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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. list
Clearance information re Foster Care Emancipation [event] (partial)
11/16/1998
P6/b(6)
(3 pages)
002. list
Clearance information re Foster Care Emancipation [event] (partial)
11/16/1998
P6/b(6)
(2 pages)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15410
FOLDER TITLE:
Emancipation-Interagency Issue [1]
2012-1035-S
kc998
RESTRICTION CODES
Presidential Records Act (44 U.S.C. 2204(a)|
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRAJ
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRAJ
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors. or between such advisors |a)(5) of the PRAJ
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Talking If Over
By Hillary Rodham Clinton
Foster children over 18
need our support, too
met the most extraordinary
foster-care children in safe, sta-
I
young woman last week. Joy
ble, loving and permanent homes.
Warren had just begun her
And it will help us meet our na-
first week at Yale Law
tional goal of doubling the na-
School. But what's remarkable is
tion's annual adoption rate.
that Joy grew up in foster care,
But, as important as this bill is,
and like more than 20,000 foster-
it doesn't address all the needs of
care children each year, she
the children who "age out" of the
"aged out" of the system when
system each year and who, like
she turned 18.
Joy Warren, have to make the
This means Joy has been en-
tough transition to living on their
tirely on her own, without the tra-
own.
ditional support system so many
Last year, at a roundtable in
families provide, for the past
Berkeley, Calif., I spent an after-
seven years - years in which she
noon listening to young people
managed to receive a college de-
describe the challenges of leaving
gree, work as an advocate to im-
the foster-care system. A dispro-
prove foster care and begin law
portionate number are homeless
school.
and have trouble finishing school,
Children who grow up in foster
finding jobs and receiving ade-
care face many of the same chal-
quate health care. And, often,
lenges as other children and have
they don't get the life skills they
many of the same needs. But they
need to survive in today's world.
also have special challenges that
There are many programs that
demand special attention - and
work, several of which exist as a
too often they just don't get it.
result of the advocacy and leader-
One 13-year-old foster child
ship of former foster kids like Joy.
told me what she wants most: "I
One national conference, Destina-
want a place that I can call home;
tion Future, where I met Joy last
a room that I can call my room; a
week, brings together older foster
family that I can love and would
children and homeless young
love me back." Is this too much to
people to teach them life skills
ask?
and advocacy techniques. Pro-
Although my own mother was
grams in Texas and Florida pro-
never in formal foster care, her
vide college-tuition assistance for
teen parents were unable to care
young people in foster care. In
for her when she was born. They
Los Angeles County, set-aside
sent her to live with her grand-
entry-level jobs are available for
parents, but when that didn't
young people aging out of foster
work out, she went to live in the
care. Massachusetts has a teen
home of a family where she
parent transitional living pro-
helped take care of the children
gram. And the California Youth
for room and board.
Connection has become a national
My mother has often told me
model of how to bring young fos-
how grateful she is to the woman
ter teens together to form a net-
with whom she lived because she
work of support and advocacy.
got to see what a real family was
One of the most critical chal-
like. She watched what happens
lenges remaining is to make sure
inside a home where parents and
that children who age out of fos-
children go through all they
ter care gain access to health
should go through as a family.
care. It is outrageous that these
And she wanted to pass that op-
young people should find them-
portunity on.
selves among the uninsured.
When I was growing up, she
Some states are addressing this
invited young women from a
issue, but there is still far to go.
group home to come and work for
We must also strengthen the
us, spending time with our family,
Federal Independent Living Pro-
much as my mother had done so
gram, which provides 85,000
many years before.
young people critical assistance
I'm proud that this administra-
in their transition to independent
tion has cared enough to improve
living, helps them earn their high
and reform our nation's foster-
school diplomas and offers access
care system, including passing
to vocational training.
the Family and Medical Leave
Federal legislation and state
Act, which gives time off for par-
programs have put us on the right
ents to adopt a child. Tax credits
track. But we must do better. Now
The Washington Times
THURSDAY, SEPTEMBER 24, 1998
are now available for families
is the time to make sure that the
who adopt, and foster care and
20,000 young people who each
adoption have been freed from
year become too old to remain in
discrimination and delays based
foster care receive the help they
on race, culture and ethnicity.
need to become independent and
I was especially proud when,
productive members of society.
last year, the president signed the
Adoption and Safe Families Act of
To find out more about Hillary
1997, a historic step toward im-
Rodham Clinton and read her
proving the lives of children in
past columns, visit the Creators
foster care. The aim of this bill is
Syndicate Web page at
to place this country's 500,000
www.creators.com
12/08/98
18:42
DAS GRANT PROGRAMS
94562878
NO. 145
001
Up
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
WASHINGTON. D.C. 20410-7000
thann and
OFFICE OF THE ASSISTANT SECRETARY FOR
COMMUNITY PLANNING AND DEVELOPMENT
DATE: December 8
MEMORANDUM TO: Nicole Rabner, Associate Director for Domestic Policy
FROM: Fred Karnas, Deputy Assistant Secretary, Department of Housing and Urban
Development
SUBJECT: HUD's Initial Response to the Issue of Youth Aging Out of Foster Care.
Attached is our initial effort to respond to your request for ideas regarding how the
Department of Housing and Urban Development could help in the effort to better respond
to youth aging out of the Foster Care system. We will continue to review HUD's
programs to determine if additional mechanisms exist for assisting this population.
Please do not hesitate to contact me at 202/708-1506 (x-4621) if you have questions.
12/08/98
18:42
DAS GRANT PROGRAMS
94562878
NO. 145
002
12/8/98
Children Aging Out of Foster Care
Response from the
Department of Housing and Urban Development
Each year, approximately 17,000 youth in the Foster Care system reach the age of 18 and
are no longer eligible for system benefits. Among the nearly 60,000 youth between the
ages of 18 and 21 who fall in this category are many who, because they lack the basic
support system, fall victim to homelessness and/or a variety of other health and social
problems.
Mrs. Clinton has requested ideas from across the Federal government for addressing this
problem. Below, are some ideas for actions the Department of Housing and Urban
Development can take to respond to this issue.
1. The Department will consider adding language to Consolidated Planning guidance
(which will be updated in 1999) encouraging communities to plan for youth aging
out of Foster Care as they develop their Consolidated Plan for housing and
community development. Since this plan is key to obtaining billions of dollars in
Community Development Block Grant and HOME affordable housing funding,
communities should respond positively.
2. The Department will issue a Directive to HUD Field Offices across the nation
highlighting the need to respond to this problem, and encourage Field Offices to work
with local communities to consider ways of increasing housing resources for this
population. It should be noted that at least one HUD Community Builder, in New
Jersey, is already involved in convening a diverse community planning group to
address this issue.
3. HUD will seek to identify "best practices" among its state and local partners (state
and local governments and non-profits) who may be providing important services to
this population, SO that information can be shared with partners across the nation and
replicated.
4. For those youth aging out of the Foster Care system who find themselves homeless,
the Department has included language in the 1999 Notice of Funding Availability
(NOFA) encouraging communities to include "persons knowledgeable on this issue in
the planning process and ensure that your Continuum of Care system adequately
addresses this need." Among other criteria, each Continuum of Care is scored based
12/08/98
18:42
DAS GRANT PROGRAMS
94562878
NO. 145
003
on the extent of their inclusion of identified sub-populations in local planning. This
requirement will be an incentive for inclusion of persons who can provide education
and guidance regarding this problem to the local homelessness assistance planning
process.
HUD will continue to review its programs to determine other possible ways that the tools
and resources of the Department can be brought to bear on the issue of youth aging out of
Foster Care.
Deborah Baker
11/30/98 11:36:28 AM
Record Type:
Record
To:
Nicole R. Rabner/WHO/EOP
CC:
Subject: Agency Responses
Nicole, I thought you might like to know where we were in trying to obtain a response from the various agencies.
I provided email addresses where I could.
debbie
Monday, November 16th, 1998 4:00PM - 5:30 PM
Foster Care Emancipation Agency Responses
Carol Williams
Department of Health and Human Services
Phone: 205.8618
Fax: 260.9345
EMAIL:
--left message with assistant, Francis
Pamela Johnson
Department of Health and Human Services
Phone: 205.8086
Fax:
260.9333
EMAIL: [email protected]
-- Carol and Pamela are both working on putting something together as soon as possible (11/25)
Sheldon C. Bilchik
Shay Bilchik
Department of Justice
Phone: 307.5911
Fax:
307.2093
EMAIL: [email protected]
--left message with secretary (11/25)
Sarah Ingersoll
Department of Justice
Phone: 616.3650
Fax:
307.2093
EMAIL: [email protected]
--left message (11/25)
Gina Wood
Department of Justice
Phone: 307.5911
Fax:
307.2093
EMAIL: [email protected]
--left message with secretary (11/30)
Maureen McLaughlin
Department of Education
Phone: 205.2987
Fax:
401.5749
EMAIL:
--left a message on voice mail (11/30).
