an im-
being abused or taken advantage of. The services consist of court-related
mediate impact on the delivery of services under Title XX. Wisconsin
activities as well as a wide range of social and health services which
is presently at its maximum federal allocation of $54.5 million. An
individually or in various combinations can constitute an alternative to
additional $22.5 million of state funds brings the total budget to $77
placement in institutions. Such services are to be made available to
million. This budget which is already allocated for the coming biennium
those who need them at their request or with their consent. Under the
does not allow for new programs or expansion of old Title VI programs.
Act, courts can order protective services only for persons who are ju-
Title XX services, estimated numbers of people to be served and
dicially determined to be incompetent.
estimated expenditures for the 21-month program period appear in the
The Act is designed to establish these services statewide and to
following table:
make them available to everyone who needs them. However, since there is
no new money to make this possible because there is no fiscal note attached
to the Act, it is unlikely that full-scale, county-based systems for
delivery of the services will be implemented in the immediate future.
The initial objective is to expand the systems of existing agencies.
Attention is given to this Act in this report because it seems
apparent that it will have particular implications for services provided
under Title XX of the Social Service Amendments. Specific services which
are likely to be affected by the Act are diagnosis and evaluation, coun-
seling, planning placement and supervision, home and financial management,
court and legal services, chore services, home-delivered and congregate
meals, housing services, transportation, day care, special living arrange-
ments and personal care services.
Title XX - Social Services
Since it is expected that Title XX services to the elderly in Wis-
consin will be essentially the same as those under Title VI of the Social
- 6
7
TITLE XX Definitions of Services
TABLE 1
TITLE XX PROGRAM
Diagnosis/Evaluation
Estimated No. of Persons b
Activities (including medical) leading to identification of the nature
Estimated
a
and/or extent of the presenting problems; the services necessary to re-
Services
65 and over to be Served
Expenditures
move, ameliorate or manage the problem; and the development of measurable
client objectives.
Health Related
7,100
$ 2,422,000
Diagnosis and
Counseling
Evaluation
2,210
216,000
The utilization of special skills to assist individuals in achieving ob-
Counseling
2,700
552,000
jectives and in decision-making through exploration of a problem and its
ramifications, examination of attitudes and feelings, and consideration
Day Services
3,400°
12,458,000
of alternative solutions.
Day Care
13,000ᶜ
838,000
Chore Services
Transportation
10,000
480,000
Performing work or household tasks which persons are unable to do for
Housing
13,300
398,000
themselves because of frailty or other conditions and which do not re-
quire the services of a trained homemaker or other specialist. Chore
Education &
services, which may be done on a paid or volunteer basis, may include but
Training
2,000
68,000
are not limited to such activities as: (a) help in shopping, (b) lawn
care, (c) simple household repairs, (d) running errands.
Personal Care
5,900
1,763,000
Home & Financial
Court Services
Management
7,400
2,265,000
Assisting the courts when requested or required in investigations, studies,
Chore Services
12,200
3,376,000
recommendations and supervision.
Home Delivered or
Congregate Meals
800
32,000
Day Care Services
Court Services
300
11,000
The provision of care of children and adults for any portion of the 24-
hour day in a setting licensed or approved by the appropriate agency for
Legal Services
100
1,000
purposes of personal care and/or for promotion of social, health, and
emotional well-being through opportunities for companionship, self-edu-
Planning, Placement
cation and other developmental activities. Settings include licensed day
and Supervision
5,800
1,605,000
care centers as well as in-home and family day care and may include pro-
vision of a noon meal. Medical if not covered under Title XVIII or XIX
Protective Payment
1,400
492,000
may also be included.
Day Services Program
ᵃSee Definitions of Services following Table 1.
Non-residential comprehensive coordinated care, services and/or treatment
ᵇssI recipients only, does not include income eligibles who may be 65+
(including medical if not covered by Title XVIII or XIX) to enhance moti-
vation and social development and to alleviate disabilities when present.
because breakdown by age was not available. The income maintenance
Day services shall provide a continuous delivery of services for a scheduled
official interviewed estimated that the bulk of SSI recipients in
portion of a 24-hour day and may include the cost of a noon meal. Examples
Wisconsin are age 65 or over.
are licensed or approved day treatment facilities, day care for the mentally
CA large portion of SSI recipients receiving these services are probably
handicapped, etc.
disabled rather than aged.
- 8 -
9 -
Education and Training
Personal Care Services
Those activities which assist persons in obtaining education and or training
The non-medical services performed for an individual to maintain well-being,
in accordance with their capacities and/or vocational needs. This service
e.g., feeding, bathing, dressing, etc.
can include payment for educational expenses as well as the actual provision
of a broad and varied curriculum of practical and/or academic subjects pri-
marily designed to develop the ability to learn, acquire useful knowledge
Planning Placement and Supervision
and basic learning skills to improve his economic well-being and/or to im-
prove the ability to apply them to everyday living.
Activities of the agency staff leading to placement of children and/or
adults in an approved or licensed setting which is suitable to the needs
of the individual; and ongoing activities assuring the appropriateness of
Health Related
and need for that placement through periodic review.
Identifying needs for preventive and prompt remedial medical services,
dental services, locating qualified providers of those services and help-
Protective Payment Services
ing solve any problems which may prevent persons from obtaining and making
optimum use of services available.
Services may include fees for guardians, conservators and related costs of
bonds and filing fees. The decision as to who is to have a protective payee
Home and Financial Management
and the actual selection of the payee are the responsibilities of the income
maintenance unit or agency.
Assisting in or providing for management of household budgets, maintenance
and care of the home, preparation of food, and nutrition.
Transportation
Home Delivered Meals or Congregate Meals
Provision of transportation and related costs to make it possible for in-
dividual or families to travel to and from facilities and resources. Ser-
This means payment for the cost of food, preparation and delivery of meals
vices may include but not be limited to the cost of transportation and
to an individual in his or her home or a central dining facility.
attendants or escorts when necessary.
Housing Services
Services directly benefiting the aged which are receiving the largest
Assisting persons in finding and maintaining living arrangements which
allocations appear to be those which coincide with the state's goal of
are suitable and adequate to meet their housing needs; planning and mak-
ing appropriate alterations in a home to meet specific needs of its occu-
keeping the aged out of institutions. These services are personal care
pants to assure safety and adequate standards; construction of ramps to re-
place stairs if an occupant is wheel-chair bound; rebuilding or rearrang-
(non-medical services to assist in maintaining well-being), chore services
ing kitchens and providing specialized equipment so a handicapped person
may function more independently; adding railing and handholds in strategic
(lawn care, simple household repairs, shopping assistance, etc.), home and
places; or other modifications. (This service includes payment of moving
expenses.)
financial management (assistance with maintenance and care of the home,
food preparation and budgeting), and health-related services which focus
Information and Referral
on preventive and prompt remedial medical and dental care. Where these
Provision of factual information to individuals and organizations concern-
ing human problems and available services and resources. Referral includes
efforts fail to enable aged persons to live independently, a substantial
a follow-up responsibility for verifying that a contact has been made with
the agency to which the client has been referred.
allocation has been provided for planning, placement and supervision to
insure that elderly persons are appropriately placed in a setting which
Legal Services
The services provided by a professionally trained attorney. (For DFS, this
is suitable to their individual needs. Ongoing supervision is also pro-
service consists of referral and follow-up.
vided by means of periodic evaluation and reviews to assure that the
- 10 -
- 11
need for such placement still exists or to determine if alternative living
taxes, etc. and no fee for other services is charged until these essentials
arrangements would be more beneficial.
are met. Some of the services to the elderly to which this administrative
A fee schedule for Title XX services provides that fees will be one-
order applies are outpatient clinic services, inpatient mental health ser-
quarter of the excess monthly income above 80% of the median income, ad-
vices, foster home care, day care, and alchoholic and drug inpatient and
justed for family size. Fees will never exceed the actual cost of ser-
outpatient services.
vices. 115% of the median income, adjusted for family size, is the maxi-
The order is most likely to apply where the recipient of services is
mum income limitation. Gross monthly income limitations for single per-
not an SSI recipient and does not qualify as medically needy under Medicaid.
sons and couples are as follows:
SSI State Supplement
80 % Median Income
115% Median Income
Wisconsin has a federally administered SSI State Supplementation
Single Person
$334
$480
program. Income standards for the state supplement are $228 per month
Couple
556
799
for an individual, $362 for a couple. All SSI eligibles are eligible for
Fees for Services
the supplement as well as others whose incomes fall within the standards.
On December 16, 1974, the State of Wisconsin issued Administrative
Examples - SSI and state supplemental benefits to individuals with and
Order No. 1.42 which provides for a complex schedule of fees, liability
without social security benefits (no other income).
and collections for any services purchased or provided with state funds.
Case I
Case II
(No system has as yet been implemented for fees for county services.)
Social Security
$
0
$186
The schedule is basically an ability-to-pay system based on the state's
1
SSI
157.70
0
expectations by way of collecting. No fees are charged where costs of
2
State Supplement
70.30
62
collecting would approximate or exceed the amount recovered or when the
$228.00
$248
fee is determined to have a sufficiently adverse effect upon the client
As of July 1975, the federal SSI benefit to an eligible individual
that it can be predicted that the positive result intended through de-
with no other income was raised from $146 to $157.70 per month; from
$219 to $236.60 for an eligible couple.
livery of the service would be appreciably impaired.
State supplement is less countable income. $20 of social security is
Each facility operated by DHSS is responsible for deciding whether
excluded.
a fee will be charged and the amount of the fee in accordance with various
Income under the state supplement program is subject to the same exclusions
formulae established for operating and unit costs of the various services
as under federal SSI. States in which the supplement is federally ad-
rendered. Any money available for spending is considered as income.
ministered have established supplemental benefit amounts for individuals
However, the means tests set aside money for essentials of food, shelter,
and couples which vary according to living arrangements.
- 12
13
There is no federal requirement that states adjust supplemental bene-
Medical Assistance (Medicaid)
fit levels as the cost of living changes or that they pass through the
Medicaid in Wisconsin is known as Medical Assistance. It is a broad-
automatic SSI cost-of-living adjustment. Because Wisconsin has what it
based program which offers the maximum benefits available under Title XIX
considers high state supplement benefit levels, it does not pass through
of the Social Security Act. Benefits are identical for Group I (categori-
the cost-of-living adjustment. It was not possible to obtain information on
cally needy) and Group II (Medically needy). According to the director
the number of state supplement recipients who were dropped from the rolls
of the Wisconsin Bureau of Medical Services there was a large upsurge in
due to income ineligibility caused by the July increase in Social Security
participation in October 1974 which has continued.
since statistics on monthly attrition are not cross-tabulated by categorical
Eligibility requirements include verification through proof of age
or a medical report that the applicant is age 65 or over, or totally and
eligibility. Becoming ineligible for SSI, however does not cause most
permanently disabled as currently defined for SSI, or blind. In addition
former recipients to lose medical assistance (Medicaid) benefits, because
the applicant must be a citizen of the U.S. or an eligible alien and a resident
they qualify as medically needy under Medicaid.
of Wisconsin. Economic conditions vary for Group I and Group II eligi-
The following SSI and state supplement data are for August 1974:
bility and are too involved to be included in detail except for annual
Number of Wisconsin Aged
1
receiving SSI payments
32,587
allowable income levels for the medically needy which are $3,400 for an
Average monthly amount of
individual, $4,000 for a couple. (These limits are somewhat below the
combined federal and
state payments
$103.18
federal SSI annual income cutoff levels, $4,800 for an individual and
Average monthly federal
$6,698 for a couple, and substantially below the state supplement cutoff
SSI payment
$ 62.64
levels of $6,492 for an individual and $9,708 for a couple.) Even if
Average monthly state
supplement
$ 64.19
annual income exceeds these amounts, persons may be eligible for benefits
where medical expenses, including health insurance premiums, equal one-
The state appropriation for SSI supplementation was $21 million for
half or more of the difference between annual income and the allowable
fiscal year 1975. The portion of this amount earmarked for the aged was
income levels given above.
not indicated.
The following participation and cost figures were provided on medical
1/ includes persons with federal SSI payments and/or state supplementation.
assistance to the aged for the first three months of 1975.
Average Benefit
Total
Beneficiaries
Per Beneficiary
Benefits
Jan.
47,540
$288
$13,703,749
Feb.
46,153
282
12,019,388
Mar.
48,483
254
12,306,970
- 14 -
- 15 -
Slightly over half of the total benefits in each of these months was
of mental health for older Americans and the care and treatment of the
expended for care in nursing homes or intermediate care facilities. In
alcoholic and other drug abusers, the mentally ill and the developmentally
the opinion of the director of the Bureau of Medical Services, there is a
disabled among the elderly. Their aim is a statewide coordinated system of
great need for the federal government to relax the regulations on outpatient
home, health, and community services to provide older Americans with
services. In many cases elderly patients are institutionalized in order
realistic alternatives to inappropriate placement in institutions. Be-
to receive services which could be delivered on an outpatient basis, allow-
cause the agreement is not fully implemented at the present time, partici-
ing these elderly persons to remain in their own homes or in other living
pation and cost data are not available.
arrangements which would afford them a greater degree of independence and
Nursing Homes
dignity. He also cited the need for federal matching of funds to provide
As of January 1974, the state of Wisconsin converted all but one of
day care for the elderly in skilled nursing home and intermediate care
its 35 county mental hospitals (7,980 beds) to nursing homes in order
facilities which would further the goal of noninstitutionalization of the
to qualify for Federal funding and to meet patient demand. There are
elderly wherever possible.
now 84 county nursing homes with a total of 13,469 residents located
A three-year demonstration project was recently begun in La Crasse,
throughout the state. They represent 68% of the total nursing homes in
Wisconsin to establish community care organizations (CCOs). The major
Wisconsin, but only 24% of total nursing home beds in the state. A 1974
function of the CCO is to locate persons presently in institutions such
report showed that 10.9 percent of Wisconsin's population of persons age
as nursing homes who could be released to outside living arrangements if
65 and over (36,268 persons) were residing in county, nonprofit, or
a minimum of community care were provided. In addition, the CCO attempts
proprietary nursing homes. Over 80% of all nursing home residents are
to locate elderly persons about to be admitted to institutions to de-
over 65 years of age. Approximately 25% of these elderly persons are
termine if the provision of certain health and home care services might
bedridden; the remainder are ambulatory or semi-ambulatory. About one-
preclude the need for placement in an institution. The hypothesis of
third of these patients are private pay and two-thirds receive Title 18,
the project is that by means of a per capita rate paid through Title XIX
Title 19 or Veterans payments. The number of Medicaid patients increased
to CCOs, services could be provided which would keep many elderly persons
by 25% from 22,882 in 1973 to 28,632 at the end of 1974. Very few elderly
out of institutions and greatly reduce the funds currently required for
persons utilize outpatient services. In fiscal year 1974, 1,547 persons
care in nursing homes and intermediate care facilities.
age 60 - 64 received outpatient services and 3,504 age 65 and over, for
Mental Health Services
a total of 5,051. An effort is being made to expand the delivery of commun-
The Division on Aging and the Division of Mental Hygiene are currently
ity-based outpatient services.
working on an agreement to further state policies for the proper maintenance
- 16 -
17 -
One example of a negative program interaction was described with
meals, assistance in locating adequate housing, nursing home placement,
respect to nursing homes. The SSI state supplement program provided
arrangement for guardianship, information and referral, friendly telephone
for a $45 per month personal allowance. In the case of a bedridden SSI
visits, counseling older persons and their families, and adult group home
recipient residing in a nursing home, the personal allowance could accumu-
placement (of which there are very few).
late to the point where it would total $1,500, the assets cutoff point
These services are intended to reduce isolation, to provide some
at which a person is no longer eligible for SSI and therefore not auto-
help to people so that they can continue to live in their own homes, or
matically eligible for Medicaid. Considering that the individual would
to protect them from harm when they are no longer able to take care of
probably still qualify as medically needy under Medicaid, this interaction
themselves.
would not appear to be a serious one. In any event, the personal allow-
County budgets for these services are very small, which accounts to
ance was recently lowered to $25 per month.
a large extent for the small numbers served. Cost figures and fee schedules,
if any, were not included in the report.
Alternative Living Arrangements
Alternative living arrangements for the elderly such as private resident
Public Health Nursing
or boarding homes, adult homes and foster care are decentralized to such
There are approximately 140 public health nursing agencies in Wis-
an extent in Wisconsin that no participation or cost data are available.
consin which are mainly county nurse offices, city and county health
departments, and visiting nurse associations. An estimated 72% of the
County-Delivered Social Services
9,000 persons served by these home health agencies were age 65 or over
A special survey was conducted in February 1974 to determine the type and
in calendar year 1972, the most recent year for which statewide data
extent of social services delivered by the counties to persons age 65 and over.
were available. Payment for these services is on a sliding scale and
The seventy-two counties of Wisconsin provided services to over 7,000 per-
varies by locality.
sons during that month. Among the services provided, purchased or
arranged for by county departments under the supervision of the regional
Housing
offices of the Division of Family Services, DHSS, were homemaker services
The following information on the total housing units under management
(could include personal care, light housekeeping, help with shopping,
for the elderly only as of August 1975 were provided by the Divison on
transportation and consumer education), home health care (provided either
Aging Housing Consultant:
by health aides of county nurse offices or else purchased from friends,
relatives or neighbors), chore services (lawn care, snow removal, errands,
etc.), transportation for medical attention or shopping, home delivered
- 18 -
19 -
areas, one-half to two-thirds of those served were elderly.
a
Housing Program
Total Units
Public Housing
7,091
Homestead Property Tax Credit Program
Rent Supplement (Housing and
In 1964, a law was passed establishing the Homestead Property Tax
Urban Development Act of
1965)
2,194
Credit Program for persons age 62 and over(age 60, if disabled) who own
Leased Housing (Sec. 23)
532
or rent their homes. The law was revised in 1973 to reduce the age of
Interest Subsidy (Sec. 236)
1,076
eligibility to 18. Claimants must have resided in Wisconsin during the
Lower Income Housing Assistance
1,799
entire year preceding the year in which a claim for credit is filed.
(Sec. 8 of Housing and Community
Development Act of 1974)
503 under construction
Income, which cannot exceed $7,000, is defined as the sum of adjusted
Co-op Housing (Sec. 202 of the
gross income, including net income from sources outside the state, alimony,
Housing Act of 1959)
124
support money, the gross amounts of any pension or annuity (including
Rural Rental Housing Loans (Sec. 515)
580
railroad retirement benefits, all payments received under the federal
451 under construction
social security act and veterans disability pensions), SSI benefits,
Total
14,350
non-taxable interest received from the federal government, workman's
compensation and the gross amount of "loss of time" insurance. General
All of these housing programs are federal programs. For eligibility
criteria, see Handbook of Programs for Older Americans which is part
assistance and AFDC recipients are ineligible as of 1973.
of this study.
The tax credit is calculated as follows: If household income was
By November 1976, Wisconsin expects to have 15,319 units under manage-
$3,500 or less during the claim year, 80% of property taxes or rent
ment for the elderly only. This compares with approximately 118,000 elderly
accrued as property taxes can be claimed, subject to a $500 limitation.
poor in the state, some of whom reside in other than private residences.
If income is between $3,500 and $7,000, the claimant can claim 80% of
The Wisconsin Department of Local Affairs and Development, Division
the amount by which it exceeded 14.3 % of household income, subject to
on Housing, confirmed that there are no state housing programs exclusively
a $500 limitation. The percentage of rent allowed as tax equivalent is
for the elderly. There are a number of Community Action Programs (CAPS) funded
25% (does not include utilities). Nursing Home residents can claim $15
by OEO which help people sell their homes and contract for repairs, but
per week.
these programs are not statewide, nor are data available by age. Last
In fiscal year 1974 there were about 193,000 claimants and the aver-
year some federal money was channeled to CAPs from the Federal Energy Agency
age payment per claimant was $183. The total amount of the credit was
for a home winterization program which provided insulation, weather stripping,
$35.4 million. Since the program was revised in 1973, changing age of
space heaters and emergency fuel aid. No data are available on the number
eligibility to 18, there are no precise data available on benefits to
of elderly served. However, it was estimated that in rural low-income
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- 21 -
persons age 62 and over. However, a legislative audit of 300 claimants
indicated that in fiscal year 1974, 85% of the claimants were 62+. The
In every Wisconsin community where there are public transportation systems
Revenue Department official interviewed cautioned that that percentage is
there are reduced fares for the elderly. The reduction is usually 50% during
closer to 60%, with the elderly receiving about 70% of the total tax credit.
off-peak hours. The transportation systems are subsidized by Federal and State
In fiscal year 1973, the last year in which only elderly persons were
funds for deficits and are therefore not directly related to providing reduced
eligible, there were 81,000 claimants. The average credit was $114 and
fares for the elderly. Consequently, there are no data indicating how many
the total credit was $9.2 million.
elderly persons are served or what the dollar amount of the benefit to them
Transportation
might be.
There are a few vehicles for transporting the elderly under Title III
Nutrition
of the Older Americans Act: 15 vehicles (8 - 18 passenger) funded under
Nutrition projects under Title VII of the Older Americans Compre-
new Title III and 44 vehicles under old Title III. Escort services under
hensive Service amendments are not statewide as yet. They are operated as
Title III allow reimbursement mileage for travel in some cases.
county projects, and presently 19 counties plus the Inter-Tribal Council have
As of June 30, 1975, the Urban Mass Transit Authority (UMTA) notified
nutrition sites. The cost is about $2.00 per meal which includes food, labor,
Wisconsin of the approval of 30 proposals totaling $623,000 for projects
administrative and back-up services. Food stamps are accepted by eight of the
scattered throughout the state. This will be an ongoing program, but the
projects, and all projects utilize commodities from the federal commodity distri-
money is strictly for capital grants which do not cover operations costs.
bution program. The meals are served in churches, city halls, community and senior
Approximately 50 vehicles (vans and buses) will be purchased to serve the
centers. Schools, hospitals, nursing homes, religious houses and food service vendors
elderly and the handicapped. Eligible applicants must be nonprofit organi-
prepare and transport the food to the sites. Support services such as trans-
zations not controlled or appointed by a government. Examples of non-
portation and escort, outreach, information and referral, recreation, nutrition
profits applying are the Red Cross and churches. The sponsor has to be
education and shopping assistance are an integral part of the nutrition program,
located in a town with a population of 5,000 or more. Rural needs in
since the aim is to provide a total service which fulfills both the nutritional
Wisconsin will be met by restricting the operation in the cities to 50%
and the social needs of the elderly. General guidelines and suggestions for
of the time. The other 50% of the time, the vehicle must serve the rural
implementing supporting services are provided to the projects and participants
areas. The Wisconsin Department of Transportation and DHSS (Division on
are surveyed to determine their needs and interests.