Lynn Jennings
Department of Labor
Phone: 219.6197
Fax:
219.9216
EMAIL:
--Will be back on Tuesday; left message (11/30)
Fred Karnas
Department of Housing and Urban Development
Phone: 708.1506
Fax:
401.8939
EMAIL: [email protected]
--Will try and send information as soon as possible (11/25)
Deborah Jospin
Corporation for National Service/AmeriCorps
Phone: 606.5000 ext 287
Fax:
565-2787
EMAIL: [email protected]
--left message with assistant (11/30)
John Gomperts
Corporation for National Service/AmeriCorps
Phone: 606.5000 ext 121
Fax:
565-2784
--left message on voice mail (11/30)
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. list
Clearance information re Foster Care Emancipation [event] (partial)
11/16/1998
P6/b(6)
(3 pages)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15410
FOLDER TITLE:
Emancipation-Interagency Issue [1]
2012-1035-S
kc998
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR, Document will be reviewed upon request.
[001]
Clearance Information for Monday, November 16th, 1998 4:00PM - 5:30 PM
Staff member: Nicole Rabner
RE: Foster Care Emancipation
Carol Williams
Department of Health and Human Services
DOB:
P6/(b)(6)
SS#:
Phone: 205.8618
Fax: 260.9345
Gilda Lambert
Department of Health and Human Services
DOB:
SS#:
P6/(b)(6)
Phone: 205.8085
Fax: 260.9333
Sheldon C. Bilchik
Shay Bilchik
Department of Justice
DOB:
P6/(b)(6)
SS#:
Phone: 307.5911
Fax: 307.2093
Sarah Ingersoll
Department of Justice
DOB:
P6/(b)(6)
SS#:
Phone: 616.3650
Fax: 307.2093
[001]
Gina Wood
Department of Justice
DOB:
P6/(b)(6)
SS#:
Phone: 307.5911
Fax: 307.2093
Maureen McLaughlin
Department of Education
DOB:
SS#:
P6/(b)(6)
Phone: 205.2987
Fax: 401.5749
Lynn Jennings
Department of Labor
DOB:
P6/(b)(6)
SS#:
Phone: 219.6197
Fax: 219.9216
Fred Karnas
Department of Housing and Urban Development
DOB:
P6/(b)(6)
SS#:
Phone: 708.1506
Fax: 401.8939
Teresa Scannell
Corporation for National Service/AmeriCorps
DOB:
SS#:
P6/(b)(6)
Phone: 606.5000 ext 300
Fax: 565-2743
[001]
Deborah Jospin
Corporation for National Service/AmeriCorps
DOB:
SS#:
P6/(b)(6)
Phone: 606.5000 ext 287
Fax: 565-2787
John Gomperts
Corporation for National Service/AmeriCorps
DOB:
P6/(b)(6)
SS#:
Phone: 606.5000 ext 121
Fax: 565-2784
Draft Discussion Paper
Transitional/Independent Living Programs
Background
There is a growing number of adolescents aging out of the foster care system who are presenting
communities with significant challenges. These challenges are similar to those presented by other,
older teens at greatest risk, including youth offenders. Adolescents in foster care are a troubled
population, particularly at risk. Without intervention, many of these troubled youth end up in the
juvenile or criminal justice system. The following statistics describe a stratified sample of foster care
youth at age 18 and are from a study (Westat, 1991) completed for the Department of Health and
Human Services (HHS).
Sample of Foster Care Youth at Age 18
- 2/3 of 18 year olds did not complete high school or obtain a GED
- 61 % had no job experience
- 17% had drug abuse problems
- 17% of the females were pregnant
Two and ½ to four years later, the status of these young adults had not improved:
Sample of Foster Care Youth 2 ½ to 4 Years Later
- 46% still had not completed high school
- 51% were unemployed
- 40 % were a cost to communities (they were either dependent upon the
welfare system or involved with the justice system)
- 60% of the women had one child
- only 17% were completely self-sufficient
Not surprisingly, the same study indicated that providing these youth a combination of
services, supports and opportunities in three core areas --employment, education and
consumer and fiscal skills management --greatly increased their positive outcomes and the
likelihood for self-sufficiency and satisfaction with their lives. By way of example, a typical
young woman who ages out of foster care has a 22% likelihood of holding a steady job for
three years. Providing services in one of the core areas increases that probability to 40%;
providing services in all three core areas increases the probability to 95%!
Easing the transition to self-sufficiency for older teens in the child welfare system is an area
with implications for the juvenile justice system --and an area to which the juvenile justice
field can contribute ideas and examples of promising practices.
Delinquency Prevention
Youth development is one of a number of critical prevention strategies and is an essential
component of what must be done to prepare all young people for adulthood. Youth must be
provided opportunities to engage in positive activities and to develop constructive skills. In
addition, adequately educating youth and providing employment and job training
opportunities are critical to delinquency prevention and to transitioning youth alike.
School-to-Work programs make use of alternative schools or develop ties to the business
community to provide academic and job training that addresses youths' needs and interests.
Mentoring --programs that seek to ensure that children and youth have caring adults in their
lives --is another delinquency prevention strategy which has application to transitioning
foster care youth. Practitioners who work with these older teens agree that adult involvement
in the lives of these children makes all the difference in the world. Some of the statistics from
a Public/Private Ventures evaluation of Big Brothers/Big Sisters mentoring indicate:
Youth with Big Brothers or Big Sisters were:
46% less likely to start using illegal drugs
27% less likely to start drinking alcohol
32% less likely to hit someone
52% less likely to skip a day of school
Also, through the Office of Juvenile Justice and Delinquency Prevention's (OJJDP) Juvenile
Mentoring Program, more than 6,000 at risk youth in 25 states --youth who are Hispanic,
incarcerated, on probation, in foster care, among others --are receiving the one-to-one
mentoring from people in all walks of life to keep them in school and off the streets.
Another intersection between delinquency prevention and transitioning older foster care
youth is aftercare. Providing continuing support for youth is a strategy that is needed
whether the youth are leaving a juvenile facility, day treatment program or foster care. To
expect that a young person has been adequately prepared by our educational, juvenile or
foster care systems to be completely self-sufficient at the age of majority is an unreasonable
expectation. Transitioning youth will need follow up support services for months --perhaps
years --after they leave foster care.
Coordination with OJJDP Activities
OJJDP is currently funding a pilot aftercare project and evaluation in four sites --the
Intensive Aftercare Program for High Risk Youth --which is designed to reintegrate youthful
offenders back into their communities. What is different about this aftercare program from
many others is its emphasis on integrated case management, pre-release planning for the
transition back to the community, and the intensive monitoring and support provided the
young person. All of these components make this program well suited for use with foster
care youth. OJJDP is supporting programs of this type through the state formula grant
program and through several other demonstrations and community-based programs including
SafeFutures, Serious, Violent and Chronic Juvenile Offender programs and the
Comprehensive Strategies sites.
These OJJDP efforts are some of those that carry out the strategies suggested by the HHS
research on outcomes related to transitioning to independent living. Preparing older teens
in the foster care system for self sufficiency requires providing the same type of supports and
opportunities that all youth need to become competent, productive adults. Working with this
population, however, requires more intensive efforts than for youth not at risk, and increased
coordination among the various public and private institutions that touch or affect youth in
foster care.
Selected Program Strategies
Key program strategies to ensure success include education and job training programs,
mentoring and aftercare or follow-up support services. Those are specific programs or
initiatives. There is another level of effort also needed to ensure success with these youth,
and that is to foster connections among agencies. One linkage that is critical is the one
between dependency courts and human or social services agencies. Three of the model
courts associated with the National Council of Juvenile and Family Court Judges'
dependency court reform project are courts in Hamilton County, OH, Alexandria, VA and
Chicago, IL with the primary goal to implement innovative and effective approaches in
handling child abuse and neglect cases. Also to develop and strengthen their relationships
with social services. Specifically, the Chicago dependency court model is developing a
Transitional Living Program component for foster care children as one of their three primary
goals this year.
Also, the Court Appointed Special Advocates volunteers often play a fundamental role.
They facilitate cross-agency linkages though the work they do in obtaining services for the
children they represent from multiple agencies.
Linkages need to be made at all levels to improve employment opportunities for high risk
youth and juvenile offenders. OJJDP has partnered with the Employment and Training
Administration of the Department of Labor to link employment/training and juvenile justice
systems at the local, state and federal levels. In connection with this effort, both agencies
are funding the Home Builders Institute, a recognized leader in vocational training for youth.
Home Builders Institute operates nationwide training programs in residential construction
for youth and adult offenders, similar to the Job Corps program. In addition, the Home
Builders Institute's training for juvenile offenders boasts a ninety-four percent placement rate
of graduates. Such successes can also be anticipated where this training is made available
to transitioning foster care youth.
Possible Next Step
Facilitate a discussion among the appropriate federal agencies to further explore
opportunities to coordinate efforts to enhance support to older youth in transition from foster
care. Also, clearly identify the population of youth in transitional and independent living
programs. Often these young people are identified as runaway and homeless youth, however
their specific needs and support services are slightly different.
Independent Living
Memo for Inter-Departmental Meeting
Each year approximately 17,000 18 year olds "age out" of the public child welfare system and are
expected to function as adults. These young adults entered foster care due to abuse and neglect.
They were unable to return to their birth families and did not find permanency with an adoptive
family. Federal financial support to them ends just at the time they are making the critical transition
to adulthood.
A proportion of these children are supported by two HHS programs:
The Independent Living Program (ILP) provides funds to the States that may be used to provide
services to foster children who are 16 year of age or older to help them make the transition to
independent living by supporting them as they earn a high school diploma; receive vocational
training and education; and learn daily living skills such as budgeting, career planning and securing
housing and employment. The types of services vary from State to State and may not be used for
room or board.
The Transitional Living Program (TLP) provides funds to local community based organizations for
residential care, life skills training, and other support services to homeless adolescents, ages 16-21.
These programs help these youth achieve self-sufficiency, avoid long-term dependency on social
welfare, and become independent, productive members of society.
Both ILP and TLP service providers are encouraged to support young people through a youth
development approach which suggests that the best way to prevent young people's involvement in
risky behavior is to help them achieve their full developmental potential. Youth development
strategies, therefore, focus on giving young people the chance to exercise leadership, build skills,
and become involved in their communities.
Like all young adults those leaving the foster care system need support to achieve an effective
passage to adulthood. Unlike most, their lives have been chaotic and unpredictable. Maltreatment,
lack of connection to families, multiple placements, and the resulting mental health and educational
consequences, make the transition to self sufficiency and adult-functioning very difficult. Research
documenting the experiences of these youngsters in the years immediately following foster care
identifies unstable housing and homelessness, depression, poor health, violence and incarceration
as part of their experience.
The support these youngsters need to achieve self-sufficiency, stable living arrangements and mature
relationships includes:
Medical services, including mental health;
Education and/or vocational training;
Employment preparation and opportunities, including internships;
Transitional and/or supported housing; and
Psycho-social support via mentorship, counseling and/or or support groups.
Nationwide Housing Discrimination Audit: On November 16, HUD announced the
most comprehensive and sophisticated nationwide audit ever conducted to root out
housing discrimination in urban, suburban, and rural communities around the nation. The
audit will include 3,000-5,000 tests for housing discrimination. It will use African
Americans, Hispanics, Asia-Pacific Islanders, and Native Americans to examine and
evaluate patterns and trends in housing sales, rentals, and mortgage lending to minorities.
Youthbuild: HUD is awarding $33.1 million this month to local governments, housing
authorities and non-profit groups to train high school drop-outs in the Youthbuild
program. Youthbuild helps young people get general equivalency high school diplomas
andel
and provides social services and training in leadership skills, in addition to training as
Set
construction workers. By building and renovating low-income housing, the participants
grant Special to
simultaneously earn a solid wage as construction workers and provide housing for people
in need. More than 850 affordable houses and apartments will be built or renovated this
year. Over $170 million in grants have been made under Youthbuild since it began in
kids aging ?
1993, enabling over 7,800 young people to take part in building or rehabilitating more
than 3,650 affordable housing units in their communities.
out
DEPARTMENT OF TRANSPORTATION
Possible Federal Express Pilot Action: On November 13, in response to the ongoing
Federal Express pilot labor discussions, the FAA increased safety oversight of Federal
Express, in accordance with established inspection procedures for carriers involved in
labor discussions. There was no evidence of safety-related concerns during the FAA
inspection and surveillance process. Both parties continue talks with the National
Mediation Board (NMB). On November 16, discussions began with Federal Express and
the NMB. A strike vote is expected on December 3.
Central America Relief Efforts: On November 10, Coast Guard Cutter SENECA
delivered more than one ton of food and clothing for victims of Hurricane Mitch in
Honduras, donated by personnel stationed at Naval Station Guantanamo Bay, Cuba. On
November 12-15, three Coast Guard C-130s delivered more than 36 tons of plastic
sheeting, water, and food to Tegucigalpa and La Masa, Honduras. The Coast Guard also
provided search and rescue assistance to Belize in connection with a missing sailing
vessel. The Federal Highway Administration identified a technical team to assess
highway and bridge damage and pinpoint the most critical links for repair or
reconstruction.
Millennium Trails Initiative: On November 13, Secretary Slater announced nearly $4
million in projects for the National Millennium Trails Initiative. Through the Federal
Highway Administration's Federal Lands Highways discretionary program, nine states
received funds, including AZ, CA, ID, WA, NY, MA, RI, SC, and WY.
Cabinet Weekly Report, November 14 - 27, page 7
November 10, 1998
MEMORANDUM FOR DISTRIBUTION
FROM:
NICOLE RABNER
DOMESTIC POLICY COUNCIL
SUBJECT:
Meeting on Foster Care Emancipation Issues
Please join a discussion on Monday, November 16th, about emancipation from foster care.
As many of you know, when young people in foster care turn 18, federal foster care assistance ends
and they begin an often difficult transition to independence. While there are some federal assistance
programs run by the Department of Health and Human Services that target this population, they are
small in scale.
The purpose of this meeting is to explore better targeting of existing resources to serve this
vulnerable population. As I have mentioned to many of you on the phone, we hope to develop an
interagency initiative in this area.
To the extent possible, please come to the meeting prepared to discuss the programs
administered by your agency that affect these young people and your agency's possible contributions
to an initiative that targets new and ongoing resources to serve them. Attached is a background
piece on this issue prepared by the Department of Health and Human Services and a recent column
by the First Lady.
The meeting will take place on Monday, November 16th, at 4:00pm in Room 100 of the
Old Executive Office Building. Please call Deborah Baker at 456-5582 to confirm your
attendance and provide clearance information (date of birth and SSN). I look forward to seeing
you next Monday. Thanks very much.
DISTRIBUTION:
Carol Williams, Department of Health and Human Services
Gilda Lambert, Department of Health and Human Services
Shay Bilchik, Department of Justice
Sarah Ingersoll, Department of Justice
Maureen McLaughlin, Department of Education
Lynn Jennings, Department of Labor
Fred Karnis, Department of Housing and Urban Development
John Gomperts, Corporation for National Service
Tess Scannel, Corporation for National Service
Jennifer Klein, White House Domestic Policy Council
Trooper Sanders, Mrs. Gore's Office
Recommendations to Improve Transition Process of Foster Care Youth to Independence
Increased Focus on and Expansion of Independent Living Programs
Mandatory Independent Living programs for foster youth-- programs should be mandated
and monitored closely by social workers
Minimum standards should be set at the federal level for these programs instead of
leaving the entire design to state and local agencies
Facilitate information sharing among states
Send kids to IL programs at an earlier age and extend service to a later age (i.e 14-21)
Integrate IL programs with school to work programs
Employ full-time independent living coordinators in all states
Provide technical assistance for states advocates, and legislatures to improve utilization of
IL resources and to make them aware of other possible resources
Train all foster parents, care givers, and service providers in independent living skills
Develop curriculum and make available to states who do not have their own
Housing
Guarantee to find safe, affordable housing
Create supervised transitional housing for older foster youth
Educational Advocacy
Financial assistance for post secondary education (i.e. create national scholarship fund)
Help with college applications and college visits
School stability
Testing for developmental disabilities
State university/community college tuition waivers
Target outreach for foster youth at colleges and universities
Develop Mentor Program (to provide youth with positive role models, tutoring, community
connections, etc.)
Employment
Provide more work experience opportunities at an earlier age
Organize and provide job resource center/job fairs/job coaches
Form partnerships with business community/private industry-- encourage companies,
private sector businesses, etc. to provide meaningful employment for foster youth
Provide workshops on interview skills, role-playing interviews, designing resume, etc.
Encourage job programs to give priority to foster youth
Foster Care Youth Involvement
State and local child welfare agencies should develop low-cost means for youth to meet
one another at conferences, picnics, etc.-- reduce stigma and isolation associated with
being a foster child
Post-care alumni mentoring-- have former foster youth teach the system to current youth
so that they can take advantage of everything being offered
Toll-free hot line for youth-- peer support/encouragement/advice
Involve current and former foster youth in all decisions and policy making
Create long term support program-- monthly support groups, etc.
Raise Age of Emancipation/Extend Services
Extend emancipation to age 21 so that foster youth can continue to receive financial
support
Provide low or no interest loans to those who need additional assistance upon leaving
foster care during their initial2 years of independence
Coordinate network of services to youth after leaving care including health care,
transportation, and child care
Funding
Identify states not using full allotment of money
Allow more flexibility with IL funds including allowing private agencies to have access
Allocate more funds to housing
Earmark federal job-training funds specifically to help foster children develop job skills
Evaluation of all Independent Living Programs
Develop performance and outcome measures
Gather research on effective programs
Brief Summaries of Medicare & Medicaid
http://www.hcfa.gov/medicare/ormedmed.htm.