Aging) are working together to implement the projects.
During fiscal year 1975 there were 16 projects in the state (three addi-
tional projects were added after June 30, 1975), with 114 nutrition
sites in operation (57 each in urban and rural areas). A total of 152
full-and part-time staff members and about 1,500 volunteers, over half
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of whom are age 60 or over, operate the projects. The total number of
different individuals who participated in the program was 54,719.
in excess of 65¢ per meal; costs in excess of 85¢ may be chargeable to
Indians. this total, 51,651 were white, 1,117 were black, and 1,817 were American Of
the participants. Capital equipment costs are not allowable in deter-
meals 1,341,527 meals were served in a congregate setting and 134,369
mining the district's average meal cost: Minimal nutritional standards
were home delivered. Approximately 30,000 of the participants (55%)
are established, consistent with federal standards and reasonable expen-
were below the poverty level. There are over 600,000 noninstitutionalized
diture limits.
persons 60 years of age and older residing in Wisconsin and more than
The program runs for the school year. An estimated 5,264 meals
one-fifth (120,000) of them have incomes below the poverty level. Presently,
were served during the last school year to approximately 1,000 persons.
only 25% of this population is being served by the program. However,
Figures on the cost to the State were not available at the time of the
progress is being made in attracting local funds which will facilitate the
state visit.
expansion of the projects. Last year $50,000 was raised from general
Title III Programs
operating funds. County Boards are also showing increased willingness
Nine area agencies on aging are located throughout the state which
to allocate some of their money for the projects. Total expenditures
offer largely support services such as transportation, escort, outreach,
funds. for FY 1975 amounted to $2,843,682, of which $288,375 were non-federal
and information and referral in addition to gap-filling services which
are purchased. An effort is being made to change the philosophy of
To augment the Title VII program, legislation was passed by the
area agencies from that of providers of funds and services to the role of
Wisconsin Legislature in April 1974 authorizing the establishment of
planning, coordinating and organizing. The area agencies are each com-
the elderly nutrition improvement program in the public schools and placing an
mitted to the state policy of providing systems and services as alterna-
administrative responsibility for carrying out the law in the Depart-
tives to placement in nursing homes and other institutions. There is no
ment of Public Instruction. If such a service is desired, the School
comprehensive state plan on aging at the present time, but work has begun
Board develops a plan for provision of the services. Each district food
on the development of a comprehensive five-year plan of health and social
service plan must provide for at least one meal each day that the school
services. No participation and cost-per-service data are available be-
is in regular session.
cause reports of the area agencies to the Division on Aging do not contain
Wisconsin residents 60 years of age or older and the spouses of
detailed estimates of such information.
such persons are eligible. They may be required to contribute up to 65¢
per meal to help defray the district's food and production expenses. The
Board on Aging
School Board may file a claim with the Department of Public Instruction
In 1971, the Wisconsin Legislature established a Board on Aging
for reimbursement payments up to 20 cents a meal for allowable expenditures
appointed by the Governor. The Board serves as an advocate in behalf
of older persons in the state and is not tied in with the Division on
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- 25
of Aging. It has no control over resources but works closely with a coalition
five aging groups to introduce legislation to help the elderly. To date
bills have failed to be passed which were introduced to provide
benefits as a statewide nutrition program to augment the Title VII such
GEORGIA
Tax disregard of social security benefits as income under the Homestead program, Property
Credit Program, a double exemption on state income tax for senior
In 1974, an estimated 575,000 persons in the state of Georgia were age
citizens, state revenues to match local efforts in building or expanding
60 and over (12% of the state's total population). Approximately 25% of
and multipurpose senior centers, and the creation of a task force to study
these persons (141,000) resided in Metropolitan Atlanta. The 400,000 persons
make recommendations for solving transportation problems of the rural
who were age 65 and over comprised 8% of the state's total population.
elderly. Although the Board has the support of the Governor, its bills have
Approximately 41% of those 65 and over had incomes below the poverty
not gotten beyond committee hearings.
level, resulting in 3.5% of Georgia's population being both 65+ and poor.
42% of the 65+ population reside in rural areas.
In 1972, there was an extensive reorganization of the state government,
resulting in the abolishment of the Former Commission on Aging. Functions
of the Commission were transferred to the Office of Aging which became part
of the newly created Department of Human Resources (DHR), which functions as
an umbrella agency to provide human resource programs through a statewide,
integrated service delivery system to needy persons of all ages. One-half
of the employees of the Georgia state government are employed in the
Department of Human Resources. The department's total budget for fiscal
year 1975 was $804.8 million. The Office of Aging's share of this budget
was $3.8 million, $353,234 of which consisted of state funds.
The seven area agencies on aging throughout the state work closely
with the ten district areas of the DHR to bring a wide range of human
services on a coordinated basis to those who need them.
It should be noted that generally the data gathered in Georgia for
this report did not contain the levels of detail of that collected in the
other states visited. Participation and financial data were provided
-26 -
27 I I
orally, and in most instances the interviewer did not have direct access
In addition some non-contract services are provided to the aged, such
available. to reports. Copies of regulations and legislation were not readily
as protective services, assistance in obtaining adequate housing, recreational
services, and information and referral. However, estimated numbers of
persons by age and corresponding cost breakdowns for these services are not
Title VI and Title XX, Social Services
available. No fee schedule will be used in implementing the Title XX plan
Georgia is presently at its maximum federal allocation of $56.6 million.
once eligibility has been determined. The gross income limits for income
An additional $14.2 million of state funds brings the total budget to
eligible participants are $4,056 for an individual and $5,304 for a couple.
$70.8 million.
Aged SSI recipients are automatically eligible.
As in many other states, programs under Title XX of the Social Service
Amendments will be quite similar to those under old Title VI with few new
State Supplementation of the Federal SSI Benefit
In July 1973, a federal amendment (Public Law 93-66) required states to
unchanged. programs offered because the total funds available for such programs is
make mandatory supplement payments to all persons receiving assistance in
December 1973 under former assistance programs whose income would otherwise
There are six services aimed primarily at the aged population: day
be reduced by transfer to the SSI program. For the period July-September
care for adults, adult foster care, chore services, homemakers services,
home-delivered and congregate meals and transportation. In addition some
1974, Georgia's mandatory state supplement totaled $402,000 or an average
health-related services are provided to the aged but these data were not
payment of $27.92 per month to aged recipients. Of the total 92,229 aged
is broken out by age. Approximately 6% of the total contract services budget
recipients in Georgia, approximately 14,400 were eligible for the mandatory
supplement. The average combined monthly federal SSI and mandatory state
spent for adult services. The major portion of the budget provides
day care for children and programs related to retardation.
supplement payment to the 92,229 eligibles in August 1974 was $83.63. There
is no optional state program in Georgia. Aged SSI recipients in August 1974
The following data are for contract services provided in fiscal year
1975 under Title VI:
represented about 23% of the state's total population who are age 65 and over.
A statewide SSI Alert Plan funded by AOA was inaugurated in early 1974.
Service
Estimated Number of
Day Care for Adults
Aged Clients Serviced
Outreach and referrals were handled through contracts with the Red Cross and
Cost
Adult Foster Care
1,177
Chore Services
201
$265,627
Community Action Programs. 6,973 applicants were determined as eligible
Homemaker Services
920
211,625
Home-Delivered and
2,365
180,856
through this program.
Congregate Meals
447,360
Transportation
2,883
7,146
382,810
Total
1,191,431
14,692
$2,679,709
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- 28 -
Medical Assistance Program (Medicaid)
of the Metropolitan Atlanta Visiting Nurse Association provided some data
Medical assistance comprises one-third of the Department of Human
for the first six months of 1975. Of 8,104 visiting nurse visits and 6,671
Resources annual budget. The Medical Office was in the midst of a financial
health aide and homemaker visits, an estimated 537 patients age 60 and over
crisis at the time of the state visit, operating $69 million in the red.
were served. Payment is made on a sliding scale. The ability-to-pay schedule
The official interviewed indicated that financial reports are not disaggregated
showed that persons or couples with net incomes below $4,000 per year are
by categorical eligibility, but he said he would try to obtain some estimates
charged no fees. Fees are nominal up to a net income level of $7,000.
of the number of aged beneficiaries and total cost figures. Follow-up efforts
Residence and Boarding Homes for the Aged
to obtain this information have been unsuccessful.
The Golden Age Information and Referral Service, sponsored by the
In addition to the mandatory services under Medicaid, the following
Atlanta Council of Jewish Women assists elderly persons in metropolitan
optional services are offered: full-service pharmaceutical, podiatry,
Atlanta to locate residence or boarding homes consistent with their ability
intermediate care, prosthetics and refractive optical services. The dental
to afford such living arrangements. There is no state licensing for these
program has been cut back to serve only persons under 21 years of age.
homes and in most cases the residents must be able to take care of their
Eligibility is determined by the Division of Social Services or by the
own personal needs. A few of the more expensive ones have a doctor and/or
Social Security Administration in the case of SSI recipients.
nurse in residence. Some of the units do utilize rent supplements but no
Nursing Homes
data are available on the number of elderly receiving supplements for this
There are 345 licensed nursing homes and intermediate care facilities
purpose. Since Medicaid cannot be used for this purpose, many persons who
(ICFs) in the state. Most of which are proprietary. The ratio of nursing
are ambulatory and require minimum health care are placed in nursing homes,
homes to ICFs is approximately three to one. Together they provide 29,338
when there is no other place for them to go.
beds which are occupied primarily by elderly patients. 80% of the patients
A directory of homes for the aged in Atlanta indicated that residents
are covered by Medicaid; the remainder are private pay or receive Medicare
are predominantly white females.
or veteran's benefits. Medicaid covers charges up to the following
Family Foster Care for the Aged
maximums: $500 per month for intermediate care, $550 per month for skilled
As of August 1975 there were 800 adults placed in foster homes. Only
nursing home care.
75-100 of these persons are elderly. Most of the elderly who might be more
Visiting Nurse Services
appropriately placed in foster homes are placed in nursing homes because
It was not possible to obtain statewide information on public health
there are no funds available to expand the foster care program. The
nursing services to the elderly. However, the support service coordinator
maximum payment to home providers is $185 per month. Adults living in
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- 30 -
for the implementation of this act and other protective services is scheduled
foster homes receive a $25 per month personal allowance. According to
be issued in late November. It is expected that the issuance and use
the chief of the Supportive Living Unit Mental Health Division, it is not
to of the manual will enable county caseworkers to expand the scope of protective
difficult to find home providers. There is no means test for this program.
services to those in need of them.
The major criterion is whether the person would be better cared for in a
family environment. Over 1400 elderly persons have been identified who
could leave nursing homes for foster homes if there were funds available.
Housing At the end of January, Georgia received notification of HUD approval of an
A request for $1 million in state funds for home providers has been submitted
million grant under Section 8 of the Housing and Community Development funds Act
to the legislature, but there is little optimism that this amount will be
$18 of 1974 for a housing assistance payments program to supplement subsidy
appropriated. That amount would defray the annual cost of providing homes
previously authorized for leased housing. The allocation for Standard Metropoli-
for about 450 persons. The opinion was expressed by a number of state
Statistical Areas (SMSAs) is $10 million which could support approximately
program people that once an elderly person is placed in a proprietary
tan new or rehabilitated housing units or 5,800 existing units. For non-SMSAs,
nursing home, there is little likelihood of being placed in an alternative
3,800 the allocation is $8 million, which could support about 3,000 new or rehabilitated of
living arrangement.
units or 6,000 existing units. At the present time it is not clear how many
these units will be under management for the elderly.
Protective Services
There are no state or private housing programs for the elderly in
Legal assistance is available to the staff of county departments of the
Georgia. The only public housing provided for them is through federal
Divison of Family and Children Services, DHR, in all 159 counties in providing
programs. Following is a summary of housing units under management for
protection for adults and children from self-neglect, neglect by others,
abuse and exploitation. Effective July 1, 1974, a bill was passed to
the elderly:
Total Units
Housing Program
strengthen these services for adults determined to be mentally retarded or
7,000*
Public Housing
incompetent to manage their own estates. The major provision of the act
LowerIncome Housing Assistance
1,000
(Section 8)
is for the appointment of guardians through the courts. When necessary,
Rental or Co-op Housing (Section
202 of the Housing Act of 1959)
2,575
the Commissioner of the Department of Human Resources will be appointed
Rural Rental Housing Loans
417
(Section 515)
guardian, as in the case of a person who has no relative or friend deemed
10,992
Total
capable of assuming guardianship. In these cases, the Commissioner will
appoint a county caseworker from the Division of Family and Children Services
This total of 10,992 compares with approximately 164,000 elderly poor in
to act in his stead as guardian. A draft of a policy and procedures manual
*There are approximately 50,000 public housing units in the state.
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The first claims under this program were filed in 1975. Because the
the state some of whom reside in other than private residences.
programs are locally administered, the Department of Revenue could not
Property Tax Reduction Programs
provide participation and benefit data.
In 1964 a law providing for the Real Property Tax Credit Program was
enacted to provide tax relief for homeowners 65 years of age and over by
Transportation There are seven public transportation systems in seven cities of Georgia.
means of a reduced assessment. Every homeowner in Georgia is eligible for
All but one receives federal subsidies and provide reduced fares for the of
a $2,000 reduced assessment. This program provides for an additional
elderly, some at off-peak hours. No data are available on the number
$2,000 reduction for elderly homeowners, or a total reduction in assessed
persons served.
valuation of $4,000. The net income limit for this reduction is $4,000.
A survey of 22 counties was conducted in 1975 to assess the transportation
Until January 1, 1975, net income was defined the same as for federal and
of the elderly and the handicapped in connection with a request for an Urban
state income tax purposes. Effective with claims filed in 1975, social
needs Transit Authority (UMTA) grant. Difficulty was encountered in providing
security and pension payments can be excluded from net income up to a
Mass matching funds. Consequently, the grant was reduced from $465,000 to $253,000, 24
maximum for a couple of $7,296, which means that some elderly couples can
$36,240 in matching funds. The outcome of the project was to provide
have a net income of up to $11,296 and still be eligible for the $4,000
with some specially equipped for persons in wheelchairs, in four counties. There
reduced assessment. For the tax year 1974, 75,000 persons qualified for
buses, is still a problem of meeting operating costs since the UMTA funds which are capital
the reduced assessment. Because tax rates vary considerably from
which cover only the purchase of vehicles. A nominal fare
jurisdiction to jurisdiction, the Department of Revenue was reluctant to
grants varies by county is charged for transportation provided by these vehicles.
estimate the average benefit. The number who qualify for this benefit is
Data are not available on the actual number of elderly persons served.
expected to increase substantially in 1975 because of the change in the
definition of net income.
Nutrition Programs
As of July 1, 1975 there were eight Title VII nutrition projects
In addition to the above program, Georgia enacted in 1974 a property
serving 83 of Georgia's 159 counties at 85 sites (51 urban and 34 rural).
tax reduction program for the levying of school district taxes. This
Another project was added in July which serves 10 more counties at 6 sites.
program also affects homeowners age 65 and over. The gross income limit
Three more projects are planned which would serve an additional 26 counties,
is $6,000 and includes income from social security and pensions. The benefit
but dates have not yet been set for the start of these projects.
is in the form of a $10,000 reduction in assessed valuation for school
825,273 meals were served in a congregate setting (senior centers,
district taxes. The assessment rates vary by locality, and the local tax
school cafeterias) and 83,824 meals were home delivered the at an
assessors determine eligibility.
churches average cost and of $1.70 per meal. Food stamps are accepted by 8 of projects.
- 34 -
- 35
Supportive services, such as transportation and escort, outreach,
counseling, and information and referral. A needs assessment of these
recreation, nutrition education, information and referral, and shopping
areas indicated that the most critical needs of the elderly in these areas,
assistance, are provided within the 20% ceiling set for these services.
as perceived by the program staff, were for adequate housing and income.
A total of 136 full- and part-time paid staff members and about 873
Transportation ranked third.
volunteers, three-quarters of whom are age 60 and over, operate the projects.
Statistics on the number of persons age 60 and over being served by
The total number of different individuals who participated was 14,382. Of
Title III programs were incomplete or not given for all areas except Atlanta
this total, 7,761 were white, 6,617 were black and 4 were American Indians.
where approximately 48,000 are being served.
(Only 28 American Indians in Georgia are known to be age 60 or over.)
A tie-line or toll-free number which persons throughout the state can
Approximately 11,666 of the participants (81%) were below the poverty level.
call for information and referral is in operation as part of the Title III
An estimated 164,000 of persons age 65 and over have incomes below the
program. According to the field service representative interviewed, the
poverty level. Approximately seven percent of these persons were served
line has not been too effective in bringing together those in need and
by the program. The total cost of the program for fiscal year 1975 was
service providers because of insufficient publicity of the telephone number,
$1.9 million, of which $141,500 were state funds. The budget for
skepticism on the part of the elderly that they may have to pay for the
1976 is set at $2,051,000 ($1.8 million in federal funds and $251,000 in
call, and the fact that many of the rural poor do not have telephones.
state funds).
There are a few meals-on-wheels programs in the state funded in part
by revenue sharing, churches and other private organizations which are
not part of the Title VII program, but no participation and cost data are
available.
Title III Programs
There are seven area agencies on aging in the state. Except for
Atlanta, each area unit operates with a small staff of two or three persons.
They rely heavily on volunteers for outreach efforts. A review of the
area plans of five of the area units revealed that the range of services
offered includes homemaker and chore services, transportation, telephone
reassurance, recreation, loan of ambulatory devices (wheelchairs and walkers),
- 36 -
- 37
MASSACHUSETTS
Through the Department of Elder Affairs, a new approach to
the entire social service delivery system has been set in motion. Programs
In 1974, an estimated 900,000 persons in the Commonwealth of Massachusetts
previously administered by various state agencies such as the Department of
were age 60 and over (15.6% of the state's total population). Persons age 65 and
Public Welfare, the Department of Community Affairs, and the Department of
over totaled approximately 652,000, or about 11% of the state's total population.
Educational Affairs are being transferred to the DEA. The approach contrasts with
An estimated 48% of these persons resided in the Boston Standard Metropolitan
previous delivery systems which combined social services, income maintenance
Statistical Area. Approximately 19% of those 65 and over had incomes below the
programs and vendor payments under the administration of a vast number of
poverty level, resulting in 2% of Massachusetts' population being both elderly
state employees accountable to offices and agencies within the extensive
and poor. An estimated 88% of the elderly population reside in urban areas.
hierarchy of state government. The DEA service delivery system is adminis-
In 1970, the Massachusetts State Legislature passed a bill creating the
tered by a small core of administrative staff which controls the planning and
first cabinet-level agency on aging in the country, the Executive Office of
administration functions related to service delivery to the elderly. The
Elder Affairs, which raised the previous state unit on aging to the top admin-
actual delivery of services is provided largely by private agencies under
istrative level of the state government. In 1973, the Office of Elder Affairs
contract to DEA and its Home Care Corporations. Payments to recipients and
was made a permanent part of the state government through the legislature's
fer vendors are handled by the Massachusetts Rate Setting Commission. The trans-
of responsibility for social services to the elderly is being accom-
adoption of Chapter 1168, establishing the Massachusetts Department of Elder
plished on a phased-in geographical basis. The first purchase of service
Affairs (DEA). It is not housed within any other agency of state government
agreements were signed by DEA and the Welfare Department in 1973, complete
but functions independently as an advocate for the elderly population and as
transfer of services is still underway.
a planner, developer and coordinator of comprehensive services for the
The DEA budget for fiscal year 1975 was $4.8 million, of which $3.65 million
elderly.
which were state funds. The department expects to receive $6.3 million for FY 1976,
The department has statutory authority to create and supervise locally
Title VI an estimated 30% will be state funds. The department received $1,125,000 of in
based, consumer-oriented Home Care Corporations which will be discussed in
funds in 1975, all of which was used for the Home Care Program.
detail in another section of this report. In addition, DEA's statutory activi-
Home Care Corporations
ties in inter-agency affairs includes input on all matters relating to the
A home care corporation (HCC) is a private, nonprofit agency chartered
licensure of longeterm care facilities (nursing homes) and the rules and regu-
by the state under auspices of the DEA. The primary goal of an HCC is to
lations governing them, review of regulations of the Department of Public
coordinate health and social services for persons age 60 and over in its area. Of
Welfare relating to the elderly (including medical assistance), and review of
the design of housing to be provided for the elderly.
to man the Manual, U.S. Senate a report by Helen C. O'Malley, Senior Project from the DEA Ombuds-
1. The information reported on HCC's was derived
views with various DEA Special staff Committee members. on Aging, Oct. 15, 1974, Coordinator, and from inter- DEA,
- 38 -
- 39 -
particular concern is the delivery of social services at a level which
As of August 1975, 18 of the projected 27 Home Care Corporations were
would prevent placement in institutions and allow elderly persons to remain
fully funded and operating in over 120 communities in the state. A statis-
in their own homes or familiar surroundings where they have a greater degree
tical analysis for the fourth quarter of 1975 revealed the following break-
of independence and sense of self-worth.
down of participation and services for all 18 HCC's:
The Home Care Program consists of two basic organizational units which
are (1) Home Care Corporations which plan and coordinate for certain geo-
Average Clients
Service
Served per Month
graphical areas consisting of several town or cities and (2) one or more
Home
1,584
Home Care Service Units which are responsible for the delivery of services
Chore
694
Transportation
in specific areas of the corporation's responsibility. The Corporations may
2,144
Housing
39
contract for services with local agencies to be provided through all or any
Health
1,217
Legal
one of their Home Care Units.
60
Each HCC is governed by a Board of Directors, averaging 17 to 21 members.
Homemaker services include food shopping, personal errands,
65% of whom are present or potential consumers, age 60 or more. The Boards,
light housekeeping, meal preparation as necessary and related activities.
which are designed to be geographically, racially, ethnically and economically
Chore services provide help in home maintenance, such as heavy household
representative of the local elderly population they serve, function in a
cleaning, minor repairs, snow removal and relocation preparation. Trans-
policy-making capacity, including priority-setting, financial review, evalua-
portation services provide mobility and independence through transportation
tion, and personnel decisions.
tral meal sites, medical appointments, community service agencies and
The staff of each HCC is composed of an executive director, a community
other loc ions. These are the three major services provided by HCC's.
services coordinator, an intake supervisor (responsible for introducing cases
ao
ion, certain supportive services were provided during the
to the system), a fiscal manager, clerical staff, and caseworkers/case
uar er of 1975 as follows:
managers in proportion to the population served (presently 1 to 100). The
HCC is responsible for providing eight basic services which include homemaker,
Average Clients
Service
Served per Month
chore, transportation, health, legal, housing assistance, nutrition and infor-
utreach
2,117
mation and referral. Information and referral and intake services are per-
'iendly Visits
788
formed directly by the HCC; other services are provided by community-based
lephone Reassurance
591
cort
113
agencies or groups under contract with the HCC to meet the special needs of
Over 10,000 indiv.duals (unduplicated count) received information and re-
the elderly. Not all HCC's offer all eight basic services.
ferral services during the fourth quarter of 1975.