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Medicaid
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BRIEF SUMMARIES
of
MEDICARE & MEDICAID
Title XVIII and Title XIX of
The Social Security Act
as of June 25, 1998
(incorporating the impacts from the Balanced Budget Act of 1997)
prepared by
Mary Onnis Waid
Social Science Research Analyst, Office of the Actuary,
Health Care Financing Administration, DHHS
NOTE:
The following are very brief summaries of complex subjects. They should be used only
as overviews and general guides to the Medicare and Medicaid programs. The views
expressed herein are those of the author, and do not necessarily reflect the policies or
legal positions of the Health Care Financing Administration or DHHS. These are not
legal documents, nor are they intended to fully explain all of the provisions or
exclusions of the relevant laws, regulations and rulings of the Medicare and Medicaid
programs, nor of the relationship between these programs. These summaries do not
render any legal, accounting or other professional advice, and should not be relied on
in making specific decisions. Only original sources should be utilized.
Top
MEDICARE: A BRIEF SUMMARY
MEDICAID: A BRIEF SUMMARY
THE MEDICAID -- MEDICARE RELATIONSHIP
CONCLUSION
BACKGROUND
Since early in this century, health care issues have continued to escalate in importance for our Nation.
Beginning in 1915, various efforts to establish government health insurance programs have been
initiated every few years. From the 1930s on, there was agreement on the real need for some form of
health insurance to alleviate the unpredictable and uneven incidence of medical costs. The main health
care issue at that time was whether health insurance should be privately or publicly financed.
Private health insurance coverage expanded rapidly during World War II, when fringe benefits were
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increased to compensate for government limits on direct wage increases. This trend continued after the
war, in part due to the favorable tax treatment of providing compensation in the form of fringe benefits.
Private health insurance (mostly group insurance financed through the employment relationship) was
especially needed and wanted by middle-income people. Yet not everyone could obtain or afford private
health insurance. Government involvement was sought. Various national health insurance plans,
financed by payroll taxes, were proposed in Congress starting in the 1940s; however, none was ever
brought to a vote.
In 1950, Congress acted to improve access to medical care for needy persons who were receivingpublic
assistance. This permitted, for the first time, Federal participation in the financing of State payments to
the providers of medical care for costs incurred by public assistance recipients. In 1960, the Kerr-Mills
bill provided medical assistance for aged persons who were not so poor, yet still needed assistance with
medical expenses. But a more comprehensive improvement in the provision of medical care, especially
for the elderly, became a major congressional priority.
After consideration of various approaches, and after lengthy national debate, Congress passed legislation
in 1965 establishing the Medicare and the Medicaid programs as Title XVIII and Title XIX of the Social
Security Act. Medicare was established in response to the specific medical care needs of the elderly (and
in 1973, the severely disabled and certain persons with kidney disease). Medicaid was established in
response to the widely perceived inadequacy of "welfare medical care" under public assistance. In 1977,
the Health Care Financing Administration (HCFA) was established under the Department of Health and
Human Services to administer the Medicare and Medicaid programs.
NATIONAL HEALTH CARE OVERVIEW
As a share of the gross domestic product (GDP), health care spending stabilized in 1993-96 at 13.6
percent. The GDP is the total value of goods and services produced in the United States. And although
1996 showed the slowest growth in more than 37 years of measuring health care spending, our nation's
total spending for health care broke the $1.0 trillion mark in 1996. For the 275 million persons residing
in the United States, the average expenditure for health care in 1996 was $3,759 per person.
Health care is funded through a variety of private payers and public programs. Private funds include
individuals' out-of-pocket expenditures, private health insurance, philanthropy and non-patient revenues
(e.g., gift shops, parking lots, etc.), as well as health services that are provided in industrial settings. For
the years 1974 through 1991, these private funds paid for 58 to 60 percent of all health care
expenditures. But by 1996, the private share of health expenditures had dropped to 53.3 percent of our
Nation's total health care expenditures, while the share of health care provided by public spending
increased correspondingly over this period.
Public spending represents expenditures by Federal, State, and local governments. Of the publicly
funded health care expenditures for our Nation, each of the following account for a small percentage of
the total: the Department of Defense health care programs for military personnel; the Department of
Veterans Affairs health programs; non-commercial medical research; payments for health care under
Workers Compensation programs; health programs under State-only general assistance programs; and
the construction of public medical facilities. Other activities which are also publicly funded include:
maternal and child health services; school health programs; public health clinics; Indian health care
services; migrant health care services; substance abuse and mental health activities; and
medically-related vocational rehabilitation services. The largest shares of public health expenditures,
however, are for the Medicare and Medicaid programs.
Together, Medicare and Medicaid financed $351 billion in health care services in 1996 -- more than
one-third of the nation's total health care bill and almost three-quarters of all public spending on health
care. Since their enactment, both Medicare and Medicaid have been subject to numerous legislative and
administrative changes designed to make improvements, with financial considerations, in the provision
of health care services to our nation's aged, disabled and poor persons.
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Historical information was extracted from the Social Security Bulletin, Volume 56, Number
4, Winter, 1993. National health expenditures data and estimates are from the Office of
National Health Statistics in the Office of the Actuary (OACT) in HCFA. Medicare data are
from the national claims history data base in the Office of Information Systems (OIS) also
in HCFA, with estimates by OACT. Medicaid data are taken from the reports sent by the
States to OIS, with estimates by OACT.
(For more information, data details, and an explanation of the various aspects of health care spending,
see the Office of National Health Statistics, OACT/HCFA, report entitled "National Health
Expenditures, 1996", by Katharine Levit, et. al., in Health Care Financing Review, Fall 1997; and in
"National Health Spending Trends In 1996", by K. Levit, et. al, in Health Affairs, January/February,
1998, Vol. 17, No. 1, pages 35-51.)
For detailed statistical data:
on National Health Expenditures, phone 410-786-7933;
on Medicare, phone 410-786-3689;
on Medicaid, phone 410-786-0165;
or visit: www.hcfa.gov/stats and data
Top
MEDICARE: A BRIEF SUMMARY
MEDICAID: A BRIEF SUMMARY
THE MEDICAID -- MEDICARE RELATIONSHIP
CONCLUSION
MEDICARE: A BRIEF SUMMARY
NOTE: The following is a very brief summary of a complex subject. It should be used
only as an overview and general guide to the Medicare program The views expressed
herein are those of the author, and do not necessarily reflect the policies or legal
positions of the Health Care Financing Administration or DHHS. This is not a legal
document, nor is it intended to fully explain all of the provisions or exclusions of the
relevant laws, regulations and rulings of the Medicare program. This summary does
not render any legal, accounting or other professional advice; original sources of
authority should be researched and utilized.
OVERVIEW
Title XVIII of the Social Security Act, entitled "Health Insurance for the Aged and Disabled," is
commonly known as "Medicare." As part of the Social Security Amendments of 1965, the Medicare
legislation established a health insurance program for aged persons to complement the retirement,
survivors and disability insurance benefits under Title II of the Social Security Act.
When first implemented in 1966, Medicare covered only most persons age 65 and over. By the end of
1966, 3.7 million persons had received at least some health care services covered by Medicare. In 1973,
other groups became eligible for Medicare benefits: persons who are entitled to Social Security or
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Railroad Retirement disability benefits for at least 24 months; persons with end-stage renal disease
(ESRD) requiring continuing dialysis or kidney transplant; and certain otherwise non-covered aged
persons who elect to buy into Medicare.
Medicare consists of two primary parts: Hospital Insurance (HI), also known as "Part A," and
Supplementary Medical insurance (SMI), also known as "Part B. When Medicare began on July 1, 1966,
there were 19.1 million persons enrolled in the program. A third part of Medicare, sometimes known as
"Part C", is the Medicare+Choice program-- which was established by the Balanced Budget Act of 1997
(Public Law. 105-33) and began to provide services on January 1, 1998. Beneficiaries must, however,
have Medicare Part A and Part B in order to enroll in a Part C plan. In 1997, about 38 million persons
were enrolled in one or both of parts A and B of the Medicare program. About 87 percent of all
Medicare "enrollees" used some HI and/or SMI service in 1997.
MEDICARE COVERAGE
Hospital Insurance (HI) is generally provided automatically to persons age 65 and over who are
entitled to Social Security or Railroad Retirement Board benefits. Similarly, individuals who have
received such benefits based on their disability, for a period of at least 24 months, are also entitled to HI
benefits. In 1997, the HI program provided protection against the costs of hospital and specific other
medical care to about 38 million people (33 million aged and five million disabled enrollees).
Approximately 22 percent of these individuals received services covered by HI during the year. The HI
benefits totaled $137.8 billion in 1997, -- an increase of 7.1 percent over the prior year, with an average
expenditure per HI enrollee of $3,600, -- an increase of 6 percent over 1996.
The following lists the health care services covered under Medicare's Hospital Insurance:
Inpatient hospital care coverage includes costs of a semi-private room, meals, regular nursing
services, operating and recovery room, intensive care, inpatient prescription drugs, laboratory
tests, X-rays, psychiatric hospital, inpatient rehabilitation, and long-term care hospitalization when
medically necessary, as well as all other medically necessary services and supplies provided in the
hospital. An initial deductible payment is required, plus co-payments for all hospital days
following day 60 within a benefit period.