- 41
- 40 -
recipients and income eligibles under Title XX. In the fourth quarter of
The total Home Care Program budget for 1975 is $3.6 million. The
1975, two out of every three clients receiving direct services were non-SSI
primary funding sources for the HCC's are Title III of the Older Americans
recipients.
Act ($2.1 million in FY 1975) and Title VI of the Social Security Act
The Home Care Program, in addition to services provided by the HCC's,
($1.5 million in FY 1975). These figures include state matching funds.
also assists in integrating nursing home residents into a community or family
Beginning with fiscal year 1976, the Home Care Program will tie in with
setting through a nursing home furlough program which was established in
Title XX of the Social Service Amendments to the extent of $5.3 million,
March 1974. Through this program, a medicaid recipient can be absent from an
providing increased financing. This tie-in is expected to have a signifi-
intermediate care facility for nonmedical reasons for up to ten days per calen-
cant effect on the composition of the elderly population served because
dar year (up to five days from a skilled nursing home) without loosing his
the program will go from an income-declaration system to an income-
place in the facility. Wherever possible ,support services are provided within
verification system in order to comply with Title XX eligibility require-
the community (usually by HCC's) to allow the patient and his family to experi-
ments. The income limits under Title XX will be $4,800 for individuals
ment with an independent living situation. The DEA and Department of Public
and $7,300 for couples. The only way that non-SSI recipients who are not
Welfare (which administers the medical assistance program) are cooperating to
expand the medicaid reimbursement structure to include a broader range of home
income eligible under Title XX will be able to utilize HCC services will
care services.
be through the availability of Title III money (a substantial portion of
The Home Care Program has also instituted the Elder Ombudsman Program to
Title III money is earmarked for the Home Care Program in 1976) or through
assist elderly persons residing in nursing homes by promoting involvement of
a voluntary fee system. The DEA expects that some elderly persons current-
the community through volunteer visiting programs and by attempting to resolve
1y utilizing the services of HCC's may discontinue their participation
the complaints and problems of nursing home residents. This program is coordi-
when it becomes necessary to submit to verification of their financial
nated with another project administered by DEA known as the State Nursing Home
status The tie-in with Title XXX funds is also expected to exert
Ombudsman Office, funded through a grant from AOA. During the past year this
increased pressure on the voluntary fee system which will apply to non-SSI No
office's efforts were directed toward establishing a nursing home information
recipients and others who exceed the income standards under Title XX.
clearinghouse within the DEA, developing rate-setting policies aimed at improv-
estimates have been made for fiscal year 1976 of the composition of the
ing patient care, facilitating complaint-solving by appropriate agencies, and
HCC clientele, but it is expected that it will consist increasingly of SSI
developing a legal-aide program for nursing home residents.
Legal Services
of DEA representatives that some of "relief" these
2. It is the opinion aversion to some programs that connote "welfare" and or assets.
Adult protective services legislation has been proposed in Massachusetts
persons and resent may the have necessity an of presenting proof of their income
but as yet has not been enacted. However, the 88 Ombudsmen in the state are
- 42 -
- 43 -
informed on the legal assistance resources available in the state and
assist their elderly clients to exercise their legal rights with respect to
services although the program people acknowledge that there is a great need for these
such matters as evictions, violations of the State Sanitary Code, consumer
as one alternative to placement in institutions.
protection credit problems, age, sex, and race discrimination, execution of
of Homemaker which services are purchased through 50 homemaker service
wills, conservatorships and guardianships, and involuntary commitment to
sist some of light are nonprofit and some of which are proprietary. The agencies,
mental institutions. The Ombudsmen provide this assistance through a variety
estimated 7,500 housekeeping, meal preparation, laundry, and shopping services con- An
of resources, such as OEO funded legal assistance projects, the Office of the
of Public elderly persons received these services through the assistance.
Public Defender, Legal Aid Societies, and such other public and private
VI funds. Welfare in fiscal year 1975, at a cost of about $4.8 million Department in Title
resources as may be available in their communities.
of Chore services were provided to an estimated 350 elderly persons
Long Term Care Facilities
offered cost $300,000 in Title VI funds. These chore services differ at a
There are approximately 48,000 nursing home beds in the state, locat-
worker by HCC's in that they are non-contract services. The local from those
ed in 600 nursing homes and 350 intermediate care facilities. About 75-
to perform makes arrangements with the client, who contacts a friend social
80% of the services provided by these long-term care facilities are paid
services. the service. The Welfare Department is billed monthly or for neighbor the
for with Medicaid funds. The remainder are private pay, or paid for by
Medicare or veterans benefits. Medicaid eligibles residing in these
By fiscal 1977 it is anticipated that the transfer of social
facilities receive $25 per month for personal needs. Figures were not
Affairs the elderly from the Department of Public Welfare to the Department services to
Welfare will be completed. In the interim, approximately $6 million of Elder
available from the Department of Public Health on the number of rest homes
in the state which also serve the long-term care needs of the elderly but
emergency Department's budget will provide homemaker, chore, transportation of the and
million services to the elderly. This amount is in addition to the
are not paid by Medicaid. Ninety percent of the long-term care facilities
which will of Title XX funds earmarked for the Home Care Program in fiscal $5.3
are proprietary; the remainder are nonprofits operated mostly by religious
federal result in a total of $11.3 million of the Massachusetts 1975 Title 1975, XX
organizations. In 1974, an estimated 7% of the state's population 65 years
Americans. allocation of $69.4 million (16%) being spent on services for older
and over (about 50,000) resided in some type of long-term care facility.
SSI State Supplement
Title VI and Title XX Social Services
The two major direct services provided to the elderly in Massachusetts
Massachusetts has a federally administered SSI State Supplementation
under Title VI are homemaker and chore services. Transportation in some
supplement program which servès over 70,000 aged persons. Income standards for the
cases is provided indirectly, but no data are available on the numbers of
are $269 for an individual and $410 for a couple. All Federal state SSI
elderly served. No day care services are provided for the elderly in Massachusetts,
fall recipients are eligible for the supplement, as well as other whose incomes
within the standards.
45
44 -
Medical Assistance (Medicaid)
In 1973, the state legislature passed a guaranteed minimum income law
Massachusetts provides a broad based system of medical assistance which
which provided that persons receiving SSI benefits would have their supple-
provides 16 services. Eight additional services are available under certain
mentary state benefit increased by 10% as of March 1974. One intent of the
circumstances but require prior approval of the Welfare Department which
administers medical assistance.
law was to provide for the subsequent pass through of cost-of-living increases
In fiscal year 1974, 43% ($460 million) of the state's annual welfare
in social security benefits in 1974. However, a similar increase was not
budget was allocated to the Medical Assistance Program. An estimated $209
granted in July 1975 when the most recent increase in social security
benefits was granted because no final state budget had been passed by the
million, or 45% of the total medical assistance budget, was expended for
legislature. Consequently, the 1975 increase was not passed through, and
services for aged SSI recipientsand aged medically needy persons. The
it is not expected that it will be included in the budget when it is
average monthly aged SSI caseload in fiscal year 1974 was 58,081. The
finalized. The cost-of-living provision would have raised the income
average monthly caseload for aged medically needy persons was 42,248.
standards for the state supplement to $290 for an individual and $443 for
Economic circumstances determining eligibility vary for the two groups and
are too complex to be included in detail. However the net income exemptions
a couple.
for medically needy (non-SSI) persons living in their own homes are $3,504
The following SSI and state supplement data are for August 1974:
for an individual and $4,296 for a couple. These exemptions are somewhat
Number of Massachusetts aged
71,984-
below the federal SSI annual income cutoff levels, $4,800 for an individual
receiving SSI payments
and $6,698 for a couple, and substantially below the state supplement cutoff
Average monthly combined
federal and state payments
$ 149.86
levels of $7,476 for an individual and $10,860 for a couple. However, even
Average monthly federal SSI
$ 66.25
if a medically needy person's income exceeds the amount of the net income
payment
Average monthly state supplement
$ 111.91
exemption, he may still be eligible for medical assistance under certain
circumstances. A six-month period is used in determining eligibility rather
Includes persons with federal SSI payments
than a monthly period because in certain cases income can fluctuate con-
and/or state supplementation.
This is an average of only those receiving
siderably from month to month.
federal SSI benefits, whereas the other
averages are based on all those persons
Example:
receiving federal and state payments, plus
Assume a non-SSI recipient age 65 who lives alone had
those receiving just state supplements.
net income of $2,500 for the six-month period used for a
determining eligibility for medical assistance:
SSI beneficiaries are not eligible for food stamps in Massachusetts. How-
$2,500
net income
-1,752
net income exemption for 6 months
ever, the state supplement payment levels include an amount equivalent to
(1/2 of $3,504, annual net income exemption)
$ 748
the cash value of the food stamp bonus.
amount of medical expenses the person must
pay himself
3. Based on a 10-month average, September 1973 - June 1974.
- 47
46 -
al expenses:
available to low-income elderly persons. There are fewer units under the 707 program
Assume further that he incurs
(an estimate was not available) than under the 667 program. However, eligibility
$3,000 medical expenses
- 748 amount person must pa
requirements, the application process, rental procedures, and management by the
$2,252 amount paid by medicaid
local housing authorities are the same for both programs.
following participation and cost figures were provided on 80,000 medical
Persons 65 years of age and older or couples, one of whom is 65 or older,
The to the aged for January 1975: 40,712 of the estimated
may be eligible if annual adjusted gross income does not exceed $4,500 (for an
assistance recipients in the state received $3.4 million in benefits. addition, These
individual) or $5,000 (for a couple), and total assets (savings, stocks, etc.)
aged SSI in most cases were direct payments to individuals. In received
do not exceed $10,000. There is no residence requirement. The housing authori-
benefits aged non-SSI recipients of the estimated 42,000 eligibles benefits were
ty may not charge the tenant more than 25% of monthly income for rent, 20%
34,810 totaling $16.5 million. These medical assistance the
maximum if the tenant pays the utilities. Once a person's or couple's rent has
benefits vendors rather than as direct payments to individuals. of 34,810 care
been set by the housing authority, annual income may increase by up to $1,200
paid to beneficiaries, an estimated 21,000 were patients in long-term for facili- this
per year without the rent being increased.
non-SSI and ICFS), which accounts for the much higher cost total
In some cases, elderly persons may have assets in excess of the $10,000 limit as
ties (nursing homes for August 1975 showed that 42%, or $20 million of the of aged and medi-
when they sell a home prior to moving into elderly housing. The amount of
group. Figures benefits ($47 million) paid that month went for care $16 million
assets above $10,000 may be placed in an irrevocable trust or an annuity. These
cal assistance combined in long-term care facilities. Approximately for aged SSI
persons may receive income from the assets, but such income is not considered as
disabled persons the total expended for care in long-term care facilities was An estimate
assets for the purpose of eligibility as long as such income, plus their regular
(80%) non-SSI of recipients. The balance was expended for the disabled.
income, does not exceed $4,500 for an individual or $5,000 for a couple at
and of the number of disabled persons age 60-64 is not available.
the time the application is approved.
Almost all housing authorities have long lists of eligibles waiting for
Housing two state housing programs for the elderly in Massachusetts, authorities. both adminis-
housing units or apartments. The waiting lists must be maintained in chrono-
logical order according to application dates and a vacancy must be offered to
There the are Department of Community Affairs through local housing construct-
the first person on the list.
tered by known as the State "667" Program which provides funds for the authori-
In addition to the state housing programs, there are approximately 20,000
One is housing units for low-income elderly persons. Local housing housing under
additional units for the elderly under federally subsidized programs (many of
ion of new the state have built more than 30,000 units of elderly each
these are under old HUD programs). There is very limited activity under
ties this across program. Most communities in the state have at least one 667 project, of
Section 515, Rural Rental Housing Loans. Approximately 500 additional units
which usually contains 40 to 100 units.
will be provided this year under Section 202 (Rental or Cooperative Housing
other state program assisting the elderly is the "707" Rental Assistance them
under the Housing Act of 1959).
Program. The In this program, housing authorities lease apartments and make
-48-
49 -
A DEA representative described a significant tradeoff which will
occur in 1976 between Section 8 of the Federal Housing and Community Develop-
ment Act and the "707" state housing program for the elderly. The State
exceed not including clothes, household furnishings, cars, boats, etc)
Department of Community Affairs has applied for $3.25 million in Section 8
mum payment $40,000 if single, $45,000 if married. An amount equal to cannot
funds for fiscal year 1976 to be used for rent subsidies for leased hous-
gross income allowable under social security may be deducted from the annual mini-
ing. Simultaneously, they have reduced their request to the state legis-
July 1, of persons applying for the property tax exemption. the
lature for "707" funds by a like amount. The state was previously committed
a couple. 1975, these amounts were $1,216.80 for an individual, $1,825.56 As of for
to $3.5 million for state subsidized "707" units. This transfer of operat-
ing costs from the state level to the federal level is a legitimate means
The on program is administered on a town-by-town basis, so the
of cutting back on state expenditure but will result in fewer housing units
provided. data the number of persons participating or the average of total DEA had no
available to low-income elderly persons.
eligible. However, it is estimated that approximately 200,000 persons benefits are
Property Tax Relief Programs
There are two state laws which provide some relief to elderly property
The Property Tax Deferrment Program allows persons age 65 and
owners in Massachusetts. One is the Property Tax Exemption for certain persons
until postpone such payment of real estate taxes to the city or town in which over to live
age 70 and over; the other is Property Tax Deferrment for homeowners age 65
estate time as the property is sold either by the owners or from they the
and over. At the present time there is no "circuit breaker" tax credit
of the of the owners. At such time the municipality recovers the full amount
program in Massachusetts.
postponed taxes plus 8% interest per year.
The Property Tax Exemption Program provides an exemption of $4,000 in
The amount the of taxes allowed to be postponed is proportional to
assessed valuation or $350 in taxes, whichever would result in the exemption
home of equity and has person has in the home. For example, if a person the amount
of the greatest amount of taxes due on real estate occupied as the domicile
pone payment of paid $10,000 of the principal on the mortgage, he or owns she a $20,000
of the claimant. A person is eligible if he or she is age 70 or over, and owns
property, or owns property jointly with a spouse, either of whom are 70 or over,
100% of the taxes 50% of the property tax due each year. If the home is may owned post- outright,
deferred may be postponed. However the total amount of
or owns property jointly or as a tenant-in-common with someone not his or her spouse.
Claimants must have lived in Massachusetts for 10 years and have owned pro-
can be owned may not exceed 50% of the owner's equity in the property. the The taxes
perty in the state for five years. Gross income from all sources cannot exceed
eligible jointly or as tenant-in-common with someone not the property
$6,000 if single or $7,000 if married, and the total value of his or her (or
and must have claimant. The claimant must have lived in Massachusetts spouse for of the
joint) real and personal property (home, land, savings, stocks, bonds, etc., but
from all owned and lived in the home for five years. Gross 10 years
4. See p. 19 of this report on Wisconsin's Property Tax Credit Program for
social sources cannot exceed $20,000. The exemption of the minimum annual amount income of
a description of how a "circuit breaker" program operates.
security benefits from gross income does not apply to this program.
- 51
- 50 -
If the mortgage is not paid off in full, or if there is a joint owner or
Although the mini-buses are not exclusively for elders,
mortgagee that has interest in the property, the bank or other party at
their routing has been planned with them in mind. Community
representatives took the following factors into consideration
interest must give written approval for the tax postponement. No person or
when planning these routes: the location of elderly housing
and high concentrations of other transit dependents, the loca-
couple may apply for both a property tax exemption and a tax deferment in
tion of health facilities, shopping areas, nursing homes,
churches, parks, hot lunch programs, and libraries. These
locations were pinpointed on a street map along with existing
the same tax year.
transit routes. Using this information, various routes were
The Tax Deferment Program was enacted early in 1974. Apparently very
suggested.
few persons utilized it the first year, but there are no accurate participa-
A unique feature of these mini-bus routes is that while
the bus has specific stops, it can also be flagged down in
tion or benefit estimates available.
between stops. For many persons, it comes close to providing
door-to-door transportation.
(In 1975, MBTA purchased 15 vehicles which are specially
Transportation
equipped to serve the elderly and the handicapped. These ve-
The position of the DEA with respect to the provision of transportation
hicles augment the mini-buses referred to above.)
services to the elderly as well as to the handicapped and other citizens
Outside the MBTA, in those parts of the State where
public transportation is virtually non-existent, the Office
requiring public transportation is set forth in the following excerpts of a
of Elder Affairs has been involved in the promotion of
accessible transportation through its participation with
1973 statement prepared by the DEA Transportation Specialist who also serves on
Regional Planning Agencies.
In Massachusetts twelve (12) Regional Planning Agen-
the Intergovernment Relations Staff:
cies are responsible for comprehensive planning on a re-
The Massachusetts Bay Transportation Authority (MBTA)
gional level. Included in this comprehensive planning pro-
cess is the determination of transportation needs, goals and
is the major operator of transit in the Metropolitan Boston Last
priorities for each of the regions.
Area and it provides service to 79 cities and towns.
seven MBTA communities became involved in an experi-
year mental program utilizing compact sized or "mini-buses". The of
Joint Transportation Planning Committees are being
established within each region as the vehicle for consumer
key element of this mini-bus program was the involvement best
the local community in planning how these buses would
input through its task forces. Elders are being encouraged
to participate in order to have input into regional needs,
serve local needs by designing their own bus routes.
goals and priorities. This kind of early involvement will,
Older persons were well represented in this planning
hopefully assure, that the development of new transit ser-
vices will be responsive to all elements of society.
through Councils on Aging and other elder-related organiza-
tions. Normally, route planning would have been done by MBTA
The state legislature established eight regional transit authorities
routing specialists with little, if any, input from the commu-
nity to be served.
(RTA's) in 1973 to promote the development of public transportation in
In many of the communities, existing bus routes provided
those parts of the state where such transportation was virtually non-
service only on main streets with little, if any, crosstown
connections. For many elders this means long walking distances than a
existent. All eight RTA's are not yet in full operation. Those that
to short distance, transportation service did not exist. With the
bus stops. For those who are not able to walk more
are operating contract for services and efforts are being made to encourage
mini-buses, service could now be linked to these areas.
them to tie in with Urban Mass Transit Authority and Title III transportation
services for the elderly and the handicapped.
52 -
- 53
In 1973, a 21-month statewide planning project called LINKS was funded
under the direction of Home Care Corporations. Although the program has no
with a $492,000 grant from Title III funds. The goal of this project was
means test, projects do provide the opportunity for clients to make contri-
to provide the elderly with a "link" to transportation services through the
butions for services received, either on a flat fee or fee schedule basis.
development of transit services geared to their needs. To avoid duplication
Food stamps are accepted by 14 of the projects. Meal cost runs about $2.00
of services, efforts have been made to coordinate the planning function
per meal, which includes food, labor, administrative and back-up services.
through the cooperation of various federal, state, and regional agencies,
All 18 projects utilize commodities from the federal commodity distribution
such as the Urban Mass Transportation Administration, the State Office of
program. Meals served in a congregate setting totaled 1,298,923. An addi-
Transportation, the State Department of Public Works, and the Regional
tional 171,934 meals were home delivered. Approximately 6,200 elderly per-
Planning Agencies.
sons are served each day, five days a week at most sites.
As of 1975 the State Office of Transportation received notification of
In addition to providing nutritious meals, the projects provide an in-
a $443,548 UMTA grant for the purchase of vehicles to transport the elderly
take service to assess clients' needs and an ongoing outreach service from
and the handicapped. This money will be distributed among 27 private non-
each project site. The projects also provide supportive services that are
profit organizations located throughout the state. The exact number of
not otherwise readily available to elders in the community, such as trans-
vehicles to be in service by January 1976 was not known at the time of the
portation and escort service to and from the project sites, information and
state visit. Project LINKS has played a significant role in planning for
referral, health and welfare counseling, nutrition education, shopping
the integration of these vehicles within the main transit systems of the
assistance and recreational activities.
areas receiving funds from this UMTA grant in an effort to avoid the develop-
A total of 324 full- and part-time staff members and about 1,200 volun-
ment of separate transportation systems which could result in a duplication
teers, 93% of whom are age 60 and over, operate the projects. The undupli-
of services. Some Title III funds will be used for operating costs to help
cated count of persons served by the program in fiscal year 1975 was 49,170.
insure continuity of service to the elderly.
Of this total 38,903 were white and 10,267 were minorities. Approximately
31,000 of the participants (63%) were below the poverty level. Of the esti-
Nutrition Programs
mated 124,000 persons age 65 and over in Massachusetts who have incomes
Nutrition projects under Title VII of the Older Americans Comprehensive
Service Amendments are not statewide as yet. There are presently 18 projects
below the poverty level, approximately 25% were served by the program.
The total expenditure for the program in fiscal year 1975 was $4,170,593,
(15 urban, 3 rural) operating at 129 sites. In 'some cases the projects are
of which $772,600 were non-federal funds.