Skilled nursing facility (SNF) care is covered by HI only if it follows within 30 days (generally) of
a hospitalization of three or more days, and is certified as medically necessary. Covered services
are similar to those for inpatient hospital, but also include rehabilitation services and appliances.
The number of SNF days provided under Medicare is limited to 100 days per benefit period
(defined below), with a co-payment required for days 21 through 100. Medicare HI does not cover
nursing facility care at all if the patient does not require skilled nursing or skilled rehabilitation
services.
Home Health Agency (HHA) care, including care provided by a home health aide, may be
furnished part-time by a home health agency in the residence of a home-bound beneficiary if
intermittent or part-time skilled nursing and/or certain other therapy or rehabilitation care is
necessary. Certain medical supplies and durable medical equipment may also be provided. There
must be a plan of treatment and periodical review by a physician. Home health care under HI has
no duration limitations, no co-payment, and no deductible. For durable medical equipment,
beneficiaries must pay a 20 percent coinsurance, as required under SMI of Medicare. Full-time
nursing care, food, blood, and drugs are not provided as HHA services.
Hospice care, is a service provided to those terminally ill persons with a life expectancy of six
months or less who elect to forgo the standard Medicare benefits for treatment of a traditional
medical treatment, and receive only hospice care. Such care includes pain relief, supportive
medical and social services, physical therapy, nursing services and symptom management for a
terminal illness. However, if a hospice patient requires treatment for a condition that is not related
to the terminal illness, Medicare will pay for all covered services necessary for that condition. For
the hospice program, the Medicare beneficiary pays no deductibles, but does pay a very small
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coinsurance amount for drugs and the cost of inpatient respite care.
An important coverage limitation of HI is the "benefit period" which starts when the beneficiary
firstenters a hospital and ends when there has been a break of at least 60 consecutive days since inpatient
hospital or skilled nursing care was provided. There is no limit to the number of benefit periods covered
by HI during a beneficiary's lifetime; however, inpatient hospital care is normally limited to 90 days
during a benefit period, and co-payment requirements (detailed later) apply for days 61 through 90. If a
beneficiary exhausts the 90 days of inpatient hospital care available in a benefit period, he or she can
elect to use days of Medicare coverage from a nonrenewable "lifetime reserve" of up to 60 (total)
additional days of inpatient hospital care.
Supplementary Medical Insurance (SMI) benefits are available to: almost all resident citizens age 65
and over; certain aliens age 65 or over even to those who are not entitled (based on eligibility for
Social Security or Railroad Retirement benefits) to HI Medicare services; and disabled beneficiaries who
are entitled to Medicare's HI. SMI coverage is optional and requires payment of a monthly premium.
Almost all persons entitled to HI also choose to enroll in SMI. In 1997, the SMI program provided
protection against the costs of physician and other medical services to about 36 million people.
Approximately 87 percent of these individuals received medical services covered by SMI during 1997,
with SMI benefits of $72.8 billion paid on their behalf.
Part B (SMI) is often thought of primarily as coverage for physician services (in both hospital and
non-hospital settings). However, SMI also covers certain other non-physician services, including:
clinical laboratory tests, durable medical equipment, most supplies, diagnostic tests, ambulance services,
flu vaccinations, prescription drugs which cannot be self-administered, certain self-administered
anticancer drugs, some other therapy services, certain other health services, and blood which was not
supplied by HI.
The expenditures for institutional services in hospital outpatient departments, ambulatory surgical
centers and certain other centers are also covered. Home Health Agency services are also covered. To be
covered, all services must either be medically necessary or be one of the prescribed preventives benefits.
Certain medical services and related care are subject to special payment rules, including: deductibles (for
blood); maximum approved amounts (for independently practicing, Medicare-approved physical or
occupational therapists); or higher cost-sharing requirements (such as that for outpatient treatments for
mental illness).
Medicare+Choice (Part C) is another option provided by the Balanced Budget Act of 1997 (BBA).
Under the BBA, Medicare beneficiaries who have both Part A and Part B can choose to get their benefits
through a variety of risk-based plans known as Part C of Medicare. To participate in this Part C, the
beneficiaries must be entitled to HI and be enrolled in SMI (except for ESRD patients, who must be
enrolled in Part C before they get ESRD; they cannot switch to Part C after they are diagnosed with
ESRD). As is the case for risk plans, organizations that are seeking to contract as Medicare+Choice
plans will have to meet specific organizational, financial, and other requirements. The primary
Medicare+Choice plans are:
Coordinated care plans, which includes Health Maintenance Organizations, Provider-Sponsored
Organizations and Preferred Provider Organizations, and other certified public or private
coordinated care plans and entities that meet the approved required standards as set forth in the
law.
The private, unrestricted fee-for-service plans, which allows beneficiaries to select certain private
providers. For those providers who agree to accept the plan's payment terms and conditions, this
option does not place the providers at risk, nor vary payment rates based upon utilization.
The Medical Savings Account (MSA) plan allows beneficiaries (only a limited number for the
first five years) to enroll in a plan with a high-deductible (maximum for 1999 = $6,000). The
Federal government pays a prescribed portion of the capitation amount into an insurance fund for
each enrollee. The difference between the Medicare capitation rate and the plan premium is
deposited into the MSA account. Deposits for the entire year are made at the start of the year.
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After the deductible is paid, the MSA plan pays providers the lesser of 100% of specified
expenses or 100% of amounts that would have been payable under the original fee-for-service
Medicare program. If extra money remains in the MSA, it can be used to pay for future medical
needs (including some not covered by Medicare e.g., dentures). Or, subject to certain
requirements, the extra money can be used for non-medical purchases.
Except for MSA-plans, all Medicare+Choice plans are required to provide the current Medicare benefit
package, excluding hospice services, and any additional health services required under the adjusted
community rate process. There are some restrictions as to who may elect an MSA-plan, even when
enrollment is no longer limited in number of participants.
OTHER MEDICARE CONSIDERATIONS
The Balanced Budget Act of 1997 included another provision for eligible persons known as PACE
(Programs of All-inclusive Care for the Elderly). PACE provides an alternative to institutional care for
persons aged 55 and over who require a nursing facility level of care and who meet the eligibility
requirements for the program within each State. PACE functions within the Medicaid program as well as
under Medicare, and is described more extensively on page 17 (in the Medicaid section below.) The
individuals enrolled in PACE receive benefits solely through the PACE program. In addition to the new
options and changes that were provided through the Balanced Budget Act of 1997, the BBA also
enhanced Medicare prevention initiatives and rural health initiatives.
It should be noted that some health care services are not provided under any part of Title XVIII.
Non-covered services under Medicare include long term nursing care or custodial care, and certain other
health care needs -- such as dentures and dental care, eyeglasses, hearing aids, most prescription drugs,
etc. These are not a part of the Medicare program unless they are a part of a managed care plan, or--after
January 1, 1999--are selected as a part of the Medicare+Choice program.
MANAGED CARE PLANS
Prepaid health care plans known as managed care plans, such as competitive medical plans (CMPs) and
health maintenance organizations (HMOs), are options for Medicare beneficiaries. Managed care plans
function on a basis different from regular fee-for-service covered under Medicare. Under managed care
plans, the Medicare beneficiary selects a specific HMO, CMP, or other approved plans within a service
area for comprehensive health care services. It is central to the managed care conceptthat this selected
plan coordinate all of the health care services for that person. Managed care plans function on a financial
basis that is different from the traditional fee-for-service reimbursements to health care providers.
Managed care plans receive a per-person payment from Medicare that is predetermined, based on a
formula that is established by law and the demographic characteristics of the Medicare beneficiaries
enrolled in their plan.
In addition to the regular services covered under Medicare, the managed care plans often cover services
such as preventive care, prescription drugs, eyeglasses, dental care, or hearing aids. Electing to
participate in a managed care plan may also serve as an alternative to purchasing "medigap insurance"
(described later) which is often wanted if the beneficiary has traditional fee-for-service coverage.
Although there are certain restrictions, limitations and differences from the fee-for-service plans, the
managed care plan's fixed monthly premiums and cost-sharing structure helps to provide more
predictability for out-of-pocket costs for the beneficiaries who do not have medigap insurance.
PROGRAM FINANCING, BENEFICIARY LIABILITIES, & VENDOR
PAYMENTS
All financial operations for Medicare are handled through two trust funds, one for the Hospital Insurance
and one for Supplementary Medical Insurance. These trust funds--which are special accounts in the U.S.
Treasury-- are credited with all income receipts and charged with all Medicare expenditures for benefits
and administration costs. Assets not needed for the payment of costs are invested in special Treasury
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Securities. The following sections describe Medicare's financing provisions, beneficiary cost-sharing
requirements, and the basis for determining Medicare reimbursements to health care providers.