In addition to the Title VII nutrition program, the Massachusetts
Department of Education administers a hot lunch program for elders through
- 54 -
- 55
WASHINGTON
the regular school lunch program. Approximately 5,600 persons ag e 60 and
over are served hot lunches daily at a fee of 50¢ per meal. The annual
In 1974, an estimated 478,000 persons in the state of Washington were
estimated budget for the 120 contracts in operation is $543,000. No support-
age 60 and over (14% of the state's population). Approximately 30% of these
ive services are offered through this program.
persons (145,616) resided in the Seattle-King County area. Persons age 65
and over totaled about 344,000 or 10% of the state's total population, with
Private Programs
about 74% of this group residing in urban areas. Approximately 24% of those
Very little detailed information was available on the nature and scope of
persons 65 and over had incomes below the poverty level, resulting in 2.4%
private agencies serving the elderly in Massachusetts. State personnel inter-
of Washington's total population being elderly and poor.
viewed indicated that the majority of private programs in the state are aimed
Since 1971, the state Office on Aging has been one of 10 offices and
at families and children. Those private agencies which do serve the elderly
bureaus operating within the Division of Community Services, which, in turn,
are direct service providers such as homemaker and chore service groups,
is one of nine divisions within the Department of Social and Health Services
Visiting Nurse Associations and church-related organizations. There are some
(DSHS). DSHS expenditures for fiscal 1975 were slightly over $600 million.
volunteer or part-time work opportunities provided for elders through private
Of this amount, $342,000 was allocated to the Office of Aging, $142,497 of
which were state funds. The Office on Aging's eight area units on aging,
agencies as well as cultural and/or ethnic groups offering companion services.
which have 15 planning and service areas, work with the six regional offices
Ombudsmen throughout the state are encouraged to develop comprehensive list-
of the Community Services Division in an effort to coordinate the delivery
ings of such programs operating in their respective towns and cities so that
of social and health services to aged persons throughout the state. However,
complete information and referral service can be provided to elderly persons
because of its position in the heirarchy of state government, its small
requiring services. In most cases the private programs are not means tested
staff, and lack of statutory power, the Office on Aging personnel interviewed
except for the Visiting Nurse Association which operateson a sliding scale
indicated that it has been difficult to fully develop and coordinate a system
fee system based on ability to pay.
of service delivery to the state's elderly population. A request for a
substantial increase in program funds for the next biennium has been sub-
mitted, which, if granted, would enable the Office on Aging to progress in
its goals to provide elderly persons with increased options for combatting
isolation, to encourage independent living, to prevent unnecessary institu-
tionalization, and to provide opportunities for meaningful involvement in
5. The amount allocated to the Office on Aging is a small portion of the total
expended on services to the elderly, many of which are delivered by other offices
within DSHS. An estimate of the proportion of the total DSHS budget allocated to
services for the elderly was not available.
- 56 -
- 57 -
Under Title XX the above services will continue to be offered to elderly
community life.
SSI recipients. In addition a limited program of day care will be provided
Title VI and Title XX - Social Services
for this group, and homemaker and health support services will be stepped
The state of Washington has been utilizing its maximum federal allo-
up to serve larger numbers of elderly persons.
cation for social services in the amount of $41.3 million for the past
Information and referral or services directed toward preventing or
two years. The state has provided matching funds of over $13.4 million each
remedying neglect, abuse or exploitation of persons unable to protect them-
year. These amounts will remain unchanged for the coming year, which means
selves are offered without regard to income eligibility requirements. An
that programs under Title XX will not change significantly from existing Title
estimated 58,000 SSI recipients will receive these services under Title
VI programs. These social service programs are administered by the Office
XX in the nine-month period ending June 30, 1976.
of Family, Children and Adult Services. As a result much of the data on Adult
The major focus of Title XX social services in Washington appears to be
services is not broken down by age, but estimates of elderly participants
on health support and homemaker services which are directed at keeping elderly
were obtained to the extent possible. Cost information for this category was
persons out of institutions. However, without projected cost figures for
not available.
these services, it cannot be stated conclusively that this is the thrust of
Participation rates can vary widely from month to month. In July 1975,
the program as it relates to the elderly.
an estimated 5,506 persons age 65 or over received one or more social services
SSI State Supplement
distributed as follows:
Washington has a federally administered State Supplementation Program
Service
Recipients Age 65 or Over
with income standards of $194 per month for an individual and $277 for a
Foster Care
39
couple. There is no pass-through of social security benefit increases by
Homemaker and Home Aide
336
the state supplement.
Health Related
3,574
The following federal SSI and other state supplement data are for June 1975:
Protective Services
448
Number of persons 65+ receiving
SSI payments
20,102
Educational and Training
14
Average monthly combined federal
Housing
396
and state payments
$91.84
Legal
84
Average monthly federal SSI payment
$66.95
Chore
1,946
Average monthly state supplement
$20.95
Mental Health
42
Includes persons receiving federal SSI payments and/or state supplementation.
Family Counseling
228
This is an average of only those receiving federal SSI benefits, whereas
the other averages are based on all those persons receiving federal
Total
5,506
and state payments, plus those receiving just state supplements.
- 59
- 58
number of participants age 60-65 was not available.
In 1974, an SSI-Alert program recruited 1,127 volunteers to make in-
dividual contacts with persons who might be eligible for SSI benefits. Over
Nursing Homes and Intermediate Care Facilities
11,000 elderly persons were contacted, but it is not known how many of these
As of June 1975 there were 198 licensed nursing homes in the state
persons ultimately qualified for SSI.
which provided 17,860 beds and 40 intermediate care facilities (ICFs) which
provided 1,418 beds. In addition there were 23 facilities which provided
Medical Assistance (Medicaid)
both nursing home and ICF care, with a total of 2,897 beds.
Washington provides a comprehensive medical assistance program consisting
In May 1975, the latest month for which data are available, 11,483 elderly
of 26 services. Eligibility is determined by the State Office of Personal
persons received care in nursing homes paid for in full or in part by the
Health Services which is part of the Health Services Division. Allowable
Department of Health and Social Services. During the same month, the Depart-
annual net income levels for the medically needy under Medicaid in Washington
ment paid in full or in part for the care of 1,063 elderly persons in ICFs.
are linked to the public assistance standards for federal SSI and state
No data are available on the number of private pay patients or those whose
supplementation, i.e. $194 per month for an individual ($2,328 per year),
care was provided by veterans benefits.
and $277 per month for a couple ($3,324 per year).
SSI recipients residing in nursing homes and ICFs receive a $25 per month
Total medical assistance expenditures for fiscal 1975 were approximately
personal needs allowance.
$172 million. Of this amount an estimated $55.4 million was expended for benefits
for persons age 65 and over. The average monthly benefit to elderly persons was
Alternative Living Arrangements
$147; an average of 35,000 elderly persons per month participate in the program.
There are two types of alternative living arrangements available to
In July 1975, 21% of the total medical assistance expenditures were for the care
elderly persons in the state, both of which are in relatively short supply.
of predominantly elderly persons in skilled nursing homes.
One is Congregate Care; the other is Family Home Care for Adults.
In addition to Medicaid, there is a limited state-funded Medical Only
A congregate care facility is one which provides its residents (in
Program which receives no federal matching funds. It is designed to provide
addition to shelter, food, laundry and household maintenance) encouragement
care for acute and emergency medical conditions for persons receiving continu-
and assistance in taking responsibility for themselves, guidance as necessary
ing or non-continuing general assistance grants, for medically indigent persons
in the activities of daily living and social and recreational activities and
between the ages of 21 and 65 who cannot qualify under one of the federally
opportunities, but which does not provide medical or social services.
aided public assistance or medical care programs, and for those who have in-
At least every six months the local office service worker reviews and
sufficient income to meet all or a portion of their medical expenses. There
re-evaluates the resident's need for congregate care to determine whether the
is a $100 deductible clause in the program and beneficiaries are not eligible
services actually rendered are adequate to the person's identified conditions
for mental-health, chiropractic or out-of-state care. An estimate of the
and needs.
- 60 -
61
A facility wishing to provide congregate care must have a valid license
Community Health Care
as a boarding home or as a private establishment and must be licensed by the
This is a private, Medicare-certified agency operating in Seattle. It
State Health Services Division as a boarding home for the aged.
is four months old and still very much in the developmental stage but
Residents must be essentially well people who need a supervised group
growing fast. The participants are about 90% Medicare patients. The ob-
living arrangement providing personal and social care. Most of them are SSI
jective of the agency is to provide home health services to delay or eliminate
and Medicaid eligibles, and they receive grants from the state from which
the need for placement in nursing homes. Services include regular home nursing
they pay $255 per month for care. Vendor payments are made when the state
care, home health aides, occupational and physical therapy, and dietary
has been designated as representative payee. The personal needs allowance
counseling. A homemaker component is in the planning stage which will rely
under this program is $25 per month. In July 1975, 340 elderly persons
somewhat on volunteers. The agency, which is one of five such private agen-
were residing in congregate care facilities.
cies in the Seattle area, has been receiving an increasing number referrals
Family Homes for Adults is also a state program with homes licensed
each month. It has 50-75 clients in active service on a monthly basis.
by DSHS after meeting certain standards to assure good family living which
The other private health care agencies are very small operations and data
includes the provision of personal care, supervision, friendly interest,
were not collected on them.
and companionship. No home can be approved to accommodate more than two guests.
Outreach for Older Adults
The monthly rate is $192.25 for persons who need supervision and personal care.
This program, which is operated by the King County (Seattle area) Health
Where minimal nursing care is required which can be safely given in a family
Department serves as a crisis intervention center for persons age 60 and over
home, the monthly rate is $219.75. The personal needs allowance is $29.60.
who refuse to leave their homes or have no resources to deal with their medical
The purpose of this program is to provide homes for adults who can meet
or psychiatric problems. The Outreach organization provides initial care and
some of their own needs, but, for varying reasons, can no longer live in their
makes referrals, often to the Visiting Nurse Association. During calendar
own homes. They may currently be in nursing homes, state hospitals, or
year 1974, Outreach for Older Adults handled 463 cases. This figure does not
other institutions only because they have no other place to go. They do not
represent only individual persons, since frequently the families of elderly
need institutional care or skilled nursing care. Only 68 of the 267 persons
persons are also involved in the crises to be resolved. The organization
residing in adult family homes in September 1975 were age 65 or over. Figures
receives administrative support from the County Health Department, and the
were not available on the number of elderly persons who might be eligible for
Mental Health Board. Its annual budget is under $100,000.
such a living arrangement if more homes were available.
Housing
There are no state housing programs for the elderly in Washington and data
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- 63 -
family income. The definition of residence was also extended to include
on existing units under federal programs was not readily available. However,
"fixed" mobile homes.
a study of the need for housing and alternative living arrangements for the
A 1973 amendment allowed an additional income exclusion of one-third
elderly has just begun to gather such data. It is estimated that there
of federal civil service and railroad retirement benefits under the income
are about 8,210 units for the elderly under the Federal Housing Act of 1959
test.
(Section 202) and an additional 300 units under the Rural Rental Housing
Participation increased substantially under the expanded program. There
Loan Program (Section 515). Whatever grants are approved under Section
were around 43,000 participants and $2.08 million in total levy relief from
8 will probably be earmarked primarily for the elderly, but no data are
1967 through 1971, compared with 89,240 participants and $8.1 million in
available on how many are planned or what the amount of the grant might be.
relief in 1974. Average relief per participant increased 81% to $93.
Property Tax Relief
In 1974, the state legislature again amended the program to combine the
In 1966, a law was passed which established The Senior Citizen Residence
aspects of the circuit-breaker and income-limited grant approaches to tax
Property Tax Relief Program. The law has been amended several times since
relief. The major changes were the extension of relief in terms of tax burden
enactment.
reductions and a residence valuation reduction of $5,000 for claimants with
Initially it provided tax relief for homeowners age 65 and over with
gross family income less than $4,000. Those with incomes under $5,000 are
family incomes of $3,000 or less. There was a $1,500 ceiling on earned income.
now exempt from 100% of levies. The following table summarizes these benefits:
To qualify, claimants must have resided in the state for three calendar years
Total Gross
Residence Value
Special Levy
preceding the year of the claim and must have occupied the residence on which
Family Income
Reduction
Exemption
the claim for exemption was made for two years preceding the year of the claim.
$
- 3,999
$ 5,000
100%
The benefit was in the form of a,grant of the first $50 of property tax liability.
4,000 4,999
-
100
These provisions were in effect for five years and provided average tax relief
5,000 5,999
-
50
of $48 per participant for approximately 43,000 participants.
In 1975, the number of participants declined slightly to 85,819. However,
In 1971, the program was amended, lowering the age requirement to 62, raising
the total levy relief increased 69% to $13.7 million. The average relief
the family income levels, and establishing an exemption formula. Claimants
per participant was $159, up 71% from the previous year.
with family income of $4,000 or less were exempted from 100% of special levies,
Effective January 1, 1976, retired homeowners 62 years of age or older
with a minimum guarantee of relief up to $50. Those with incomes between
will be eligible for a new program which provides for the deferral of property
$4,001 and $6,001 were exempted from 50% of special levies.
taxes and special assessments.
In 1972, the $1,500 earned income ceiling was removed, and claimants were
For 1976, the income limit is $8,000. In subsequent years, it will be
allowed to exclude one-third of social security payments when calculating
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- 65 -
Transportation
an amount equal to the previous year's income limit adjusted by the per-
centage change in the cost of living for the 12-month period ending September
There are presently 25-30 vehicles which serve the elderly and the
1 of the previous year. Persons who receive pension payments can exclude
handicapped in various parts of the state. A $319,000 UMTA grant for
from declared income the portion they contributed. In the case of social
fiscal year 1975 will be used to purchase 30 additional vehicles. It has
security this is set at one-third. There is no asset test. The claimant
not as yet been determined what the source of operating costs for these
vehicles will be.
must have regularly occupied the dwelling during the two calendar years
preceding the year in which claim is filed and must have been a resident of
Public transportation systems operate in Seattle, Tacoma, Olympia and
the state for at least three calendar years preceding the year in which a
Spokane, all of which provide reduced fares for persons age 60 and over.
deferral claim is filed. "Residence" under this law is defined as a single-
A bill was recently passed by the state legislature which provides for the
family dwelling, excluding land not to exceed one acre. "Fixed" mobile homes
improvement of transit services in unincorporated areas which may affect the
qualify under this definition.
elderly, in that it allows county commissioners to approve the extension of
Retired persons are allowed to defer payment of property taxes and spe-
transit routes to designated selections of unincorporated areas.
cial assessments on their residences up to 80% of their equity in the pro-
Nutrition Programs
perty. The deferred amount becomes a lien in favor of the state and bears
There are currently 14 Title VII nutrition projects operating in 25 of
interest of 8% each year, the rate presently prescribed for delinquent taxes,
Washington's 39 counties, at 42 urban and 38 rural sites. Two of the pro-
payable upon sale of the property, upon the death of the claimant (unless the
jects serve Indian nations at seven sites. An additional five projects are
surviving spouse qualifies for the deferral program), upon condemnation or
expected to be in operation by January 1976. Most of the urban sites serve
exercise of eminent domain, or at such time as the claimant ceases to reside
meals five days a week; the rural sites do not all serve meals five days a
permanently in the residence.
week. Community gardens have become an important adjunct to the program in
The Tax Deferral Program is intended to provide additional tax relief.
certain areas and the produce they supply has contributed to keeping the
Therefore, persons who meet the eligibility requirements may participate in
average cost per meal at $1.98 including food, labor, administrative and back-
both programs.
up services. The gardens are located on public land under power lines. The
There were 20 tax proposals related to senior citizen tax relief in-
project arranges to have the land plowed and provides the water; the planting,
troduced in the last legislative session. The tax deferral program com-
maintenance and harvesting are done by volunteers. Several projects also have
bined three of them. The others did not pass.
purchase agreements with local canneries and fisheries which enable them to
Volunteer senior citizens are currently working on disseminating in-
obtain food at reduced prices.
formation on the tax deferral program. No estimate of the number of potential
eligibles was available.
66
- 67
During fiscal year 1975, 812,063 meals were served in a congregate
operating with Title III funds, serving about 120 persons. These will be
setting and 76,650 meals were home delivered. The unduplicated count of
continued under Title XX, with restorative care as the focus.
persons served was 31,663, of which 29,821 were white, 383 were black,
One small area agency on aging is an Indian Nation located in Yakima
1.010 were American Indians and 304 were oriental. The remainder were
which has approximately 500 elderly persons (57% of the total population
Spanish speaking or other limited English speaking individuals. Approximately
of the Indian Nation). About $30,000 in Title III funds are allocated to
57% of the participants had incomes below the poverty level.
this area, and the Tribal Council provides the balance of money required
The projects are operated by 342 full- and part-time paid staff and
for services to the elderly in that area. This area also receives about
over 3,000 volunteers, 47% of which are age 60 or over. Total expenditures
$45,000 in Title VII funds.
for fiscal year 1975 were $2,022,385, of which $609,846 were non-federal
funds.
Other Programs
In addition to the Title VII program there are several small programs,
The State of Washington provides free fishing licenses to persons age
including those operated by Community Action Programs (CAPs), for which de-
70 and over as well as passes to state parks for persons age 65 and over.
tailed participation and cost data are not available.
During the last legislative session a measure became law which authorizes
the governing boards of post-secondary institutions, including community
Title III Programs
colleges, to waive in whole or in part tuition and other fees for students
A substantial portion of Title III funds is used to provide seed money
who are Washington residents age 60 and over.
to get programs started and to mobilize other resources. For example,
Very little information on private programs for the elderly could be
Title III used to be a major funding source for senior centers which are
gathered in the time allotted. In was stated by a number of state program
now predominantly funded locally. In addition, in 1974, a home visitation
people that church-related and other private organizations are focusing
project, a mobile health service center, and a geriatric screening project
attention on the needs of elderly persons, but that the programs are
were initially funded with Title III money. Many of these projects continue
generally very small and data are not readily available on the nature or
to operate when Title III funds are no longer available. According to Office
scope of them.
on Aging representatives, there is an 80-90% chance of such projects con-
tinuing under funding provided locally from other resources once the pro-
ject becomes firmly established.
The major services currently provided by the eight area agencies on
aging in the state are outreach, information and referral, personal escort
and other forms of transportation. Three adult day care projects have been
- 69 -
- 68
with the day-to-day demands of living often outweigh or exacerbate the plight
SUMMARY STATEMENT
of being both poor and elderly. There are a wide range of services designed
to alleviate these problems, such as homemaker services, chore services, health
It was not the intent of this study to make a comparison of the states'
maintenance and rehabilitation, nutrition services, transportation services,
effectiveness in meeting the needs of the elderly, but, rather, to present a
legal and advocacy services and emergency services. However, these services
general description of the services which might be available to an elderly
are, in fact, available to and utilized by relatively small numbers of elderly
person residing in any one of the four states. The program descriptions in
persons when participation rates are compared with the total elderly population
this report, while not in great depth or completely comprehensive due to
in a state who are potential beneficiaries of such services. If a needy elderly
time limits imposed on the study, nevertheless do provide a broad overview
person also resides in a rural area, the problems are compounded, since in most
of program activity in the four selected states. Based on this limited
cases, these services are more readily available in urban areas.
survey, some tentative summary statements can be made.
There was considerable, if not surprising, commonality in the types of
The level of program activity varied considerably among the four states,
programs offered in the four states, even though the level of program activity
as did the methods of planning, coordinating, and providing services to the
differed substantially. Over three-fourths of the programs offered in any one
elderly.
state were offered in all four states, though sometimes in slightly different
The location of the state office on aging within the hierarchy of state
form.
government may have some bearing on the level of program activity, with those
Finally, all four states seemed to have in common a major objective to
operating as major offices or divisions with some statutory authority having
which many programs were tied, namely providing alternatives to placement of
the more extensive program activity. The four offices on aging visited each
the elderly in institutions through a diverse offering of social and health
occupy a somewhat different position within the framework of state government.
services.
Three operate within large umbrella-type state departments of health and/or
In the course of interviewing numerous state program personnel, certain
social services, but at different levels, while one operates as a cabinet-
administrative problems and recommendations were consistently expressed. A
level department devoted solely to serving the needs of the elderly.
major problem cited in all four states concerns eligibility determinination.
While the level of program activity varied considerably among the
Elderly persons attempting to get into the system often experience long delays
states, all states--regardless of the location of the office on aging--faced
in determining eligibility. Frequently it is necessary to visit several
budget constraints which severely limited their ability to provide services
different offices to determine what benefits are available and whether the
to all elderly persons in need. While poverty and the related factors of
applicant qualifies. In the case of the frail elderly, there is the increased
inadequate housing, food and other essentials are major problems for the
elderly, isolation, anxiety, poor health, and the decreasing ability to cope
- 70 -
problem of making such visits and persevering until eligibility is determined.
In some programs, such as SSI, the administering office will send a claims
representative to the person's home to assist in filling out the application,
but this is not a common practice for all programs.
State program administrators in each of the states visited also emphasized
that the complexity of federal regulations and the frequent changes in those
regulations make it costly and time consuming to administer the programs.
Funds which could be used to provide increased benefits and services to the
elderly are eaten up by administrative costs.
It was the consensus of those interviewed that a great need exists for
more effective information systems which would enable the states to improve
outreach efforts and reorder service priorities. They recognize that such
refined information systems would undoubtedly lead to the need for program
expansion, which, in turn, would require increased appropriations, a touchy
issue in most states which are increasingly faced with budgetary problems.
More effective information systems, however, would still serve to improve
the distribution of funds among programs and indicate more persuasively the
areas in which increased appropriations are most crucial.
DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
POSTAGE AND FEES PAID
WASHINGTON. D.C. 20201
U.S. DEPARTMENT OF H.E.W.
OFFICIAL BUSINESS
U.S.MAIL
HEW-391
DHEW Publication No. (OHD) 76-20952
The
Interrelationships
of Benefit Programs
for the Elderly
LIBRARY GERALD R FORD
The Combined Impact of
Appendix III
Selected Benefit Programs
on Older Americans:
A TRIM Analysis
*******
Federal Council on the Aging
The
Interrelationships
of Benefit Programs
for the Elderly
Appendix III
The Combined Impact of Selected Benefit Programs on
Older Americans: A TRIM Analysis
Prepared for
The Federal Council on the Aging
by
The TRIM Staff of the Human Resources
and Income Security Project
The Urban Institute
December 29, 1975
FEDERAL COUNCIL ON THE AGING
WASHINGTON, D.C. 20201
For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402
TABLE OF CONTENTS
I.
INTRODUCTION
1
Purpose of Study
1
The Methodology of the Transfer Income Model
2
The Use of Program Elements
7
Program Interactions
9
II.
SIMULATED BASELINE CASELOADS AND COSTS
11
III.
ANALYSES OF PROGRAM INTERACTIONS
22
The Effect of a Change in the Federal SSI Payment Standards
23
The Effect of a Change in the Federal and State SSI Payment
Standards
34
The Effect of a Change in Social Security Payments
43
IV.
SENSITIVITY OF CHANGES IN SSI PROGRAM FEATURES
54
Eliminating the Payment Variation Due to Living Arrangements
55
Changing the SSI Benefit-Reduction Rate on Earned Income
56
Adjusting The Income Disregards
57
Alternative Treatments of The Asset Value of Homes
58
V.
SUMMARY AND CONCLUSIONS
69
APPENDICES
74
A.
The Data Bases
74
B.
Projecting the Data Bases
77
LIST OF TABLES
1. Overview Tables Of Multiple Participation In SSI,
Food Stamp And Medicaid Programs
13
2. Distribution Of Multiple Participation By Program
14
3. SSI Benefits Received By Unit Income And Joint
Participation In Other Programs
16
4. Medicaid Benefits Received By Unit Income And Joint
Participation In Other Programs
18
5. Food Stamp Benefits Received By Unit Income And Joint
Participation In Other Programs
19
6. Sum of Food Stamp Bonus, Medicaid Benefits And SSI
Payments As A Percentage Of Gross Resources By Unit
Income And Joint Participation Status
20
7. Changes In Program Participation Status Resulting
From A Change In The Federal SSI Payment Standard
25
8. Impact On SSI Caseload And Cost From A Change In
The Federal Payment Standard
27
9. Impact On The Medicaid Program Resulting From A
Change In The Federal SSI Payment Standard
28
10. Impact On The Food Stamp Program Resulting From A
Change In The Federal SSI Payment Standard
30
11. Impact On Combined Program Benefits For Selected
Groups Resulting From A Change In The Federal SSI
Payment Standard
31
12. Changes In Program Participation Status Resulting
From A Change In The Federal And State Voluntary
SSI Payment Standards
35
13. Impact On SSI Caseload And Cost From Changes In
The Federal And State Voluntary SSI Payment
Standards
37
14. Impact On The Medicaid Program Resulting From
Changes In The Federal And State Voluntary SSI
Payment Standards
38
15. Impact On The Food Stamp Program Resulting From
I. INTRODUCTION
Changes In The Federal And State Voluntary SSI
40
Payment Standards
This paper is part of a research effort directed at assessing
16. Impact On Combined Program Benefits For Selected
Groups Resulting From Changes In The Federal and
the combined impact of various benefit programs on Older Americans.
State Voluntary SSI Payments Standards
41
Two reports preceded this one--a compendium of Federal and Federally-
17. Changes In Program Participation Status Resulting
From A Change In Social Security Benefits
44
supported benefit programs affecting the elderly and a description of
18. Impact On SSI Caseload And Cost Resulting From A
the programs available in four selected states. The information
46
Change In Social Security Benefits
gathered from the compendium of Federal benefit programs and the State
19. Impact On Medicaid Caseload And Cost Resulting
From A Change In Social Security Benefits
47
program data served as background material for the analysis reported
20. Impact On Food Stamp Benefits Resulting From A
here. This report, in turn, serves as a primary source of information
Change In Social Security Benefits
49
for a further report of the recommendations for refining and restructur-
21. Impact On Combined Benefits Of A Change In Social
51
Security For Selected Groups
ing income tested programs which affect Older Americans.
22. Impact Of Variable Rates Of Return To Assets On The
60
Total SSI Caseload And Benefits
Purpose of the Study
23. Tenure Profile Of SSI Eligible Filing Units By
This report focuses on the interrelationships among three of the
Categorical Eligibility
61
major benefit programs for the elderly. These programs are the Supple-
24. Distribution Of SSI Homeowning Eligibles And Benefits
By Market Value Of Home
63
mental Security Income program, Medicaid and the Food Stamp program.
25. Effect On Total Caseload And Benefits Of Variable Market
These programs are emphasized because the work performed under the preceding
Value Limitations
64
tasks has demonstrated that significant interactions occur across these
26. Impact Of Imputing Variable Percentages Of Total Home
Equity To Countable Income On The Total SSI Caseload
three programs, and also because these programs readily lend themselves
66
And Benefits
to examination within the context of the analytical method utilized.
27. Impact Of Imputing Variable Percentages Of Total Home
Equity To Countable Income On The Distribution Of SSI
The interaction of these programs is studied by introducing a change
67
Eligible Homeowners
in one of the programs and tracing through the primary and secondary impacts
of the change on individual program benefits and on the combined benefits
received from all three programs.
- 2
- 3
Special attention is given to the Supplemental Security Income
to which the eligible individual or family is entitled. Finally,
program, since this program, more than any other, is directed at providing
those who qualify for benefits are screened to determine if they will
basic living expenses for those among the elderly who are most in need.
actually participate in the program.
Thus, in addition to examining the interaction of this program with
The TRIM model has three features which make its use desirable
others, this report examines alternative treatments of selected features
for the analysis reported here. First, the impact of a change in one
of the SSI program.
program on both the original program and a series of other programs can
The Methodology of the Transfer Income Model
be measured for the entire sample of individuals and families. These
The results reported in this paper were derived by utilizing the
measurements would include the number of families who are eligible after
TRIM Microsimulation Model. TRIM was developed at the Urban Institute
the change or who lost eligibility because of the change, the change in
as an evaluation tool for policy makers, and as such, it has been used
program costs, and the change in average benefits--for each program separately
extensively by various Federal, State and Congressional agencies.
The
or for all the programs combined.
model consists primarily of a set of modules which represent the rules
Secondly, since the model simulations operate on a large number of
and regulations of tax and transfer programs in computer-oriented logical
representative families, the individual results can be aggregated or
and mathematical instructions. These rules and regulations are then
summarized for a large number of socio-economic subgroups of the population.
applied to each person and family included in a representative sample of
This allows the analyst to identify and assess any difference in impact
the population. In this way, the model is able to operate in essentially
for the various subgroups. This capability may highlight any particularly
the same manner as a caseworker or tax accountant. First, the program
onerous treatment which was unintended and unexpected. Third, the TRIM
rules and regulations are applied to each relevant individual or family to
model permits the analyst to alter particular program features and trace
determine which are eligible. Then the model uses the economic data and
out the impact, both primary and secondary, on the welfare of the population.
program benefit formulae available to it to determine the amount of payment
In determining eligibility or benefit payments, each program draws
upon its own definition of which individual or groups of individuals are to
The following organizations have utilized TRIM estimates for various
purposes: the Social and Rehabilitation Service and the Office of the
be considered jointly. These definitions vary extensively across programs.
Assistant Secretary for Planning and Evaluation of the Department of Health,
Education and Welfare, Office of Policy Development and Research of the
The Food Stamp program, for example, considers all members of a household
Department of Housing and Urban Development, the Joint Economic Committee,
The Brookings Institution and the Economic Research Service of the Department
and their resources jointly, while the Supplemental Security Income program
of Agriculture. Currently a Federal Consortium of TRIM users consists of
the executive department above, the Office of Tax Analysis of the Treasury
Department and the Food and Nutrition Service of the Department of
Agriculture.
5
- 4
An additional data limitation, common to both the CPS and CPUS,
considers either a single adult individual, a husband and wife unit, or
does not totally preclude simulation of any particular program but causes
in those cases where the eligible person is a blind or disabled dependent
the simulations to be more complex. Both the CPS and CPUS lack information
child, the entire family's resources. In order to accommodate these
on assets. To compensate for this absence of data, it is assumed that
diverse definitions of units of eligibility, TRIM operates on a hierarchically-
income reported as rent, interest and dividends represents a percentage
structured data base, that is a file in which the members of a household can
return on the total value of assets held. Employing this assumption, we
be disaggregated into families and family members disaggregated into persons.
then work backwards to determine an individual's total dollar value of
The data files which have been used for this analysis are the March 1974
assets.
Current Population Survey (CPS), adjusted to reflect the population that
Naturally, the rate of return on assets held depends upon the
would be represented by a 1976 survey, and the 1970 Census Public Use Sample
form in which the assets are held and the total dollar value held in each
(CPUS), adjusted to represent the projected population in 1976.
form. Availability of this information, however, would obviate the
The capabilities of TRIM are limited by the data it utilizes. Each
need for determining the relevant rate of return. Thus in the absence
individual data base imposes a unique set of constraints. The CPS and CPUS,
of this information, we are forced to estimate a percentage return on total
have several limitations in common. In order to determine eligibility and
assets. For these tasks, it was assumed that the income received in the
benefit payments under the Social Security program, a detailed work and
form of interest and dividends represent a six percent return on total
earnings history must be available for each individual on the file. The
assets. In this manner, the total dollar value of assets held can be
absence of such information on both the CPS and CPUS data files automatically
derived by dividing total income from interests and dividends by .06.
precludes simulating the Social Security Program. However, Social Security
Thus it was possible to partially compensate for this particular data
recipients and the benefits they receive are identified on the data files.
limitation of the CPS and CPUS.
Similarly, data limitations involving the identification of veterans, amount
3/
For example, one would expect a higher rate of return on a portfolio
of time served, and type of discharge received currently preclude the simulation
consisting of certificates of deposit, stocks and bonds, than on a portfolio
which consists only of passbook savings accounts.
of veterans' programs within TRIM.
4/
The CPUS simulations assume a seven percent rate of return.
2/
These data files are discussed in Appendix A and the procedures used
Rental income is excluded in the determination of total assets for
to update them are presented in Appendix B.
purposes of the SSI program since that program excludes income-producing
property in determining total assets if such property is relied upon as a
significant factor in producing income. Rental income is included in total
income in determining whether or not the filing unit passes the income test.
6
- 7
are available. Thus, it is not possible to simulate the State administered
Another component of assets, market value of the home, is required
in the simulation of the Supplemental Security Income program. While the
supplementation programs, and our treatment of the SSI program, in the
following tasks represents the total basic Federal program and that
CPS contains most of the information required to simulate the SSI program,
it does not contain detailed housing information. Thus the CPS simulation
portion of the State supplementation program that is Federally administered.
of the SSI programs includes all the asset limit screens to which eligibles
The Use of Program Elements
are submitted, with the exception of the maximum excludable market value
Despite the diversity of eligibility criteria and benefit formulae
of an owner-occupied home. For this reason we use the CPUS instead of the
across programs, certain key elements are common to every program. The
CPS to analyze the impact of the home value limit on eligibility for SSI.
identification of these elements permits the analyst and TRIM to accurately
Data constraints external to those imposed by either the CPS or
portray the complex rules and regulations of each individual program and
CPUS further restrict the range of possible TRIM applications. One such
greatly facilitates the identification of interactions across programs.
limitation precludes simulation of the Medicare program. Here the fault
The program elements and their interactions can be grouped into three
lies not with the CPS or CPUS but with the lack of administrative data on
main categories: those which occur in the categorical eligibility criteria
benefit payments. Information concerning benefits paid to Medicare partici-
(e.g., age, sex of head of household, condition of health), those which
pants is available only in aggregated amounts by state and county. For
occur in the economic eligibility criteria, and those which occur in the
this reason, this report does not include simulation results for the
computation of benefits. These subdivisions and the elements contained in
Medicare program.
each are described below.
Still another external data constraint affects the TRIM simulation
Categorical Eligibility Criteria
of the Supplemental Security Income program. The SSI program is composed
The filing unit defines the individual or group of individuals who
of three major parts: the basic Federal program, State optional supplemen-
are considered jointly in determining benefits or eligibility. Filing units
tation and State mandatory supplementation. The two State supplementation
are generally defined according to familial relationship, age, sex or
programs may be administered by the Federal government or the State
deprived status. Deprivation may be based upon conditions of health, as in
government, at the option of the State. States administering their own
the SSI coverage of the blind and disabled, or upon unemployment status, as
supplementation programs are permitted to set their own administrative
in the unemployment compensation program or upon absence of a parent, as
guidelines and procedures such that no single standardized structure exists
in the Aid to Families with Dependent Children program.
for these programs and no data concerning the individual States' procedures
- 8
9
deducted while 100 percent of unearned income above a disregard is deducted.
Economic Eligibility Criteria
Many programs require that the filing unit meet certain economic
Program Interactions
criteria, as well as categorical criteria before it is eligible to receive
Program interactions occur in primarily two ways: (1) receipt of
benefits. These means-tested, "income-conditioned" programs generally
benefits from one program may either preclude or automatically entitle the
state the types of income that are included in the program definition of
beneficiary to eligibility in another program; or (2) receipt of benefits
income and state the maximum amount of income which the filing unit may
from one program may affect the beneficiary's level of benefit payment in
have and still be eligible for benefits.
another program without affecting basic eligibility.
The remaining component of economic eligibility criteria is the
Automatic eligibility occurs when legislation or program regulations
treatment of assets. Once again, the program rules state what items are
specifically state that beneficiaries of one program are automatically eligible
included in the definition of assets and set the maximum allowable dollar
for benefits in another program. Hence, Social Security beneficiaries are
amount of assets the filing unit may hold and still remain eligible. Once
automatically eligible for Medicare benefits, and SSI recipients are automatic-
the individual or individuals have fulfilled the categorical and economic
ally eligible for Food Stamp benefits. Similarly, in many states, SSI
eligibility criteria, the only remaining step is the calculation of their
recipients are automatically eligible for medical care assistance under the
benefit payment.
Medicaid program.
Computation of Benefits
Interactions affecting the level of benefits received from a program
The determination of benefits varies across programs and may vary
depend primarily upon cross-program definitions of countable income and most
within a particular program according to family size, place of residence,
often occur because one program includes the benefits of a second program in
living arrangements or other program-stipulated criterion. Generally, a
its definition of countable income. Hence, an increase in Social Security
payment standard is the amount of assistance which would be paid to any
benefits will lead to a reduction in SSI benefits for units receiving assistance
filing unit which had no program-defined income. The benefit paid to
from both programs. The same is true of SSI beneficiaries who also receive
persons who do have income is determined by adjusting this payment standard
Food Stamps. Any increase in their SSI payment will lead to a reduction in
according to the program's benefit formula. This adjustment usually involves
their Food Stamp bonus.
reducing the full benefit by some fraction of program-defined income. The
These are the types of interactions that some of the simulations will
fraction of income deducted may vary depending upon type of income. In
identify and examine in detail; additional simulations will explore the
the SSI program, 50 percent of earned income after a small disregard is
11
- 10
significance of particular elements within individual programs. More
II. SIMULATED BASELINE CASELOADS AND COSTS
specifically, this research effort will include an analysis of the impact
of: (1) changing the Federal SSI payment standards; (2) changing the
The initial step in analyzing the nature and extent of program
Federal and State SSI payment standards; (3) changing the amount of
interaction is the identification of the total number of individuals who
income received from Social Security and Railroad Retirement; (4) removing
receive benefits from these programs and the number who receive multiple
reduced SSI payment standards for those living in the household of another;
benefits. Thus our first task is to determine the number of individuals
(5) adjusting income disregards in SSI; and (7) varying the treatment
who participate in one or more benefit programs.
of owner-occupied homes in the SSI asset test.
The first problem confronted in presenting such an analysis arises
First, however, a description of the level and extent of existing
from the lack of uniformity among programs in the definition of the recipient
multiple-program participation will be presented in the following section.
unit. As stated in the previous section, each program contains its own
This will also serve as a baseline simulation for the analyses in sections
definition of an éligible unit. Thus, for example, the Food Stamp filing
III and IV.
unit includes the entire household, while the SSI unit may include only
one or two members of that household. Unless otherwise stated, our analysis
unit will be based on the concept of a family as opposed to a household or
an individual. Thus, a unit may contain one or two persons--a single in-
dividual or a husband and wife. In a household with two or more family
units, therefore, our analysis unit will consist of only the elderly persons
(age 60 and over) and their spouses. Institutionalized persons are excluded
from our sample, since they do not appear on the CPS data base.
Finally, consistent with the scope of this study, we are only concerned
with analysis units in which the head or spouse is age 60 or older. (With
regard to SSI, it should be noted that simulated SSI participants include
only those disabled or blind persons between the ages of 60 and 64. Blind
and disabled persons age 65 or over are defined as categorically eligible for
SSI due to age.) With these definitions in mind, we now turn to an examina-
tion of the incidence of multiple participation in the SSI, Food Stamp, and
Medicaid Programs.
- 12
- 13
Table 1 presents an overview of the simulated participation in the
TABLE 1
three programs. Note that these are simulated as opposed to actual
OVERVIEW TABLES OF MULTIPLE PARTICIPATION
IN SSI, FOOD STAMP AND MEDICAID
caseloads. It is also important to note how Medicaid is handled in the
PROGRAMS
simulation. Because the receipt of Medicaid benefits is predicated upon
incurring a medical expense, in addition to meeting the other eligibility
Distribution of Participating Units
criteria, and because the CPS does not contain data on medical expenditures,
Program Participation Status
Number of Units
Percent
we cannot accurately simulate the number of Medicaid recipients in any given
(000's)
year. Rather, the simulated figures represent those eligible for assistance
SSI Only
100.6
1.5
from Medicaid in the event that they incur covered medical expenses, and the
Food Stamps Only
1,029.2
15.2
benefit assigned to each eligible unit is the total Medicaid benefits paid
SSI and Food Stamps
80.2
1.2
out, divided by the total number of eligibles (not recipients), and adjusted
Medicaid Only
2,197.6
32.3
by state of residence, age, and basis for eligibility. Thus the Medicaid
SSI and Medicaid
1,625.0
23.9
benefit emanating from the simulation is an average benefit received by all
Food Stamps and Medicaid
582.9
8.6
eligibles.
SSI, Food Stamps and Medicaid
1,173.6
17.3
Table 1 indicates that 6,788,598 units are estimated to participate in one or
Total Participants
6,788.6
100.0
more of the three programs in 1975. This represents 21.9 percent of all units
where the head or spouse is age 60 or over, of the participants, 3,327,434
or 49.0 percent are estimated to receive benefits from only one program,
2,288,081 or 33.7 percent participate in two programs, and 1,173,083 or 17.3
percent participate in all three programs.
Table 2 demonstrates that Medicaid participants are the least likely to
receive benefits from another program with 39.4 percent of all Medicaid
participants receiving benefits from only that program. SSI recipients are
the most likely to participate in another program with only 2.7% of all
participating SSI units receiving benefits from that program alone. This is
because in all but six states, SSI recipients are automatically eligible for
Food Stamps and in approximately two-thirds of the states, SSI recipients are
- 14
- 15
automatically eligible for Medicaid benefits. Thus, it is highly probable
TABLE 2
that an SSI unit would also participate in one or the other, if not both, of
DISTRIBUTION OF MULTIPLE PARTICIPATION
BY PROGRAM
the remaining programs.
Tables 3 through 6 present the estimated distribution of program bene-
Total SSI Participants (000's)
29,978.8
fits for the various combinations of multiple participation. The first of
these tables (table 3) shows estimated SSI benefits received and the extent
Percentage of SSI Participants
Receiving Benefits from:
of joint participation in other programs by income class. In each of Tables
SSI Alone
3.4%
3 through 6 income is defined as earnings plus reported unearned income minus
SSI and Food Stamps
2.7
reported AFDC and general assistance payments plus simulated SSI benefits for those
54.5
units receiving benefit payments from SSI. This income definition replicates
SSI and Medicaid
the Current Population Survey's definition of income which excludes in-kind
SSI, Food Stamps and Medicaid
39.4
benefits, such as Food Stamps and Medicaid benefits. It should also be noted that
blank cells signify that no unit appeared in that cell, while cells contain-
Total Food Stamp Participants (000's)
2,865.4
ing dashes mean that the number of units falling into that cell was so small
Percentage of Food Stamp Participants
as to be of questionable validity and therefore is not shown. Given this
Receiving Benefits from:
information, we may now proceed with the presentation of our results.
Food Stamps Alone
35.9%
Examination of Table 3 shows that 50 percent or more of the units esti-
Food Stamps and SSI
2.8
mated to participate in SSI alone or SSI plus any combination of other pro-
Food Stamps and Medicaid
20.3
grams had annual post-transfer incomes between $2,000 and $4,000. No
Food Stamps, SSI and Medicaid
40.9
units receiving SSI benefits fall into the less than $1,000 post-transfer
income category, since those units with less than $1,000 in pre-transfer
Total Medicaid Participants (000's)
5,578.6
income would receive an SSI benefit of sufficient value to push their post-
transfer income above the $1,000 level. At the other end of the distribu-
Percentage of Medicaid Participants
Receiving Benefits from:
tion, it can be observed that only those SSI participants who also partici-
Medicaid Alone
39.4%
pate in Medicaid had annual incomes in excess of $7,500. This is a
Medicaid and SSI
29.1
Medicaid and Food Stamps
10.4
1. The average 1975 SSI payment is $1,821 to an individual with no
income ($1,202 if living in someone else's household) and $2,744 to a couple
Medicaid, SSI and Food Stamps
21.0
with no other income ($1,804 if in another's household).
- 17
- 16
reflection of the fact that those states with a high level of voluntary
SSI, MED and Food Stamps
Total Annual
Benefits
($ millions)
287.260
800.629
311.376
29.824
28.937
30.323
1,502.536
supplementation to SSI also provide SSI recipients with automatic eligibility
for Medicaid benefits. Thus SSI recipients with high post-transfer income
appear only in the group receiving both SSI and Medicaid benefits.
Number of
Units
(000's)
159.7
777.4
190.5
23.0
9.1
12.1
1,173.6
Table 4 shows Medicaid benefits and the number of eligibles by par-
ticipation group and income class. The figures further demonstrate
the availability of Medicaid benefits to higher income units. Here
SSI and Medicaid
Total Annual
Benefits
($ millions)
309.946
683.098
524.388
92.508
51.620
245.674
75.906
18.286
2,005.071
units with incomes as high as $15,000 receive Medicaid benefits. This
reflects the fact that 25 states and the District of Columbia permit the
"medically needy" to participate in the Medicaid program, allowing units
Units
11.4
SSI BENEFITS RECEIVED BY INCOME UNIT AND JOINT
Number of
(000's)
316.0
635.5
378.8
80.6
48.8
117.4
35.1
1,625.0
with incomes equal to or below 133 1/3 percent of the state's AFDC payment
PARTICIPATION IN OTHER PROGRAMS
PROGRAM PARTICIPATION STATUS
standard to receive Medicaid benefits. It should be noted that the number of
units participating in both Medicaid and SSI is the same as that shown in
TABLE 3
SSI and Food Stamps
Total Annual
Benefits
($ millions)
31.536
3.393
38.310
Table 3. The benefits received by these units in Table 4, however, repre-
sents Medicaid benefits instead of SSI benefits as displayed in Table 3.
Number of
Units
(s,000)
69.2
8.3
80.162
Table 5 presents the distribution of Food Stamp benefits by participation
status and income class. Of those 1,029,200 persons aged 60 or over who par-
ticipate only in the Food Stamp program, 940,400 or 91.4 percent have incomes
Total Annual
below $4,000 per year, and they receive 91.2 percent of the total benefits.