Program financing:
The Medicare Part A program (HI) financing is primarily through a mandatory payroll deduction
("FICA tax"). Almost all employees and self-employed workers in the U.S. work in employment
covered by the Medicare HI program and pay taxes to support the cost of benefits for aged and disabled
beneficiaries. The FICA tax is 1.45 percent of earnings (paid by each employee and by the employer for
each), as well as 2.90 percent for self-employed persons. For 1994 and later, this tax is paid on all
covered wages and self-employment income without limit. (Prior to 1994, the tax applied only up to a
specified maximum amount of earnings.) The trust fund for the HI program also receives income from:
(i) a portion of the income taxes levied on Social Security benefits paid to high-income beneficiaries, (ii)
premiums from certain persons who are not otherwise eligible and choose to enroll voluntary, (iii)
general funds reimbursements for the cost of certain other uninsured individuals, and (iv) interest
earnings on the invested assets of the trust fund. The taxes paid each year are used mainly to pay benefits
for current beneficiaries. Income not needed to pay current benefits and related expense is invested in U.
S. Treasury securities. The hospital insurance trust fund money is used only for the HI program, and the
SMI trust funds cannot be transferred for HI use.
The Medicare Part B program (SMI) is financed through: (1) premium payments ($43.80 per month in
1998) which are usually deducted from the monthly Social Security benefit checks of those who are
enrolled in the SMI program, and (ii) through contributions from general revenue of the U.S. Treasury.
SMI benefits may also be "bought" for persons by a third party directly paying the monthly premium on
behalf of the enrollee. Beneficiary premiums are currently set at a level that covers 25 percent of the
average expenditures for aged beneficiaries. Except for a small amount of interest income, general
revenues provide the balance of the financing for SMI.
The Medicare Part C program (Medicare+Choice) has rather complex financing, depending upon which
plan is chosen. Basically, the funding for the Medicare+Choice program comes from the HI and SMI
trust funds in proportion to the relative weights of HI and SMI benefits to the total benefits paid by the
Medicare program.
Beneficiary payment liabilities:
For Parts A and B, beneficiaries are responsible for charges not covered by the Medicare program, and
for various cost-sharing aspects of both HI and SMI. These liabilities may be paid: (1) by the Medicare
beneficiary, (2) by a third party such as private "medigap" insurance purchased by the Medicare
beneficiary, or (3) by Medicaid, if the person is eligible. The term "medigap" is used to mean private
health insurance which, within limits, pays most of the health care service charges not covered by Parts
A or B of Medicare. These policies-- which must meet Federally-imposed standards-- are offered by
Blue Cross and Blue Shield, and various commercial health insurance companies.
For hospital care covered under HI, the beneficiary's payment share includes a one-time deductible
amount at the beginning of each benefit period ($764 in 1998). This covers the beneficiary's part of the
first 60 days of each spell of inpatient hospital care. If continued inpatient care is needed beyond the 60
days, additional coinsurance payments ($191 per day in 1998) are required through the 90th day of a
benefit period. Medicare pays nothing after day 90, unless the beneficiary elects to use "lifetime reserve"
days, for which a co-payment ($382 per day in 1998) is required from the beneficiary.
For skilled nursing care covered under HI, the first 20 days of SNF care are fully covered by Medicare.
But for days 21 through 100, a co-payment ($95.50 per day in 1998) is required from the beneficiary.
After 100 days of SNF care per benefit period, Medicare pays nothing for SNF care. Home health care
has no deductible or co-insurance payment by the beneficiary. In any HI service, the beneficiary is
responsible for fees to cover the first three pints or units of non-replaced blood per calendar year. The
beneficiary has the option of paying the fee or of having the blood replaced.
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There are no premiums for the HI portion of Medicare for most people aged 65 and over. Eligibility for
HI is generally earned through the work experience of the beneficiary or that of a spouse. However,
some persons who are otherwise unqualified for Medicare may purchase HI coverage if they also buy
the SMI coverage. The cost is determined by a formula: if they have 30 to 39 quarters of coverage as
defined by the Social Security Administration, the 1998 cost of HI is reduced to $170 per month; if not,
the HI cost is $309 per month.
For SMI the beneficiary's payment share includes: one annual deductible (currently $100); the monthly
premiums; the co-insurance payments for SMI services (usually 20 percent of the medically-allowed
charges); a deductible for blood; and payment for any services which are not covered by Medicare.
These "cost-sharing" contributions are required of the beneficiaries for SMI services. For ESRD patients,
Medicare SMI covers kidney dialysis and physician charges incurred by the patient and donor during the
transplant and follow-up care. Regular SMI cost-sharing also applies for ESRD services.
For Part C, the beneficiary's payment share is based upon the cost-sharing structure of the specific
Medicare+Choice plan selected by the beneficiary (see descriptions on page 6 & 7), as each plan has its
own requirements.
Vendor payments:
For HI, prior to 1983, payment to vendors was made on a "reasonable cost" basis. Medicare payments
for most inpatient hospital care are now paid under a plan known as the Prospective Payment System
(PPS). Under the PPS, a hospital is paid a predetermined amount, based upon the patient's diagnosis
within a "diagnosis related group" (DRG), for providing whatever medical care is required during that
person's inpatient hospital stay. In some cases the payment received is less than the hospital's actual
costs; in other cases it is more. The hospital absorbs the loss or makes a profit. Certain payment
adjustments exist for extraordinarily costly cases. The BBA made some reductions in the amounts paid
to hospitals, and to other payments for traditional fee-for-service programs. Payments for inpatient
rehabilitation, psychiatric, home health, hospice and for skilled nursing care coverage continue to be
paid under the reasonable cost methodology, with each service having some restrictions and limitations
although payment methods will be restructured as required by the BBA.
For SMI prior to 1992, physicians were paid on the basis of "reasonable charge." This was initially
defined as the lowest of (1) the physician's actual charge, (2) the physician's customary charge, or (3) the
prevailing charge for similar services in that locality. Starting January, 1992, allowed charges were
defined as the lesser of: the submitted charges, or a fee schedule based on a relative value scale (RVS).
Payments for durable medical equipment and clinical laboratory services are also based on a fee
schedule. Hospital outpatient services and HHAs are currently reimbursed on a reasonable cost basis.
The BBA provided for implementation of a Prospective Payment System for these services in the future.
If a doctor or supplier agrees to accept the approved rate as payment in full ("takes assignment"), then
payments provided must be considered as payments in full for that service. No added payments (beyond
the initial annual deductible and co-insurance) may be sought from the beneficiary or insurer. If the
provider does not take assignment, the beneficiary will be charged for the excess (which may be paid by
medigap insurance). Limits now exist on the excess which doctors or suppliers can charge. Physicians
are "participating" physicians if they agree before the beginning of the year to accept assignment for all
Medicare services they furnish during the year. Since Medicare beneficiaries may select their doctors,
they have the option to choose those who do participate.
For Part C, payments to the Medicare+Choice plans are based on a blend of local and national capitated
rates, generally determined by the capitation payment methodology described in Section 1853 of the
Social Security Act. Actual payments to plans vary based on characteristics of the enrolled population.
New risk adjusters are scheduled to be implemented in January 2000.
MEDICARE CLAIMS PROCESSING
The BBA included provisions for anti-fraud and for countering abuse, as well as improvements in
protecting the Medicare programs' integrity. Other aspects of the BBA provisions are quite extensive and
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have significant impacts on both the HI and SMI part of Medicare. However, since this is only an
overview and brief summary of the total Medicare program, additional details will not be included
herein.
Medicare claims are processed by non-government organizations or agencies that contract to serve as the
fiscal agent between providers and the Federal government to locally process Medicare's HI and SMI
claims. These claims processors are known as "intermediaries" and "carriers." They apply the Medicare
coverage rules to determine the appropriateness of claims.
Medicare "intermediaries" process HI claims for institutional services, including inpatient hospital
claims, skilled nursing facilities, home health agencies, and hospice services. They also process hospital
outpatient claims for SMI. Examples of intermediaries are the Blue Cross and Blue Shield Association
(which utilize their plans in various States), and other commercial insurance companies.
Intermediaries' responsibilities include:
determining costs and reimbursement amounts;
maintaining records;
establishing controls;
safeguarding against fraud and abuse or excess use;
conducting reviews and audits;
making the payments to providers for services; and
assisting both providers and beneficiaries as needed.
Medicare "carriers" handle SMI claims for services by physicians and medical suppliers. Examples of
carriers are the Blue Shield plans in a State, and various commercial insurance companies.
Carriers' responsibilities include:
determining charges allowed by Medicare;
maintaining quality of performance records;
assisting in fraud and abuse investigations;
assisting both suppliers and beneficiaries as needed; and
making payments to physicians and suppliers for services which are covered under SMI
Peer Review Organizations (PROs) are groups of practicing health care professionals who are paid by
the Federal government to do the general overview of the care provided to Medicare beneficiaries in
each State, and improve quality of services. PROs act to educate and assist in the promotion of effective,
efficient and economical delivery of health care services to the Medicare population they serve.
ADMINISTRATION of MEDICARE
The Department of Health and Human Services (DHHS) has the overall responsibility for administration
of the Medicare program, with the assistance of the Social Security Administration (SSA). The Health
Care Financing Administration (HCFA) is a component of DHHS. HCFA has primary responsibility for
Medicare, including: formulation of policy and guidelines; contract over-sight and operation;
maintenance and review of utilization records; and general financing of Medicare. SSA is responsible for
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the initial determination of an individual's Medicare entitlement, and has the overall responsibility for
maintaining the Medicare master beneficiary record.