Benefits
($ millions)
16.533
29.365
20.048
70.223
Table 6 shows, for each participation group, the percentage of total
SSI Only
per unit income (this time including Medicaid and Food Stamp benefits) that
Number of
is contributed by the benefits received (in other words, in computing the
Units
(000's)
39.3
30.5
19.7
100.6
percentages, the numerator is the total combined benefits received and the
denominator is the same plus earned income and all non-transfer unearned
POST-TRANSFER
UNIT INCOME
Under $1,000
1,000 1,999
2,000 2,999
3,000 3,999
4,000 4,999
5,000 5,999
6,000 7,499
7,500 9,999
10,000 14,999
income, eg. interest and dividends). For consistency with the previous
15,000+
TOTALS
TABLE 4
MEDICAID BENEFITS RECEIVED BY INCOME UNIT AND JOINT
PARTICIPATION IN OTHER PROGRAMS
POST-TRANSFER
PROGRAM PARTICIPATION STATUS
UNIT INCOME
Medicaid Only
SSI and Medicaid
Food Stamps and Medicaid
SSI, MED and Food Stamps
Number of
Total Annual
Number of
Total Annual
Number of
Total Annual
Number of
Total Annual
Units
Benefits
Units
Benefits
Units
Benefits
Units
Benefits
(000's)
($ millions)
(000's)
($ millions)
(000's)
($ millions)
(000's)
($ millions)
Under $1,000
309.2
103.197
140.9
36.159
18
1,000 1,999
592.9
212.401
316.0
80.971
243.9
60.006
159.7
31.753
2,000 2,999
716.6
457.165
635.5
230.830
152.4
60.022
777.4
194.947
3,000 3,999
394.6
372.553
378.8
79.986
39.2
23.470
190.5
88.672
4,000 4,999
86.6
97.504
80.6
49.484
23.0
15.355
5,000 5,999
27.1
11.821
48.8
25.490
9.1
2.759
6,000 7,499
30.1
15.635
117.4
40.013
12.1
8.779
7,500 9,999
19.4
10.876
35.1
18.653
10,000 14,999
21.2
6.973
11.4
2.079
15,000+
9.9
5.649
343.265
TOTALS
2,197.6
1,293.775
1,625.0
527.999
582.9
180.581
1,173.6
TABLE 5
FOOD STAMP BENEFITS RECEIVED BY INCOME UNIT AND JOINT
PARTICIPATION IN OTHER PROGRAMS
POST-TRANSFER
PROGRAM PARTICIPATION STATUS
UNIT INCOME
Food Stamps Only
SSI and Food Stamps
Food Stamps and Medicaid
SSI, MED and Food Stamps
Number of
Total Annual
Number of
Total Annual
Number of
Total Annual
Number of
Total Annual
Units
Benefits
Units
Benefits
Units
Benefits
Units
Benefits
(000's)
($ millions)
(000's)
($ millions)
(000's)
($ millions)
(000's)
($ millions)
Under $1,000
156.8
73.469
140.9
75.705
19
1,000 1,999
217.2
66.157
243.9
77.986
159.7
28.122
2,000 2,999
356.2
66.703
69.2
13.820
152.4
38.092
777.4
143.480
3,000 3,999
210.2
57.487
8.3
1.805
39.2
9.772
190.5
56.892
4,000 4,999
46.1
13.478
23.0
7.230
5,000 5,999
24.1
6.235
9.1
3.974
6,000 7,499
12.6
3.112
12.1
3.439
7,500 9,999
10,000 14,999
15,000+
TOTALS
1,029.2
289.237
80.2
16.588
582.9
203.873
1,173.6
244.296
- 20
- 21
tables, the first column--Post-Transfer Unit Income--is defined the same as
before, ie., it excludes Medicaid and Food Stamp benefits. This table demon-
All Three
Programs
(%)
99.0
52.9
58.4
42.4
61.9
48.2
58.5
strates that, of those persons participating in all three programs, an
average 58.5% of their total income is derived from SSI benefits, Medicaid
benefits, and cash equivalents of Food Stamp bonus coupons. Except for those
Food Stamps
and Medicaid
(%)
75.8
27.4
21.1
20.4
---
---
29.2
with incomes under $2,000, each income class receives from 40 to 62 percent
of their total income in benefits from the three programs.
The next most significant contribution of benefits to total income, is
SSI and
Medicaid
(%)
----
69.3
49.2
43.7
34.9
26.7
36.3
31.0
16.6
44.3
the benefits paid to those units participating in both the SSI and medicaid
programs. Of the total resources available to those units, 44.3 percent is derived
SUM OF FOOD STAMP BONUS, MEDICAID BENEFITS
from SSI and Medicaid benefits.
AND SSI PAYMENTS AS A PERCENTAGE OF
GROSS RESOURCES BY INCOME UNIT
AND JOINT PARTICIPATION STATUS
PROGRAM PARTICIPATION STATUS
Medicaid
Only
(%)
53.8
19.4
20.0
22.0
20.3
7.6
7.3
6.1
2.7
2.7
19.1
Because of small sample sizes in some of the cells, the individual per-
TABLE 6
centages should be interpreted with some caution, but the pattern of relat-
SSI and
Food Stamps
ionships, both between income classes and across participation categories,
(%)
25.3
18.1
24.9
should be accurate. In looking at these patterns, units with lower incomes
receive a greater proportion of their income in benefits, with the propor-
tion declining as income rises, as would be expected. Looking across cate-
Food Stamps
Only
(%)
91.0
16.3
7.4
7.6
6.3
4.5
3.7
10.9
gories, Food Stamp benefits add the least to income, while both SSI and
Medicaid are major contributors to the total income of these older recipients.
In summary, these simulations indicate that approximately 21.9 percent of all
SSI
Only
(%)
---
15.9
27.8
23.2
---
---
19.7
units where the head or spouse is over age 60, participate in at least one
program. Of these participating units, 49.0 percent are estimated to receive
benefits from only one program, 33.7 percent participate in two programs, and
POST-TRANSFER
UNIT INCOME
Under $1,000
1,000 1,999
2,000 2,999
3,000 3,999
4,000 4,999
5,000 5,999
6,000 7,499
7,500 9,999
10,000 14,999
17.3 percent in all three programs. It is further indicated, that for
TOTALS
those participating units with post, cash-transfer incomes of less than
15,000+
$2,000, the benefits they receive account for a major portion of their total
income.
- 22
- 23
III. ANALYSES OF PROGRAM INTERACTIONS
The Effect of a Change in the Federal SSI Payment Standard
The three analytical tasks in this section illustrate the ways
The purpose of this analysis task is to illustrate the secondary impacts
in which, and the extent to which, programs for older Americans inter-
of a change in the federal SSI payment standard on the Food Stamp and Medicaid
act and overlap. The method of illustration is to introduce a change
programs resulting from program interaction. Many of the state Medicaid pro-
in benefits of one program, or in income from other sources, and simulate
grams tie eligibility for medical care benefits to the receipt of SSI benefits
both the direct and indirect impacts on the benefits received from all
or to eligibility for SSI payments. A more generous SSI standard should re-
programs by those age 60 or older.
sult in a larger proportion of the older population becoming eligible for
In all three cases an increase was utilized rather than a de-
Medicaid benefits.
crease but it is expected that the impacts estimated would be symmetrical
The SSI/Food Stamp interaction operates in two ways. In many states,
over the same range. These tasks do not suggest that benefit levels be
households consisting entirely of public assistance recipients are automatically
increased but only show the impact of an increase for analytical purposes.
eligible for Food Stamp bonuses. The second interaction affects older people
Both of the major types of program interactions are highlighted; namely
residing in the households of others. When their SSI payment increases or the
when eligibility for one program automatically entitles the beneficiary
SSI payment of another adult categorical unit in the household increases, the
to eligibility in another program, and where receipt of benefits from
household income as defined by the Food Stamp program increases and the house-
one program affect the beneficiary's level of benefits from another program.
hold's bonus may be reduced, or its eligibility may be lost altogether.
The interactions identified and examined here are those that
It is expected that when the federal SSI standard is increased we should
occur among and between the three major income-conditioned programs
have an increase in the number of Medicaid recipients. The direction of change
for older Americans--the Supplemental Security Income Program (SSI),
in the number of Food Stamp recipients is not predictable a priori because
Medicaid, and the Food Stamp Program. The three subsections to follow
the two affects mentioned above operate in different directions.
analyze the primary and secondary impacts of (1) increasing the Federal
In order to explore these interactions the SSI program was simulated
SSI payment standard, (2) increasing both the Federal and Federally-
with a 10 percent increase in the federal standard. Food Stamps and Medicaid
administered State payment standards, and (3) increasing Social Security
were then simulated using the new SSI payment and the newly eligible SSI
payments.
recipients.
- 24
- 25
The effect of increasing the federal SSI payment standard by 10 percent
is to increase the number of older SSI recipients by approximately 283,000,
Totals
Before
Change
24,229
101
1,029
80
2,198
1,625
584
1,174
or 9.5 percent, and the total cost of SSI to this group by $535 million, or
31,020
almost 15 percent. Another 216,000 units were affected by secondary changes
All
Three
Programs
46
22
in eligibility status for other programs as a result of program interactions.
1,087
1,160
Table 7 presents in detail the caseload dynamics which would presumably
be caused by such a change. The row headings are the program participation
status before the simulated change, and the column headings indicate the pro-
Food
Stamps
and
Medicaid
25
538
563
gram participation status after the simulated change. An entry in the table
indicates the number of units who were in the row participation status before
30
99
22
87
the change and who are in the column participation status after the change.
SSI
and
1,862
The row totals indicate number of units in the eight participation statuses
after the simulated change.
CHANGES IN PROGRAM PARTICIPATION STATUS RESULTING
FROM A CHANGE IN THE FEDERAL SSI PAYMENT STANDARD
RESULTING PROGRAM PARTICIPATION STATUS
Medicaid
1,621
(Number of Units in Thousands)
Medicaid
Only
87
2,099
2,188
Column one of Table 7 indicates that 147,000 units or about six-tenths
of a percent of those who participated in no other programs prior to the change,
TABLE 7
SSI
and
Food
Stamps
30
74
104
received benefits under one or more programs after the change. Of these,
29,000 units would be new participants in the SSI program, 87,000 would re-
ceive benefits from the Medicaid program and 30,000 more would receive bene-
Food
Stamps
Only
919
919
fits from both the SSI and Medicaid programs.
SSI
Only
29
Of the 1,029,000 units previously participating only in the Food Stamp
101
137
program, 46,000 would also have benefits from SSI and Medicaid, 30,000 would
receive SSI benefits in addition to their Food Stamp bonuses, and 25,000 would
None
24,082
24,087
receive medical care benefits (through becoming eligible for SSI even though
they did not participate).
About 99,000 of the participants previously receiving only Medicaid
benefits would also receive SSI payments. Of the 584,000 units previously
receiving both Food Stamps and Medicaid benefits, 22,000 would also receive
INITIAL PROGRAM
PARTICIPATION STATUS
SSI Only
Food Stamps Only
None
SSI and FS
Medicaid Only
SSI and MED
FS and MED
All Three Programs
TOTALS AFTER CHANGE
- 26 -
27
SSI, while another 22,000 would lose Food Stamp bonuses and gain SSI. Also
87,000 of the 1,174,000 previously receiving benefits from all three programs
would lose their food stamp eligibility. The information contained in Table
7 indicates that most of the units experiencing changes gain eligibility for
one or more new programs while only 87,000 units (17 percent of those units
Average
Change
Per Unit
$
230
151
245
202
267
145
275
166
164
changing participation status) lose eligibility for food stamps.
The change in the federal SSI standard increased the amount of total
SSI payments by $534.6 million, or almost 15 percent. The distribution of
Number
of Units
Affected
60
101
80
80
99
(000)
1,625
44
1,174
3,262
this increase by initial program participation status is presented in Table
8. The third column contains the increase in SSI payments going to the various
participant groups. Of the $534.6 million total, $71.9 million or 13.5 percent
goes to those who previously received no SSI benefits (2.6 percent to those who
Differences
in SSI
Payments
($000)
13,787.0
15,243.5
19,570.4
16,236.7
26,449.4
236,083.3
12,121.1
195,147.9
534,639.3
previously did not receive benefits under any of the three programs and 10.9
percent to those receiving benefits under Food Stamp or Medicaid or both but
not SSI). The remainder (86.5 percent) of the increase in benefits goes to
those already receiving SSI benefits (3 percent to those receiving only SSI
TABLE 8
IMPACT ON SSI CASELOAD AND COST FROM A
CHANGE IN THE FEDERAL PAYMENT STANDARD
Resulting
Payments
($000)
13,787.0
85,466.2
19,570.4
54,331.8
26,449.4
SSI
2,241,154.5
12,121.1
1,697,684.1
4,150,564.5
benefits before the change, 30 percent to previous SSI and Food Stamp recipients,
44 percent to previous SSI and Medicaid recipients, and 36.5 percent to those
previously receiving benefits from all three programs). A total of 3.262
million units are affected by the change in the federal payment standard:
Initial
283,000 who did not receive any SSI benefits previously would receive an average
SSI
Payments
($000)
70,222.7
38,095.1
2,005,071.2
1,502,536.2
3,615,925.2
SSI payment of $254 per year and the remaining 2.98 million units who previously
received SSI payments experience an increase in their payment ranging from $145
to $202 or an average of $155.
Table 9 shows the impact on Medicaid of the change in SSI. The results
indicate that an additional 192,000 units are now eligible for Medicaid
unit filing may The unit. contain reason persons for this not loss categorically of Food Stamp eligible bonus is for that the Food Stamp filing
Initial
Participation
Status
SSI Only
Food Stamps Only
None
SSI and FS
Medicaid Only
SSI and MED
FS and MED
All Three Programs
TOTALS
resources of all However, the resources of the food stamp filing inclusion unit in the SSI
received by the occupants of the housing unit and would include SSI include the
the smaller SSI filing unit. Thus an increase in SSI may payments eliminate
household from eligibility for the Food Stamp bonus.
- 28 -
- 29
TABLE 9
benefits averaging $338 per unit. The total additional cost to the Medicaid
IMPACT ON THE MEDICAID PROGRAM
program of these benefits is $65 million.
RESULTING FROM A CHANGE IN THE
FEDERAL SSI PAYMENT STANDARD
Table 10 indicates that there is an overall decrease in the amount of
Food Stamp bonuses of $29.9 million dollars due to an increase in income
arising from higher SSI benefits. There is also a net decline in the number
Initial
Number of
Participation
Value of New
New Medicaid
Average
of recipient units who reside in the households of others. This $29 million
Status
Medicaid
Beneficiaries
Value of
Benefits
New Medicaid
decrease in Food Stamp bonuses includes only the loss of benefits to Older
(000's)
($000's)
Benefits
Americans and their spouses. Food Stamp benefits are based on all occupants
($)
None
of a housing unit. The amount of bonus attributed to members of the Older
118
49,535.0
419.79
Food Stamps Only
Americans analysis unit is the sum of the per capita bonus received by this
74
15,512.8
209.63
smaller elderly unit. If the household contains 5 people and there is one
TOTALS
192
65,047.8
elderly person in the household, any change in Food Stamps bonus reported would
338.79
be 20 percent of the change in the household bonus. Thus the $29 million de-
crease should be considered as a lower bound estimate of the secondary impact
on the Food Stamp program brought about by the increased federal standards and
program interaction.
Finally, Table 11 indicates the impact of the change in SSI standards on
the combined benefits received from the three programs. The first row indicates
that the $13.8 million in SSI benefits which would be received by those previously
receiving no benefits from any of the three programs is only 22 percent of the
total benefits they would receive. Vitrually all of the remaining 78 percent
is Medicaid benefits. Thus an increase in the Federal SSI payment standard of
10 percent would through program interaction, increase Medicaid benefits nearly
four times more than SSI benefits for those previously receiving no benefits.
Those receiving only Food Stamps before would gain an increase in SSI benefits
of $19.6 million, which is 60 percent of their total increase in benefits. The
total benefit change of all other groups is equal to the SSI increase, or less
(i.e. they lose some other benefits as a result of increased income via ad-
ditional SSI benefits). Sixteen percent of the additional SSI benefits which
TOTALS
All Three Programs
FS and MED
SSI and MED
None
SSI and Food Stamps
Food Stamps Only
Status
Participation
Initial
753,994.2
244,296.2
203,872.9
0
16,587.8
289,227.3
0
(000$)
Stamp Bonuses
Initial Food
FEDERAL SSI PAYMENT STANDARD
724,055.2
223,536.5
199,297.8
294.5
286,628.2
100.3
Stamp Bonuses
Resulting Food
RESULTING FROM A CHANGE IN THE
IMPACT ON THE FOOD STAMP PROGRAM
TABLE 10
30
14,197.9
(000$)
+
-29,939
+
-20,759.7
4,575.1
294.5
2,389.9
2,609.1 I
100.3
(000$)
Bonuses
Food Stamp
uI Change
TABLE 11
IMPACT ON COMBINED PROGRAM BENEFITS FOR
SELECTED GROUPS RESULTING FROM A CHANGE
IN THE FEDERAL SSI PAYMENT STANDARD
Initial
Initial Total
Resulting Total
Change in
Change in
Change in SSI
SSI Benefits
Benefits as a
Participation
of Combined
of Combined
Combined
Benefits
Percentage of
Status
Benefits
Benefits
($000)
($000)
($000)
($000)
The Change in
Combined Benefits
(%)
None
0
63,422.3
63,422.3
13,787.0
21.7
70,222.7
85,466.2
15,242.5
15,243.5
100.0
31
SSI Only
Food Stamps Only
289,237.3
321,711.4
32,474.1
19,570.4
60.3
FS and SSI
54,897.3
68,529.6
13,632.3
16,236.7
119.1
MED and SSI
2,533,070.2
2,769,447.9
236,377.7
236,083.3
99.9
All Three Programs
2,090,097.1
2,264,485.3
174,388.2
195,147.9
111.9
5,037,524.6
5,573,062.7
535,538.1
469,068.8
92.6
TOTALS
- 33
32 -
would be received by units previously receiving Food Stamps and SSI would be
the secondary impact on the Medicaid caseload is illustrative The small
offset by reductions in Food Stamps bonuses. A similar but smaller offset would
Similarly of the tied eligibility between Medicaid and SSI. entitles
occur for those previously receiving benefits from all three programs.
of increase the impact in SSI benefits which would be received by new eligibles
In summary, this illustration of an increase of 10 percent in the Federal
them to valuable medical care benefits.
SSI payment standard has demonstrated that there are not only significant
one conclusion that can be drawn from these results is that
interaction effects with other programs, but that the interactions are complex.
looking Certainly at the benefit structure of any one program may be misleading because
Changes can have quite different effects on different groups, depending on their
of the various forms of program interaction.
initial program status. Some units become eligible for other programs by be-
coming eligible for SSI, some would merely receive the full increase in the
SSI benefit, and others would receive less than the full benefit because reduced
benefits from other programs partially offset the increase in SSI benefits.
Everyone would be made better-off as a result of the increased SSI standard
but some units would gain more and others would gain less than is indicated
by simply the change in SSI payments because of program interactions. In the
case of SSI the people who would benefit most from an increase in the standard
are usually experiencing the interaction of tied eligibility. People who benefit
the least are experiencing the interaction of one program reducing the benefits
received from another program.
This analysis task only addresses the consequences of a small change
in the SSI payment standard, but the results are illustrative of the impact
of including SSI payments in program-defined income for determining Food
Stamp eligibility and bonus. Total Food Stamp bonuses transfered to Older
Americans are considerably lower than would be the case if the Food Stamp
income definition did not include SSI payments.
- 34
35 -
The Effect of a Change in the Federal and
State SSI Payment Standards
Totals
1,029
80
Before
Change
24,229
101
2,198
1,625
584
1,174
31,020
The purpose of this analysis task is to illustrate the primary and secondary
All
Three
Programs
47
20
1,080
1,152
impacts of a change in the Federal and State Voluntary SSI payment standards.
This differs from the previous analysis task in that the state voluntary payment stan-
dard is also increased, whereas it was held constant before and only the
Food
Stamps
Medicaid
24
and
537
561
Federal payment standard was increased.
The expected consequences are the same as for the previous changes
except that the impacts should be larger in magnitude. There should be
Medicaid
55
105
1,621
25
94
SSI
and
1,903
more new Medicaid eligibles and a greater reduction in Food Stamp benefits
received by the elderly.
CHANGES IN PROGRAM PARTICIPATION STATUS RESULTING
FROM A CHANGE IN THE FEDERAL AND STATE
VOLUNTARY SSI PAYMENT STANDARDS
RESULTING PROGRAM PARTICIPATION STATUS
Med Medicaid
Only
110
The analysis confirms these expectations. It shows that a 10 percent change
2,093
2,205
in both standards would increase the total cost of SSI by $689 million dollars,
TABLE 12
or about 19 percent. This is $154 million more than the increase brought about
SSI
and
Food
Stamps
30
74
104
by raising the Federal standard only, which was a 15 percent increase. An additional
316,000 units would participate in the SSI program, or a 10.6 percent increase in case-
load. Another 245,000 units would be affected by secondary changes in eligibility
Food
Stamps
Only
919
919
for other programs as a result of program interaction, compared to 216,000 in
previous analysis.
SSI
Only
29
101
137
Row one of Table 12 shows that 195,000 units, or 0.8 percent of those who
participated in none of the programs prior to the change, would receive benefits.
Of these, 29,000 units would receive benefits from the SSI program alone, 110,000
None
24,034
24,039
would receive Medicaid benefits alone, and 55,000 more would receive benefits
from both the SSI and Medicaid programs. Of the 1,029,000 units previously
benefiting only from the Food Stamp program, 47,000 would also receive ad-
ditional assistance from both SSI and Medicaid, 30,000 would receive SSI benefits
in addition to Food Stamp bonuses, and 24,000 would also receive Medicaid benefits.
INITIAL PROGRAM
PARTICIPATION STATUS
SSI Only
Food Stamps Only
None
SSI and FS
Medicaid Only
SSI and MED
FS and MED
All Three Programs
TOTALS AFTER CHANGE
36 -
37 -
About 105,000 of the participants previously receiving only Medicaid
assistance would also receive SSI payments. The remaining changes are also
similar in direction to the results discussed under the earlier analysis
task but are larger in magnitude.
Average
Change
Per Unit
($)
209
152
248
204
338
218
297
181
209
As stated previously, the change in both SSI standards increased the
amount of total SSI payment by $689 million, or about 19 percent. The
distribution of this increase is shown in Table 13. Of the $688.8 million in-
Number
of Units
Affected
(000)
85.0
100.6
81.0
80.2
105.0
1,625.0
45.0
1,173.6
3,295.4
crease, only $90 million, or 13 percent, would go to those not previously partici-
pating in the SSI program (3.1 percent to units previously not receiving aid from
any of the three programs and 10 percent to those receiving benefits from Food
Stamps, Medicaid or both). These units would receive an average payment of
Payments
(000$)
21,130.7
15,243.5
20,070.7
16,328.7
35,477.0
354,521.0
13,379.5
212,645.6
688,796.7
IMPACT ON SSI CASELOAD AND COST FROM CHANGES
Differences
$285 (compared to $254 in the prior analysis). The remaining $598.7 million
in SSI
or 87 percent, would go to those already receiving SSI payments and results in
an average increase in their benefits of $201 (compared to $155 when only
the Federal standard was raised). The distribution of this 87 percent is
TABLE 13
SSI PAYMENT STANDARDS
Resulting
Payments
($000)
21,130.7
85,466.2
20,070.7
54,423.8
35,477.0
2,359,592.2
13,379.5
SSI
1,715,181.8
4,304,721.9
as follows: 2.2 percent to those only previously receiving SSI, 2.4 per-
cent to those previously receiving SSI and Food Stamps, 51.5 percent to
IN THE FEDERAL AND STATE VOLUNTARY
those previously participating in SSI and Medicaid and 30.9 percent to those
previously participating in all three programs.
The impact on the Medicaid caseload is presented in Table 14. An ad-
Initial
SSI
Payments
($000)
70,222.7
38,095.1
:
2,005,071.2
1,502,536.2
3,615,925.2
which ditional 337,000 units become eligible for Medicaid benefits averaging $338,
is would increase the cost of the Medicaid program by $80.9 million. This
about $15 million higher than the increase resulting from a change in the
Federal standard alone. Of this $80.9 million, over 80 percent would go to
19 those units not previously receiving any program benefits and the remaining
Initial
Participation
percent would go to those units previously receiving only Food Stamp bonuses.
Status
SSI Only
Food Stamps Only
None
SSI and FS
Medicaid Only
SSI and MED
FS and MED
All Three Programs
TOTALS
38 - -
39
TABLE 14
IMPACT ON THE MEDICAID PROGRAM RESULTING
Table 15 presents the secondary impacts on the Food Stamp program.
FROM CHANGES IN THE FEDERAL AND STATE
VOLUNTARY SSI PAYMENT STANDARDS
There is a $32.0 million decrease in the cost of the Food Stamp program.
This decrease is about $2 million larger than the decrease resulting from
altering only the Federal standard. The largest proportion of this decline,
Initial
Number of
Value of New
Average
Participation
69.5 percent, is experienced by older people who previously participated in
New Medicaid
Medicaid
Value of
Status
Beneficiaries
Benefits
New Medicaid
(000)
all three programs. Here again, this magnitude should be considered a lower-
($000)
Benefits
($)
bound on the real loss of welfare to older Americans.
None
166
Finally, Table 16 presents the total impact on combined benefits re-
65,428.0
394
Food Stamps Only
74
ceived by six selected groups. These groups would experience an increase in SSI
15,512.8
210
benefits of $639.9 million, but the increases in combined benefits is $693.9
TOTALS
240
80,940.8
337
million. Thus the change in combined benefits is 8.5 percent higher than the
change in SSI benefits.
The group previously receiving benefits from none of the three programs would
experience a change in combined benefits which is four times as large as
the change in SSI benefits. The increase in combined benefits for those
only on food stamps before the increase in the SSI standard is nearly 65 per-
cent higher than the increase in SSI benefits alone.
The group previously receiving both SSI and food stamps has a change
in combined benefits which is 16 percent lower than the change in SSI benefits,
i.e., they "lose" 16 percent of the SSI increase via reductions in other pro-
gram benefits (or put another way, consistent with the last column in the table,
the increase in SSI benefits exceeds the increase in combined benefits by 19
percent). Similarly, those previously receiving benefits from all three pro-
grams would experience a total change in combined benefits which is 10.5 per-
cent lower than their change in SSI benefits.
41
40
TABLE 15
IMPACT ON THE FOOD STAMP PROGRAM
RESULTING FROM CHANGES IN THE FEDERAL AND STATE
VOLUNTARY PAYMENT STANDARDS
Change in SSI
Benefits as a
Percentage of
the Change in
Combined Benefits
(%)
24.4
100.0
60.8
119.0
100.0
111.7
92.2
Initial Food
Resulting Food
Change in
Initial
Stamp Benefits
Stamp Benefits
Food Stamp
Participation
($000)
($000)
Benefits
Status
($000)
Change in
SSI Benefits
($000)
21,130.7
15,243.5
20,070.7
16,328.7
354,521.0
212,645.6
639,940.2
100.3
+
100.3
0
None
286,644.6
2,592.7
Food Stamps Only
289,237.3
16,587.8
14,197.9
2,389.9
SSI and FS
294.5
IMPACT ON COMBINED PROGRAM BENEFITS FOR SELECTED GROUPS
RESULTING FROM CHANGES IN THE FEDERAL AND STATE
VOLUNTARY SSI PAYMENTS STANDARDS
Change in
Comb ined Combined
Benefits
($000)
86,658.9
15,243.5
32,990.8
13,724.3
354,815.5
190,425.6
693,868.6
294.5
+
SSI and MED
0
198,720.3
5,152.6
FS and MED
203,872.9
222,076.2
-22,220.0
TABLE 16
All Three Programs
244,296.2
TOTALS
753,994.2
722,033.8
-31,960.4
Resulting Total
of Combined
Benefits
($000)
86,658.9
85,466.2
322,228.1
68,621.6
2,887,885.7
2,280,522.7
5,731,383.2
Initial Total
of Combined
Benefits
($000)
0
70,222.7
289,237.3
54,897.3
2,533,070.2
2,090,097.1
5,037,523.8
0
Initial
Participation
Status
SSI Only
Food Stamps Only
None
FS and SSI
MED and SSI
All Three Programs
TOTALS
42 -
43 -
As noted earlier the total increase in combined benefits for these
The Effect of a Change In Social Security Payments
selected groups is nearly $694 million, and each group experiences a net
increase in combined benefits. However, two groups--those previously on
The purpose of this analysis task is to assess the secondary impacts of
none of the programs and those only participating in the Food Stamp program--
a 10 percent increase in Social Security payments received by Older Americans.
experience an increase in combined benefits of 400 and 164 percent respectively,
It is expected that SSI payments to Social Security recipients will decline,
of their increases in SSI benefits because of the tied eligibility interaction
and since Medicaid eligibility is tied to SSI eligibility in many states,
between SSI and Medicaid. Two of the other groups--units on the Food Stamp
Medicaid costs and caseloads should also fall. Furthermore, since Social
and SSI programs and units on all three programs--have increases in combined
Security payments are counted as income in determining Food Stamp benefits,
benefits which are 10 to 20 percent lower than their increases in SSI benefits.
the increased social security payments should result in lower Food Stamp
This and the previous analysis shows that, when SSI benefits are increased,
costs and caseloads.
there is some "leakage", in that combined benefits do not rise as much as the
The mechanics of this analysis task are as follows: The amount of
SSI increase if the unit was previously receiving Food Stamps. An interaction
social security income reported by individuals on the CPS was inflated by 10
of greater magnitude, however, is that between SSI and Medicaid, and it works in
percent. These higher social security amounts were then used to simulate SSI.
the opposite direction. Because Medicaid eligibility is tied to SSI eligibility,
Finally, the new SSI payments were used in simulating benefits under the Food
a small increase in the SSI payment standard can make a sizeable number of older
Stamp and Medicaid programs.
families eligible for (small) SSI payments, but their combined benefits can be
The 10 percent increase in social security payments to Older Americans
quite large because of becoming automatically eligible for Medicaid benefits.
amounted to $4.789 billion, of which 21.5 percent or slightly over $1 billion,
would go to units previously receiving benefits from one of the three programs.
This would cause SSI benefits to that portion of the group who previously re-
ceived SSI to decline by $404 million, or 11 percent, and the number of units
receiving SSI benefits would decline by 352,000, or almost 12 percent. An ad-
ditional 772,000 units would have their eligibility for programs altered in
other ways.
Table 17 presents the caseload dynamics. The second row of that table
indicates that 25,000 units, out of the 100,000 previously receiving only
SSI but not food stamp and Mediciad benefits, would lose SSI payments. Of the
44 -
45 -
Totals
Before
24,230
100
1,029
80
Change
2,198
1,624
583
1,173
31,020
2,865,000 units previously receiving Food Stamps (the sum of rows 3, 4, 7, and
8), 314,000 or nearly 11 percent would lose benefits from the Food Stamp program.
About 30,000 units, out of 80,000 units previously receiving Food Stamps
All
Three
Programs
1,033
1,033
and SSI but not Medicaid, would lose their SSI benefits but would retain their
Food Stamp benefits.
A large number of units, 587,000, nearly 11 percent of the 5,578,000
Food
Stamps
and
Medicaid
472
35
511
who previously received Medicaid benefits (sum of rows 5-8), would lose
them (but, as will be explained later, this is probably an overestimate).
Of the 1,624,000 previously receiving SSI and Medicaid but not Food Stamps,
1,414
1,420
135,000 units would lose their SSI benefits, 15,000 units would lose their Medicaid
CHANGES IN PROGRAM PARTICIPATION STATUS RESULTING
RESULTING PROGRAM PARTICIPATION STATUS
(Number of Units in Thousands)
SSI and
Medicaid
benefits and 56,000 units would lose their previous eligibility for both SSI and
Medicaid. One hundred and eleven thousand units previously receiving Food
FROM A CHANGE IN SOCIAL SECURITY BENEFITS
Medicaid
Only
1,828
135
61
2,032
Stamps and Medicaid assistance but not SSI would lose benefits from one or both
programs (61,000 would lose Food Stamps, 39,000 would lose Medicaid and 11,000 would lose
TABLE 17
both). Of the 1,173,000 units originally benefiting from all three programs,
SSI
and
Food
Stamps
50
35
85
35,000 would lose only SSI, 35,000 would lose only Medicaid, 6,000 would lose only
Food Stamps, and 64,000 would lose benefits from two or more programs.
Food
Stamps
Only
801
30
39
56
931
In summary as many as 973,000 units lose all benefits from at least one
program. As many as 123,000 units lose all benefits from two or more programs.
SSI
Only
72
15
87
As stated previously, the total amount of SSI benefits transferred to
Older Americans decreased by $404 million, or 11.2 percent. The distribution
25
228
370
56
11
None
24,223
24,918
of this reduction is shown in Table 18. The largest percentage decline (38.5
percent) is experienced by the group previously receiving both SSI and Food
Stamp benefits, the next highest percentage decline (22.9 percent) is imposed
on those previously receiving only SSI benefits and the smallest decline ($.9
percent) in SSI benefits is for those previously getting assistance from all
INITIAL PROGRAM
PARTICIPATION STATUS
Food Stamps Only
three programs.
None
SSI Only
SSI and FS
Medicaid Only
SSI and MED
FS and MED
All Three Programs
TOTALS AFTER CHANGE
As a result of the decreased SSI caseload the Medicaid benefits received by Older
Americans would decline by $195.4 million or 9.1 percent as indicated in table 19. This decline is
TABLE 18
IMPACT ON SSI CASELOAD AND COST RESULTING FROM
A CHANGE IN SOCIAL SECURITY BENEFITS
Initial
Initial
Resulting
Differences
Percentage
Participation
SSI
SSI
in SSI
Decrease in
Status
Payments
Payments
Payments
SSI Payments
(000s)
($000)
($000)
(%)
SSI Only
70,222.7
54,132.8
16,089.9
22.9
SSI and FS
38,095.1
23,420.4
14,674.7
38.5
-
46
SSI and MED
2,005,071.2
1,765,139.5
-229,931.7
12.0
-
All Three Programs
1,502,536.2
1,369,155.8
-133,380.4
8.9
TOTALS
3,615,925.2
3,211,848.5
-404,076.7
11.2
TABLE 19
IMPACT ON MEDICAID CASELOAD AND COST RESULTING FROM
A CHANGE IN SOCIAL SECURITY BENEFITS
Initial
Initial
Resulting
Change in
Percentage
Participation
Medicaid
Medicaid
Medicaid
Status
Change in
Benefits
Benefits
Benefits
Medicaid
($000)
($000)
($000)
Benefits
(%)
Medicaid Only
1,293,775.0
1,132,137.6
-161,637.4
12.5
MED and SSI
527,990.1
519,767.0
8,223.1
1.6
MED and FS
180,581.3
177,021.5
3,559.8
47
2.0
All Three Programs
343,264.9
318,894.3
24,370.6
7.1
TOTALS
2,345,611.3
2,147,820.6
-195,356.9
9.1
48
49
the largest for those units previously receiving only Medicaid assistance, a.
12.5 percent decrease in Medicaid benefits. Units previously receiving all three
forms of assistance would experience a decline in Medicaid benefits of slightly
over 7 percent. The other two groups would be only slightly affected.
The overall decline in Medicaid benefits, as well as the figures for the
individual groups, are likely somewhat overstated. This is because the "spend-
Percentage
Change in
Food Stamp
Benefits
(%)
19.0
2.2
11.3
1.6
10.8
down" provision is not incorporated into the Medicaid simulation. The spend-
down feature of Medicaid allows a previously ineligible family to receive
benefits after it has incurred sufficient medical expenditures to bring family
income down below the income eligibility cutoff. This is not incorporated in
Change in
Food Stamp
Benefits
(000$)
-54,923.2
356.4
-23,061.2
3,822.3
-81,450.3
the TRIM simulation because the CPS has no record of medical expenditures.
+
Rather, we assign average Medicaid benefits to eligible families, with this
amount varying only by state of residence and basis of eligibility (i.e.,
whether by being declared medically needy or through eligibility for SSI).
TABLE 20
IMPACT ON FOOD STAMP BENEFITS RESULTING FROM
A CHANGE IN SOCIAL SECURITY BENEFITS
Resulting
Food Stamp
Benefits
($000)
234,314.1
16,944.2
180,811.7
240,473.9
672,543.9
Thus in the simulation, if the family's income rises above the eligibility
level, it loses all Medicaid benefits. In reality, those with large medical
bills can receive a partial subsidy through the spend-down provision. For
example, a family with income $500 above the eligibility income cutoff, but
Initial
Food Stamp
Benefits
(000$)
289,237.3
16,587.8
203,872.9
244,296.2
753,994.2
with medical expenses of $1,000, can pay the first $500, then become eligible
for medical assistance, and have Medicaid pay the remaining $500.
The impact of increased social security payments on the food stamp case-
load and cost is presented in Table 20. There would be an overall decline in cost
of $81.5 million or 10.8 percent. This decline is heavily concentrated on
two groups--those previously receiving only food stamp benefits, (a decline
Initial
Participation
of $54.9 million, or 19 percent) and those previously receiving food stamp
Status
Food Stamps Only
FS and SSI
MED and FS
All Three Programs
TOTALS
and Medicaid benefits (a decrease of $23 million, or about 11 percent).
Food stamp benefits of the other two groups would be only minimally affected,
50 -
- 51 -
TABLE 21
and it should be noted that these are the ones receiving cash assistance from the
SSI program. Units receiving both SSI and Social Security payments would expe-
IMPACT ON COMBINED BENEFITS* OF A CHANGE
IN SOCIAL SECURITY FOR SELECTED GROUPS
rience relatively small changes in income as measured by the Food Stamp Program
because SSI benefits are reduced one-for-one as Social Security payments in-
crease. The two affected groups--those not receiving SSI payments--would have in-
Initial
Initial
Resulting
Participation
Resulting
Combined
Combined
creased income as measured by the Food Stamp program as a result of the 10
Benefits as
Status
Benefits
Benefits
A Percentage
($000)
($000)
percent increase in Social Security payments.
of Initial
Benefits
The consequences on combined benefits are depicted in Table 21. Unlike
(%)
in the earlier Tables, combined benefits include Social Security payments.
SSI Only
210,873.9
209,293.1**
99.3**
A 10 percent increase in Social Security payments leaves four of the eight
Food Stamps Only
1,986,413.6
2,101,208.0
105.8
groups with about the same total benefits. All of those units received SSI
SSI and FS
193,553.9
192,886.9**
99.7**
benefits prior to the change, and for many the increase in Social Security
Medicaid Only
5,169,129.5
5,395,028.1
104.4
payments was merely offset, dollar-for-dollar, by reduced SSI benefits. How-
MED and SSI
4,861,512.2
4,846,930.3**
99.7**
ever, one would expect an increase in benefits for those whose increase in
FS and MED
1,172,767.9
1,224,978.2
104.5
Social Security payments exceeded the amount of SSI benefits before the change.
All Three Programs
3,388,919.7
3,357,228.7**
99.1**
Thus the average change in combined benefits for these four groups would be
TOTALS
16,983,170.7
slightly positive. This is partially, if not wholely, offset, however, by
17,327,553.3
102.0
the fact that participation in the SSI program declines as benefits decline--
for some, it is simply not worth the bother of applying and/or becoming re-
* Unlike earlier tables, combined benefits include social security benefits
** Figures are understated--see text
certified for eligibility. Thus some families (and particularly new ap-
plicants over time) may actually wind up with less total benefits. For
example, consider a family with a monthly Social Security payment of $180
and a monthly SSI benefit of $25. A 10 percent change in social security
raises these payments to $198 per month and lowers the SSI payment to $7
per month. The family may not bother with reapplying for the latter, re-
sulting in a combined benefit loss of $7, or an after-change benefit of
96.6 percent of the before-change benefits.
- 52
53 -
Since information on participation rates, particularly for those eligible
transfers from the three income-conditioned programs) was increased by 10
for small benefits, is limited, one should view the numbers in Table 21 for
percent. The pattern of the results are identical to those discussed above,
these four groups as approximate. The change in combined benefits for these
though the magnitudes of change are slightly different. The total decrease
groups may be either positive or negative, but in any case they are not large.
in SSI payments was $438 million, only $34 million greater than the $404
Those receiving Food Stamps and/or Medicaid but not SSI benefits (the
million decline brought about by increasing only social security payments.
second, fourth and sixth groups) would experience an increase in combined benefits.
The resulting combined benefits for all groups were also quite similar.
Those families previously receiving Food Stamps only have their bonuses reduced
by 25-30 percent for each $1 increase in Social Security payments and thus expe-
rience the largest percentage increase in combined benefits. Families previously
receiving both Food Stamps and Medicaid receive less of an increase in combined
benefits because in addition to the loss in Food Stamp bonuses they also lose
Medicaid benefits. Finally, those units previously receiving benefits from
Medicaid alone have a percentage change in combined benefits which is approximately equal
to that experienced by the units previously receiving Medicaid and Food Stamp
benefits.
In summary, this analysis shows that, for SSI recipients, an increase in
Social Security payments is pretty much offset by the dollar-for-dollar re-
duction in SSI benefits. Those gaining most in combined benefits are units who
were receiving Food Stamps and/or Medicaid benefits but not SSI payments.
The analysis also demonstrates that, due to program interaction, a change
in one program has produced secondary effects which substantially mitigate the
direct effects of the change.
In addition to the above analysis, a second simulation was carried out
in which all non-earned income (including Social Security income but excluding
54 -
- 55
IV. SENSITIVITY OF CHANGES IN SSI PROGRAM FEATURES
Eliminating the Payment Variation
Due to Living Arrangements
In addition to looking at problems which arise because of the
overlap and interaction of programs for Older Americans, the scope
of concern encompasses features of individual programs which may lead
The current SSI program reduces the payment standard by one-third if
to inequitable treatment among older recipients, or between older and
the recipient is living in the household of another. The rationale behind
younger beneficiaries, or for the same recipient under changing economic
this feature is that there are economies of scale in living in larger house-
conditions. In line with this expanded scope, simulations were made
holds, and further, that these older persons are presumed to be receiving
under alternative program features to provide backup information for
in-kind benefits from the primary family. There is some debate concerning
possible recommendations that might be made to the Council in a separate
the validity of the latter assumption. Also, it is not clear how the pro-
report.
gram determines who is living with whom. Since there is some arbitrariness
Four of these simulations are reported here. They explore the
involved in this reduction, it was decided to assess the impact of eliminating
consequence of changes in SSI--the major income-conditioned program
it.
for those age 65 or over. Specifically, they address the consequences
The total amount of SSI payments increases by $234 million, or 6.5 per-
of (1) eliminating reduced SSI payments to elderly persons residing
cent, when the reduction is eliminated. This increase represents a 46 per-
in someone else's household, (2) increasing the benefit-reduction rate
cent increase in SSI payments which go to units residing in the households
on earned income, (3) Adjusting income disregards by the CPI, and (4)
of others and is a consequence of both increasing existing payments and ex-
alternative ways of treating the value of owner-occupied homes in the
tending eligibility to some previously ineligible units.
SSI asset test. Indirect (secondary) impacts are not reported because
they are small--principally because the magnitudes of the direct (primary)
impacts are not very large.
56
1
57
Changing the SSI Benefit-Reduction
Adjusting the Income Disregards
Rate on Earned Income
One feature of the SSI program is that all income up to a specified
The purpose of this experiment is to assess the sensitivity of SSI pay-
limit ($20 for earned income and $65 for unearned income) is disregarded
ments to one of the major elements in the program design. This task does not
(not counted) in determining eligibility and payment levels. The SSI pay-
suggest that the benefit-reduction rate be increased, but uses an increase to
ment standard is adjusted for the cost of living, but the disregards are not.
illustrate the sensitivity of program costs to this parameter. The amount
In times of inflation, then, SSI recipients with income (either earned or
of SSI payments received by our analysis units decreases by $28 million,
unearned) above the disregards experience a real decline in benefits. To
or less than 1 percent, as a consequence of a 10 percent increase (to 55
assess how much real benefits have declined due to this feature since the
percent) in the benefit-reduction rate. This small reduction in payments
program was initiated (January 1974); the SSI program was simulated with
reflects the fact that older Americans receive very little of their resources
the disregards adjusted by the CPI
from earnings; thus, altering the benefit-reduction rate imposed on earned
If the disregard had been adjusted, Older Americans would have received
income has very little impact on program cost. This is contrary to what
$97.7 million more in SSI payments in 1975 alone. This represents a 2.7
would be expected from an income-conditioned program which extended eligibility
percent increase in SSI payments received by this group. The largest part
to the so-called working poor--low income families headed by prime-age males.
of this increase, 88.3 percent, accrues to those units previously receiving
So while the benefit-reduction rate may be a major issue in welfare reform,
SSI benefits, and 11.7 percent of the increase goes to units not previously
it's significance for older Americans is considerably less.
receiving SSI payments.