A Board of Trustees, which is composed of two appointed members of the public and four ex-officio
members, oversees the financial operations for the trust funds for both HI and SMI. The Secretary of the
Department of Treasury is the managing trustee. The Board of Trustees reports the status and operation
of the Medicare trust funds to Congress on or about the first day of April each year.
State agencies (usually State Health Departments under agreements with HCFA) assist by helping
DHHS to identify, survey, and inspect provider and supplier facilities or institutions wishing to
participate in the Medicare program. In consultation with HCFA, they then certify those that
arequalified. The State agency also assists providers as a consultant, and coordinates the various State
programs to assure effective and economical endeavors.
MEDICARE DATA SUMMARY
The Medicare program covers 95 percent of our Nation's aged population, plus many of those eligible
persons who are on Social Security because of disability. In CY 1997, HI covered about 38 million
enrollees at a cost of $137.8 billion, and SMI covered 36 million enrollees at a cost of $72.8 billion in
1997. Administrative costs were 1.2 percent of HI and 1.8 percent of SMI disbursements for 1997. Of
those persons who were entitled to Medicare in 1997, about 87 percent used Supplementary Medical
Insurance services, while only 22 percent used the Hospital Insurance services. The combined HI and
SMI benefit payments for all Medicare services in CY 1997 averaged about $6,300 per enrollee. Total
disbursements for Medicare for 1997 was $213.575 billion.
Since certain Medicare beneficiaries also receive some assistance from the Medicaid program, please
note the brief Medicare and Medicaid Relationship summary that is described on pages 21 and 22
herein, after the following Medicaid Summary.
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MEDICARE: A BRIEF SUMMARY
MEDICAID: A BRIEF SUMMARY
THE MEDICAID -- MEDICARE RELATIONSHIP
CONCLUSION
MEDICAID: A BRIEF SUMMARY
NOTE: The following is a very brief summary of a complex subject. It should be used
only as an overview and general guide to the Medicaid program The views expressed
herein are those of the author, and do not necessarily reflect the policies or legal
positions of the Health Care Financing Administration or DHHS. This summary does
not render any legal, accounting or other professional advice; nor is it intended to fully
explain all of the provisions or exclusions of the relevant laws, regulations and rulings
of the Medicaid program. Original sources of authority should be researched and
utilized.
OVERVIEW of MEDICAID
Title XIX of the Social Security Act is a Federal-State matching entitlement program that pays for
medical assistance for certain vulnerable and needy individuals and families with low incomes and
resources. This program, known as Medicaid, became law in 1965 as a jointly funded cooperative
venture between the Federal and State governments ("State" used herein includes the Territories and the
District of Columbia) to assist States furnishing medical assistance to eligible needy persons. Medicaid
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is the largest source of funding for medical and health-related services for America's poorest people. In
1996, it provided health care assistance to more than 36 million persons, at a cost of $160 billion dollars.
Within broad national guidelines established by Federal statutes, regulations and policies, each State: (1)
establishes its own eligibility standards; (2) determines the type, amount, duration, and scope of
services; (3) sets the rate of payment for services; and (4) administers its own program. Medicaid
policies for eligibility, services, and payment are complex, and vary considerably even among
similar-sized and/or adjacent States. Thus, a person who is eligible for Medicaid in one State might not
be eligible in another State; and the services provided by one State may differ considerably in amount,
duration, or scope from services provided in a similar or neighboring State. In addition, Medicaid
eligibility and/or services within a State can change during the year.
BASIS of ELIGIBILITY and MAINTENANCE ASSISTANCE STATUS
Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions
of the Federal statute, Medicaid does not provide health care services even for very poor persons unless
they are in one of the groups designated below. And low income is only one test for Medicaid
eligibility for those within these groups; their resources also are tested against threshold levels (as
determined by each State within Federal guidelines).
States generally have broad discretion in determining which groups their Medicaid programs will cover
and the financial criteria for Medicaid eligibility. To be eligible for Federal funds, however, States are
required to provide Medicaid coverage for certain individuals who receive Federally assisted
income-maintenance payments, as well as for related groups not receiving cash payments. In addition to
the Medicaid program, most States have additional "State-only" programs to provide medical assistance
for specified poor persons who do not qualify for Medicaid. Federal funds are not provided for
State-only programs. The following displays the mandatory Medicaid "categorically needy" eligibility
groups for which Federal matching funds are provided:
Individuals are generally eligible for Medicaid if they meet the requirements for the AFDC
program that were in effect in their State on July 16, 1996, or-- at State option -- more liberal
criteria;
Children under age six whose family income is at or below 133% of the Federal poverty level
(FPL);
Pregnant women whose family income is below 133% of the FPL (services to women are limited
to: those related to pregnancy, complications of pregnancy, delivery and postpartum care);
SSI recipients in most States (some States use more restrictive Medicaid eligibility requirements
that pre-date SSI);
Recipients of adoption or foster care assistance under Title IV of the Social Security Act;
Special protected groups (typically individuals who lose their cash assistance due to earnings from
work or from increased Social Security benefits, but who may keep Medicaid for a period of
time);
All children born after September 30, 1983 who are under age 19, in families with incomes at or
below the FPL. (This phases in coverage, so that by the year 2002, all such poor children under
age 19 will be covered); and
Certain Medicare beneficiaries (described later).
States also have the option of providing Medicaid coverage for other "categorically related" groups.
These optional groups share the characteristics of the mandatory groups (that is, they fall within defined
categories), but the eligibility criteria are somewhat more liberally defined. The broadest optional groups
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for which States will receive Federal matching funds for coverage under the Medicaid program include:
Infants up to age one and pregnant women not covered under the mandatory whose family income
is no more than 185% of the FPL (the percentage amount is set by each State);
Children under age 21 who meet what were the AFDC income and resources requirements in
effect in their State on July 16, 1996, (even though they do not meet the mandatory eligibility
requirements);
Institutionalized individuals eligible under a "special income level" (the is set by each State --up to
300% of the SSI Federal benefits rate);
Individuals who would be eligible if institutionalized, but who are receiving care under home and
community-based services waivers;
Certain aged, blind or disabled adults who have incomes above those requiring mandatory
coverage, but below the FPL;
Recipients of State supplementary income payments;
Certain working and disabled persons with family income less than 250% of FPL who would
qualify for SSI if they did not work;
TB-infected persons who would be financially eligible for Medicaid at the SSI income level if
they were within a Medicaid-covered category (however, coverage is limited to TB-related
ambulatory services and TB drugs);
"Optional targeted low-income children" included within the Children's Health Insurance Program
(CHIP) established by the Balanced Budget Act of 1997 (BBA); and
"Medically needy" persons (described below).
The Medically Needy (MN) program allows States the option to extend Medicaid eligibility to
additional qualified persons. These persons would be eligible for Medicaid under one of the mandatory
or optional groups, except that their income and/or resources are above the eligibility level set by their
State. Persons may qualify immediately, or may "spend-down" by incurring medical expenses that
reduce their income to or below their State's MN income level.
The medically needy Medicaid program does not have to be as extensive as the categorically needy
program, and may be quite restrictive in rules as to who is covered and/or as to what services are offered.
Federal matching funds are available for MN programs. However, if a State elects to have any MN
program, there are Federal requirements that certain groups and certain services must be included.
Children under age 19 and pregnant women who are medically needy must be covered; and prenatal and
delivery care for pregnant women, and ambulatory care for children must be provided. A State may elect
to provide MN eligibility to certain additional groups, and may elect to provide certain additional
services within its MN program. In 1996, forty-two States elected to have a MN program, and provided
at least some MN services for at least some MN recipients. All remaining States utilize the "special
income level" option (above) to extend Medicaid to the "near poor" in medical institutional settings.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193)
--known as the "welfare reform" bill -- made restrictive changes regarding eligibility for Supplemental
Security Income (SSI) coverage that will have an impact on the Medicaid program. The new law may be
significant for certain aliens' Medicaid coverage. For most legal resident aliens and other qualified aliens
who entered the United States on or after August 22, 1996, Medicaid is barred for five years. Medicaid
for most aliens entering before that date is a State option, as is coverage after the five year ban, except
for emergency services. For aliens who lose SSI benefits because of new restrictions regarding SSI
coverage, Medicaid can continue, except for emergency care, only if these persons can be covered for
Medicaid under some other eligibility status. Although a number of disabled children lost SSI as a result
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of changes to the P. L. 104-193, their continued eligibility for Medicaid was assured by Public Law
105-33: the Balanced Budget Act of 1997 (the BBA).
In addition, welfare reform repealed the open-ended Federal entitlement program known as Aid to
Families with Dependent Children (AFDC), and replaced it with Temporary Assistance for Needy
Families (TANF), which will provide grants to States to be spent on time-limited cash assistance. TANF
limits a family's lifetime cash welfare benefits to a maximum of five years, and permits States to impose
a wide range of other restrictions as well --in particular, requirements related to employment. However,
the impact on Medicaid eligibility is not expected to be significant. Under welfare reform, persons who
would have been eligible for AFDC under the AFDC requirements in effect on July 16, 1996, generally
will still be eligible for Medicaid. Although most persons covered by TANF will receive Medicaid, the
law does not so require.