- 58
- 59
Alternative Treatments of the Asset Value of Homes
displayed in the following tables represent total SSI eligibles in the
The primary purpose of this task is to analyze the effect of the
year 1976 rather than SSI participants in 1975. Thus the reader is
exclusion from countable assets of homes of market value less than or
cautioned that these combined factors preclude the comparability of this
equal to $25,000 and to examine possible alternatives to this allowable
task with preceding tasks. This lack of comparability should not lessen
exclusion.
the significance of either, however, since preceding tasks deal with
As previously stated, these simulations will rely upon the Census
cross-program interactions and this task treats a specific program
Public Use Sample instead of the Current Population Survey. The CPUS
element of the SSI program. A final technical note must be made before
contains detailed information on housing tenure, home value and mortgage
we proceed with the analysis.
debt, all of which are required in order to examine the effect of, and
Since the decision to assume that income from interest and dividends
alternatives to, the limit on the market value of homes in the SSI asset
represents a seven percent return on assets can be considered arbitrary,
test. It should also be recalled that the baseline simulations per-
we have performed a sensitivity analysis to determine the degree of impact
formed for this task and presented here, assume a seven percent return
this assumption exerts upon the total cost and caseload. Table 22 displays
on assets rather than a six percent return as assumed in simulations per-
the results of assuming that income from these sources represents a 7, 8,
formed on the CPS. Three additional differences should be noted--the
and 10 percent return on total assets. It is easily observed that
simulation results presented here reflect (unless specifically stated
changing the assumed rate of return exerts little influence upon the total
otherwise) 1976 eligible SSI filing units. Since this task does not treat
cost or caseload size. We can therefore presume that assuming a seven
cross-program interactions, the "analysis units" of previous tasks can
percent rate of return does not introduce any extreme biases or unexplained
be replaced by SSI filing units. In addition, as stated above, the figures
errors.
As evidenced by the figures in Table 23, 3,627,000 of the estimated
$35,000 if the residence is in Alaska or Hawaii.
9,230,000 eligible SSI filing units own the homes in which they reside.
2 The specific file used in the simulations described here is an
Thus, an estimated 39.3 percent of the total population of SSI eligibles
extract of the 1970 Census 1 in 1,000 data file aged to 1976. The file
includes 56,365 households and 219,613 persons. In addition to containing
are subject to loss of SSI benefits if they do not reside in homes of market
valuable housing information use of this file has another advantage in that
in creating the extract tape, the population of primary concern to this
study, those age 60 and over, were intentionally oversampled.
These estimates represent categorically eligible filing units who
have passed the income test and the asset test without the $25,000 limit
on home value.
60
- 61
TABLE 22
BOI
IMPACT OF VARIABLE RATES OF RETURN TO ASSETS
ON THE TOTAL SSI CASELOAD AND BENEFITS
Benefit
Assumed Rate
Total Caseload
($ millions)
$5,466.8
4,339.6
4,096.9
Total Benefits
Average Benefit
$13,903.2
of Return
(%)
(000's)
($ millions)
($)
TOTAL
7
8,817,927
$12,368.2
$1,403
Eligibles
(000's)
3,627
2,476
3,127
9,230
8
8,820,620
12,373.8
1,403
10
8,825,792
12,379.0
1,403
TENURE PROFILE OF SSI ELIGIBLE FILING UNITS
Blind and Disabled
Benefit
($ millions)
$1,183.3
1,629.7
1,629.8
$4,442.8
TABLE 23
BY CATEGORICAL ELIGIBILITY
BASIS OF ELIGIBILITY
Eligibles
(000's)
587
676
1,049
2,312
Benefit
($ millions)
$4,283.4
2,709.9
2,467.0
$9,460.3
Aged
Eligibles
(000's)
3,040
1,800
2,078
6,918
TENURE
Homeowners
Renters
Other
TOTALS
62
63
value less than or equal to $25,000. Table 24 demonstrates that of
TABLE 24
these 3,627,000 filing units, 3,133,068 or 86.39 percent do in fact
DISTRIBUTION OF SSI HOMEOWNING ELIGIBLES AND BENEFITS BY MARKET VALUE OF HOME
reside in homes with a market value less than or equal to $25,000.
These 3,133,068 units receive estimated benefit payments of $4,082,402.
Total Eligible
Total
Average
Table 25 shows the impact that adoption of alternative excludable
Market Value of Home
Filing Units
Benefit
Benefits
($000s)
($)
market values limitations exerts upon the total SSI eligible population
and total benefits. If this market value limitation were lowered to
< $ 5,000
1,366,496
1,852,258
1,355
$15,000, 591,876 units would become ineligible for benefits amounting to
5,000 10,000
684,204
390,860
1,302
$746,274,000. This would result in an 18.9 percent reduction in total case-
10,001 15,000
490,492
593,010
1,209
load, and an 18.3 percent reduction in total benefits. If on the other
15,001 20,000
375,907
435,308
1,158
hand, the market value limitation were raised to $35,000 nationwide, an
20,001 25,000
215,969
310,966
1,440
additional 279,017 filing units would become eligible for benefit payments of
25,001 25,500
27,718
43,454
1,568
$441,508. This represents an 8.9 percent increase in the total number
25,501 30,000
152,770
222,344
1,455
of eligibles units and a 10.8 percent increase in total benefits. It
30,001 30,500
6,937
4,054
584
should be recalled that these 279 thousand units represent persons who
30,501 31,000
12,594
22,689
1,801
do not receive SSI benefits solely because the market value of their
31,001 31,500
7,373
13,191
1,789
home exceeds $25,000. Exploring the effect of this limitation even further,
31,501 32,000
7,101
19,921
2,805
we can observe that total removal of the market value limit would result
32,001 32,500
9,283
17,357
1,870
in increasing the estimated caseload by 13.6 percent from 3,133,068 eligible
32,501 33,000
2,890
3,945
1,365
homeowning units to 3,626,850 eligible homeowners. It would further increase
33,001 33,500
3,972
5,204
1,310
benefit payments to this group by 16 percent from $4,082,402 to $4,859,871.
33,501 34,000
15,899
37,958
2,387
Table 25 displays the impact of assuming alternative market value exclusion
34,001 34,500
20,809
34,043
1,636
limits upon the total simulated eligibles and benefits. The advisability of
34,501 35,000
11,671
17,348
1,486
extending the nationwide home value limit by $10,000 from $25,000 to $35,000
35,001 +
214,764
335,963
1,564
or totally abandoning the limit, is dependent upon one's interpretation of
TOTAL
3,626,850
4,859,871
1,340
the relative equity of including such a limit. The cost arising from such
action can be evidenced by the above estimates.
64 -
- 65
TABLE 25
The argument can reasonably be advanced that allowing a home
EFFECT ON TOTAL CASELOAD AND BENEFITS
to be excluded from countable assets, regardless of what total value
OF VARIABLE MARKET VALUE LIMITATIONS
is excludable, is inequitable in that it provides homeowners with an
economic advantage not available to the 2,891,000 eligible SSI units
Home Value Limit
Total Eligibles
Total Benefits
who are not homeowners. One means of rectifying this inequity is to
($000's)
discard any special provisions for owner-occupied homes and treat homes
$25,000 Limit
8,817,927
$12,368,186
like any other type of asset. In this manner, homeowners can be expected
$15,000 Limit
8,226,051
11,621,912
to receive a reasonable rate of return on this asset and include this
$35,000 Limit
9,096,944
12,809,694
return in their countable income.
No Limit
9,311,708
13,148,657
Table 26 presents the impact of including equity income at various
rates of return in countable income on the total number of SSI eligible
filing units. The first row in Table 26 represents the benefits and
caseload of eligible units who pass the SSI categorical, income and asset
tests prior to imputing home equity to income. Inclusion of six percent
of total home equity in countable income results in a decrease of 472,417
eligible units and $698,247 in benefits, a 5.4 percent decrease in the
number of eligible units, and 5.7 percent decrease in total benefits. The
impact of imputing equity to countable income increases as the percentage
of equity imputed increases. Thus, imputing 8 percent of total equity to income
results in a 7.9 percent decline in the number of eligible units and a 10.2
percent decline in total benefits; imputing 10 percent of total equity
results in a 10.3 percent decrease in total caseload and a 10.2 percent
decrease in total benefits. It thus becomes evident that adopting this
alternative approach to the treatment of owner-occupied homes exerts a
significant impact upon the total program cost and caseload. Table 27 displays
to income
home equity
10% of total
After imputing
to income
home equity
8% of total
After imputing
to income
home equity
6% of total
After imputing
of home
on market value
$25,000 limit
income with
home equity to
Before imputing
Home Value
Handling of
7,910,318
8,121,447
8,345,510
8,817,927
Total Caseload
11,105,505
11,356,426
11,669,939
$12,368,186
(s,000$)
Total Benefits
TO COUNTABLE INCOME ON THE TOTAL SSI CASELOAD AND BENEFITS
IMPACT OF IMPUTING VARIABLE PERCENTAGES OF TOTAL HOME EQUITY
TABLE 26
66
1,404
1,398
1,398
$1,403
($)
Average Benefits
TABLE 27
IMPACT OF IMPUTING VARIABLE PERCENTAGES OF TOTAL HOME EQUITY TO
COUNTABLE INCOME ON THE DISTRIBUTION OF SSI ELIGIBLE HOMEOWNERS
ALTERNATIVE RATES OF RETURN ON EQUITY
Before Imputing Equity
Equity Imputed at 6%
Equity Imputed at 8%
Equity Imputed at 10%
SSI Countable Income
Eligibles
Benefit
Eligibles
Benefit
Eligibles
Benefit
Eligibles
Benefit
(000s)
($000s)
(000s)
($000s)
(000s)
($000s)
(000s)
($000s)
Equal to $0
696
1,915,282
266
722,311
243
653,534
220
595,359
$1 999
447
978,452
544
1,237,665
505
1,128,584
468
1,032,105
67
1,000 1,999
1,418
1,455,618
1,009
1,054,250
884
938,984
825
880,998
2,000 2,999
748
638,776
580
541,069
560
532,778
489
498,432
3,000 3,999
170
254,474
143
198,759
126
171,642
122
166,838
4,000 4,999
80
134,313
55
87,070
51
86,755
52
84,268
5,000 5,999
57
65,558
57
48,005
59
53,349
44
40,062
6,000 7,999
9
16,545
5
12,583
7
12,681
3
7,530
8,000 9,999
1
5,615
1
5,816
1
5,611
1
5,496
10,000 +
1
2,120
0
0
0
0
0
0
TOTALS
3,627
5,466,753
2,660
3,907,528
2,436
3,583,918
2,224
3,311,088
- 69
- 68
V. SUMMARY AND CONCLUSIONS
the effect that this alternative scheme has upon the distribution of
SSI eligible homeowners. It can be seen that as the rate of return on
equity imputed increases the number of persons in each countable income
The purpose of this study was to assess the impact of various benefits
cell decreases.
programs on Older Americans. To accomplish this task we first estimated the
In summary, it can be evidenced from this analysis that varying
joint participation in the three major income-conditioned programs, the
the market value exclusion limit in the asset test results in significant
amount of benefits received from each of these programs and, finally, the
changes in the total number of eligibles and the benefits they receive.
proportion of total benefits received from the three programs compared to
However, the magnitude of resulting change appears to be even greater if
the total cash income and in-kind benefits of Older Americans.
the home value limitation is replaced by imputing equity to countable
The second step was to illustrate the interrelationships of these three
income. In addition, it may be suggested that the latter treatment is
programs by introducing a change in one program's benefit levels or in income
more equitable in terms of the treatment of homeowners vis-a-vis non-
received from another source and analyzing the impact on combined benefits.
We have attempted to illustrate that the consequences of a change on combined
homeowners.
benefits can be quite different than the impact of the change on any single
program.
Our baseline estimates indicate that about 22 percent of older Americans
will receive assistance from at least one of the three income-conditioned
benefit programs--SSI, Food Stamps and Medicaid--during 1975. Of these bene-
ficiaries, 49 percent are estimated to participate in only one program, 34
percent to participate in two programs and 17 percent in all three programs.
The most significant overlap is between SSI and Medicaid, with 41 percent of
the units receiving assistance from both. The Food Stamp/Medicaid overlap
affects 26 percent of the recipient units, and the Food Stamp/SSI overlap
involves only 18 percent. Thus, considerable overlap exists between programs.
Over 50 percent of the participants, or nearly 3.5 million units, receive
benefits from 2 or more programs, and all of these units are likely at some
time to be affected by program interactions.
- 70 -
- 71
The 6.8 million units receiving assistance have over $6.7 billion in
either Food Stamps or Medicaid. Thus, looking at just the impact on the SSI
benefits transferred to them through the three programs ($3.6 billion from
caseload masks the substantial secondary impacts which result from tied-
SSI, $2.3 billion from Medicaid and $0.8 from the Food Stamp Program).
eligibility and from reductions in benefits from one program as benefits from
These benefits account for a substantial proportion of the resources
another are increased.
available to these units. The benefits received by those units on only one
Not only did we find marked interactions in eligibility status, but we
program represent between 11 and 20 percent of their available resources.
also found that the impact of changes in the SSI program on combined program
Between 25 and 44 percent of the available resources of units participating
benefits was often substantially different from the impact on SSI benefits
in two programs is contributed by those programs. Finally, nearly 60 per-
alone. In both the SSI simulations, about 7 percent of the initial increase
cent of the available resources of units participating in all three programs
in SSI benefits was offset by reductions in other program benefits via
is accounted for by combined program benefits.
secondary impacts. Moreover the secondary impacts were not evenly distri-
To summarize, there are a considerable number of people receiving assis-
buted across participation groups. Units who participated in SSI and one or
tance, a large number are affected by program interactions, and their eco-
more of the other programs had changes in combined benefits which were equal
nomic resources and economic well-being are highly dependent on the three pro-
to or less than the initial change in SSI benefits. Units previously not
grams.
receiving assistance always had increases in combined benefits in excess
The third section of the paper illustrated the primary and secondary
of the initial increase in SSI benefits.
impacts on benefit patterns by introducing three changes. Two of these
When Social Security payments were increased by 10 percent, the result-
changes dealt with increasing payment standards in the SSI program and the
ing increase in combined benefits was always less than 10 percent, and was
other was an increase in Social Security payments.
considerably less than this, almost zero, for the units previously receiving
All three cases indicate that the primary impact on SSI caseloads signi-
SSI payments.
ficantly understates the impact of the change through secondary impacts.
More than anything else, the analysis of program interactions in Section
When the Federal SSI standard was increased, 283,000 units had their SSI eli-
III demonstrated two fundamental points. First, the primary impact of a
gibility affected but an additional 216,000 units experienced changes in
change in one program may be substantially altered by the interaction of that
participation status in other programs. When both Federal and state SSI stan-
program with other programs. Second, even when only three programs are con-
dards were altered, 316,000 units were added to the SSI caseload, and an
sidered, the interactions are so complex that to trace them out prior to
additional 245,000 people had their eligibility for other programs affected.
actually implementing the change is virtually impossible without simulating
Similarly, when Social Security payments were increased, 352,000 units lost
the change first. Clearly adding more programs increases the complexity of
SSI eligibility and an additional 765,000 units lost their eligibility for
the interactions and the potential for even more dramatic changes in combined
- 72
- 73
eligibility and benefits resulting from a modification of one of the pro-
tial loss of benefits to homeowners if a return to home equity were imputed
to income using a rate of 6 percent. In this case, as many as 472,000 home-
grams.
In addition to the experiments designed explicitly to measure the impact
owners who would otherwise be eligible for SSI could lose their eligibility.
of program interactions on Older Americans, a set of simulations were designed
Clearly program costs and caseloads are sensitive to changes in the treat-
ment of owner-occupied houses.
to examine the sensitivity of SSI costs and caseloads to changes in a number
of features of that program. The findings as reported in Section IV are as
follows: First, removing the current one-third reduction in the SSI standard
for SSI eligibles living in someone else's household would increase potential
program benefits to Older Americans by $234 million or 6.5 percent, and would
increase the payments to SSI eligibles living in other's households by about
46 percent. The second major finding from thisset of SSI simulations was that
both program costs and the benefits received by individuals appear to be insensi-
tive to changes in the benefit-reduction rate imposed on earned income. A 10
percent increase in that rate led to only a $28 million dollar reduction in
benefits to Older Americans. A third SSI simulation adjusted the current
earned and unearned income disregard by the CPI to prevent its erosion in
real terms over time. Older Americans would have received about $100 million
(2.7 percent) in additional SSI benefits had this provision been in effect
since the inception of the SSI program in January of 1974. A final set of
SSI simulations explored the impact of changing the limit on the value of
owner-occupied homes or imputing income to homeowners based on their house
equity. The effect of these changes on total SSI payments and the size of
the eligible caseload was quite substantial. We estimated that the house
value limit of $25,000 eliminates almost 500,000 SSI units
from the eligible SSI population. Furthermore, permitting these units to
enter the program could increase the caseload by as much as 13 percent and
program costs by as much as 16 percent. Equally dramatic would be the poten-
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APPEND IX A
Thus, as a result of the need for a current source of reliable data,
THE DATA BASES
most of the analysis tasks presented in this paper were performed on the
March 1974 Current Population Survey. The March CPS is based on a sample
As explained in the body of this paper, operation of the Transfer In-
of 461 areas comprising 924 counties and independent cities with coverage
come Model requires the use of a hierarchically structured data file. Three
in every State and the District of Columbia. Approximately 50,000 house-
data files of this type have been used in TRIM applications: the 1966-67
holds are selected for interview from these areas. The sample follows a
Survey of Economic Opportunity (SEO) the 1970 Census Public Use Sample (CPUS)
rotation scheme so that a portion of the sample is changed each month. This
and the March Current Population Surveys (CPS) for the years 1967-1974. Each
rotation is performed in order to avoid the poor response rate which might
of these data files contain individual strengths which commend their usage,
occur as a result of continuously interviewing the same persons and to
and individual weaknesses which may or may not prohibit their use in certain
reduce the cumulative effect of biases in response which may occur when a
applications of TRIM.
constant panel is repeatedly interviewed. According to the rotation scheme,
The Survey of Economic Opportunity is the most complete in terms of
each household is interviewed for four consecutive months, dropped from
providing data on individual holdings of assets. This information has, how-
the sample for eight months and returned for the same four months the
ever, become outdated since the survey was conducted in 1966 and 1967. As
next calendar year. This procedure insures that 75 percent of the sample
a result of the age of this data, the SEO is seldom utilized since substantial
is constant from month to month and 50 percent from year to year, thus
adjustments would be required in order to make the data current. Such adjust-
providing a substantial degree of overlap in the panel, reducing discon-
ments would compromise the integrity of the data and any estimates produced
tinuities in the series of data without placing a burden on any specific
through its use.
group of households through unnecessarily lengthy periods of interview.
The Census Public Use Sample is based upon the 1970 Decennial Census of
The CPS is conducted under strict quality control procedures to insure
the Population. This data base has been used extensively in TRIM applications
the accuracy of the data collected. Each month, one-sixth of the total
since it contains valuable information on housing tenure and geographic location,
number of interviewers are selected and one-third of their work assignment
and is a large sample consisting of 60,000 household observations. As we move
is reinterviewed as a quality control check. After the reinterviews, all
farther away in time from the 1970 Census, however, the problem of the age of
the data collected are submitted to extensive editting and allocation pro-
the data base once again becomes an important consideration.
cedures so that the record for each person interviewed is complete and in-
ternally consistent.
The housing variables contained on this file permitted the analysis of
the effect of the market value limit on homes in the asset test of the Sup-
For a description of the Current Population Survey, see Marvin M. Thompson
plemental Security Income program. This analysis task is described in part
and Gary Shapiro, The Current Population Survey: An Overview, dated August 28,
1972, prepared for the Conference on the Current Population Survey - September
II of this paper.
1972. Unpublished.
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- 77
Each month in a given calendar year, a certain set of questions are
APPENDIX B
included in the interview so that the questionaire for any given month is
PROJECTING THE DATA BASES
consistent from year to year. TRIM utilizes the March CPS because this
The most recent CPS data base available for use at the time
file contains information on family structure, work experience and income.
this study was undertaken was the 1974 CPS (the file that is repre--
Thus TRIM can obtain from the March CPS all the demographic and economic
sentative of the demographic population in 1974 and the economic conditions
data it requires to produce tax and transfer program estimates.
of 1973). Significant changes have taken place which have affected the
Despite the timeliness of the Current Population Survey, a time lag
national economy, the demographic profile of the population and the avail-
of approximately 8 months to one year generally exists between the date
ability and structure of individual benefit programs. In order to more
that the survey is taken, and the date that the data is available for public
accurately represent the present situation, this data base was aged to
use. Procedures exist within TRIM to compensate for this time lag and
represent the population and economic conditions that would be represented
produce estimates representative of the current population. A description
by a survey taken in the year 1976.
of these procedures follows.
This adjustment is performed in two steps. The first step adjusts
the data base to reflect growths and shifts in the demographic composition
of the population. This adjustment takes into account any changes which may
have occurred in the age, sex and race profile of the population between 1974
and 1976. The second major adjustment is performed to reflect the changes which
have occurred in the national economy through inflation and productivity
gains and in individual changes in income by source.
These two major adjustments are discussed in greater detail in the
following sections.
Demographic Aging: The procedure used to adjust the size and demographic
composition of the population attempts to çapture the projected changes
in the population as reported by the Bureau of the Census. This is
achieved in two steps. The first step modifies the distribution of the
population by age, race and sex to agree with the Census Series II
projection for the survey month which would be consistent with a survey
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taken in 1975. The resultant or intermediate household distribution
In summary, the aging procedures used to update the 1973 CPS
which arises from the above discussed adjustment of the demographic
to be representative of a 1975 CPS are aimed at making the data base
distribution of persons is then reconciled with the Census Series B
consistent with two acceptable sources of data projections: Bureau of
projections of households for the survey period which would be consistent
the Census demographic projections and DRI economic forecasts.
with a sample survey taken in 1975.
This methodology results in an adjusted data base that is demo-
graphically consistent with the Bureau of the Census' middle range
projections.
Economic Aging: Once the population has been adjusted to represent the
demographic composition of the population in 1975, an adjustment
must be made for the change in income experienced between the years
1973 and 1975. TRIM identifies income according to fourteen
sources (Wages, Business Earnings, Farm Income, Social Security, Rent,
Interest, Dividends, Private Pensions, Workmen's Compensation, Unemployment
Insurance, Welfare, Government Pensions, Veteran's Benefits and Other) for
each person on the file. The adjustment factors are derived from observed
and/or projected growth in the national aggregates for these income
sources. These aggregate growth rates are further adjusted to reflect the
rate of change in the number of recipients for each source. The resultant
adjustment factors are the growth in average per-recipient amounts.
Aggregate national estimates for observed time periods are obtained
from various government publications; estimates for future time periods
are derived from the control projections from the Data Resource Incorporated
(DRI) macro-economic model of the United States.
These include but are not restricted to the DHEW's monthly Social
Security Bulletin, the Department of the Treasury's Statistics of Income,
and the Department of Commerce publication, Survey of Current Business.
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DHEW Publication No. (OHD) 76-20953