Title XXI of the Social Security Act, known as the Children's Health Insurance Program (CHIP), is a
new program initiated by the BBA. In addition to allowing States to craft or expand an existing State
insurance program, CHIP will provide more Federal funds for States to expand Medicaid eligibility to
include more children who are currently uninsured. With certain exceptions, these are low-income
children who would not qualify for Medicaid based on the plan that was in effect on April 15, 1997.
Funds from the CHIP also may be used for providing medical assistance to children during a
presumptive eligibility period for Medicaid. This is one of several options for States to select for
providing health care coverage for more children, as prescribed within the BBA's Title XXI program.
Medicaid coverage may begin as early as the third month prior to application-- if the person would have
been eligible for Medicaid had he applied during that time. Medicaid coverage generally stops at the end
of the month in which a person no longer meets the criteria of any Medicaid eligibility group. The BBA
allows States to provide 12 months of continuous Medicaid coverage (without reevaluation) for eligible
children under the age of 19.
SCOPE of MEDICAID SERVICES
Title XIX of the Social Security Act ( the Medicaid program) allows considerable flexibility within the
States' Medicaid plans. However, some Federal requirements are mandatory if Federal matching funds
are to be received. A State's Medicaid program must offer medical assistance for certain basic services to
most categorically needy populations. These services generally include:
inpatient hospital services;
outpatient hospital services;
prenatal care;
vaccines for children;
physician services;
nursing facility services for persons aged 21 or older;
family planning services and supplies;
rural health clinic services;
home health care for persons eligible for skilled-nursing services;
laboratory and x-ray services;
pediatric and family nurse practitioner services;
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nurse-midwife services;
Federally-qualified health-center (FQHC) services, and ambulatory services of an FQHC that
would be available in other settings; and
early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age
21.
States also may receive Federal matching funds for providing certain optional services. The most
common of the 34 currently-approved optional Medicaid services include:
diagnostic services;
clinic services;
intermediate care facilities for the mentally retarded (ICFs/MR);
prescribed drugs and prosthetic devices;
optometrist services and eyeglasses;
nursing facility services for children under age 21;
transportation services;
rehabilitation and physical therapy services; and
home and community-based care to certain persons with chronic impairments.
The Balanced Budget Act included another provision for eligible persons as a State option known as
PACE (Programs of All-inclusive Care for the Elderly). PACE provides an alternative to institutional
care for persons aged 55 and over who require a nursing facility level of care. The PACE team offers and
manages all health, medical and social services, and mobilizes other services as needed to provide
preventative, rehabilitative, curative and supportive services. This care is provided in day health centers,
homes, hospitals and nursing homes -- while helping the person maintain independence, dignity and
quality of life. PACE functions within the Medicare program as well as under Medicaid. Regardless of
source of payment, PACE providers receive payment only through the PACE agreement, and must make
available all items and services covered under both Titles XVIII and XIX without amount, duration or
scope limitations, and without application of any deductibles, copayments or other cost sharing. The
individuals enrolled in PACE receive benefits solely through the PACE program.
AMOUNT and DURATION of MEDICAID SERVICES
Within broad Federal guidelines and certain limitations, States determine the amount and duration of
services offered under their Medicaid programs. States may limit, for example, the number of days of
hospital care or the number of physician visits covered. Two restrictions apply: (1) limits must result in a
sufficient level of services to reasonably achieve the purpose of the benefits; and (2) limits on benefits
may not discriminate among beneficiaries based on medical diagnosis or condition.
In general, States are required to provide Medicaid coverage for comparable amounts, duration and
scope of services to all categorically-needy and categorically-related eligible persons. There are two
important exceptions: 1) Medically necessary health care services identified under the EPSDT program
for eligible children which are within the scope of mandatory or optional services under Federal law,
must be covered even if those services are not included as part of the covered services in that State's Plan
(i.e., only these specific children might receive that specific service); and 2) States may request
"waivers" to pay for otherwise-uncovered home and community-based services (HCBS) for
Medicaid-eligible persons who might otherwise be institutionalized (i.e., only persons so designated
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might receive HCBS). States have few limitations on the services which may be covered under such
waivers as long as the services are cost effective (except that, other than as a part of respite care, they
may not provide room and board for such recipients). With certain exceptions, a State's Medicaid Plan
must allow recipients to have some informed choices among participating providers of health care, and
to receive quality care that is appropriate and timely.
PAYMENT for MEDICAID SERVICES
Medicaid operates as a vendor payment program. States may pay providers directly, or States may pay
for Medicaid services through various prepayment arrangements, such as health maintenance
organizations (HMOs). Within Federally-imposed upper limits and specific restrictions, each State
generally has broad discretion in determining the payment methodology and payment rate for services.
Generally, payment rates must be sufficient to enlist enough providers so that covered services
areavailable at least to the extent that comparable care and services are available to the general
population within that geographic area. Providers participating in Medicaid must accept Medicaid
payment rates as payment in full. States must make additional payments to qualified hospitals that
provide inpatient services to a disproportionate number of Medicaid recipients and/or to other
low-income or uninsured persons under what is known as the "disproportionate share hospital" (DSH)
adjustment. Excessive use of the DSH adjustment resulted in rapidly increasing Federal expenditures for
Medicaid. However, under legislation passed in 1991, 1993, and again within the Balanced Budget Act
of 1997, the State allotments for payments to DSH hospitals have become increasingly limited.
States may impose nominal deductibles, coinsurance or co-payments on some Medicaid recipients for
certain services. Certain Medicaid recipients, however, must be excluded from cost sharing: pregnant
women, children under age 18, hospital or nursing home patients who are expected to contribute most of
their income to the cost of institutional care. In addition, all Medicaid recipients must be exempt from
co-payments for emergency services and family planning services.
The Federal government pays a share of the medical assistance expenditures under each State's Medicaid
program. That share, known as the Federal Medical Assistance Percentage (FMAP) is determined
annually by a formula that compares the State's average per capita income level with the national income
average. States with a higher per capita income level are reimbursed a smaller share of their costs. By
law, the FMAP cannot be lower than 50 percent nor higher than 83 percent. In 1997, the FMAPs varied
from 50 percent (to 13 States and the District of Columbia) to 77.2 percent (to Mississippi), with the
average Federal share among all States being 57.0 percent. However, the BBA permanently raised the
FMAP for D.C. from 50% to 70%, and raised the FMAP for Alaska from 50% to 59.8% for three years.
For the children added to Medicaid through the CHIP program, the FMAP average is higher -- about
70% compared to the Medicaid average of 57%.
The Federal government also reimburses States for 100% of the cost of services provided through
facilities of the Indian Health Service; provides financial help to the 12 States that provide the highest
number of emergency services to undocumented aliens; and shares in each State's expenditures for the
administration of the Medicaid program. Most administrative costs are matched at 50 percent for all
States, with higher rates for certain activities such as development of mechanized claims processing
systems. The Medicaid statute does provide, however, higher matching rates for certain functions and
activities.
Except for the CHIP program and the QI program (described later), Federal payments to States for
medical assistance have no set limit (cap); rather, the Federal government matches (at FMAP rates) State
expenditures for the mandatory services plus the optional services that the individual State decides to
cover for eligible recipients, and matches (at the appropriate administrative rate) all necessary and proper
administrative costs.
MEDICAID SUMMARY and TRENDS
Medicaid was initially formulated as a medical care extension of Federally-funded programs proving
cash income assistance for the poor, with an emphasis on dependent children and their mothers, the
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disabled, and the elderly. Over the years, however, Medicaid eligibility has been incrementally expanded
beyond its original ties with eligibility for cash programs. Legislation in the late 1980s assured Medicaid
coverage to an expanded number of low-income pregnant women, poor children andto some Medicare
beneficiaries who are not eligible for any cash assistance program. Legislative changes also focused on
increased access, better quality of care, specific benefits, enhanced outreach programs, and fewer limits
on services.
Since its inception, Medicaid has had very rapid growth in expenditures. Although the rate of increase
has subsided recently, acceleration over the years has been noteworthy. This rapid growth in Medicaid
expenditures has been due to several factors. The primary ones include:
expanded coverage and utilization of services, and the increase in the size ofthe Medicaid-covered
populations (a result of Federal mandates, of population growth, and of the earlier economic
recession);
the disproportionate share hospital (DSH) payment program, coupled with provider tax and
donations programs;
the increase in the numbers of very old and disabled persons requiring extensiveacute and/or long
term health care and various related services;
the results of technological advances to keep more very low birth-weight babies and other
critically ill or severely injured persons alive and in need of continued extensive and very
expensive care; and
increased payment rates to providers of health care services, when compared to general inflation.
As with all health insurance programs, most Medicaid recipients require relatively small average
expenditures per person each year. Providing health care coverage for almost 17 million children, who
otherwise would usually receive little or no medical care, is and has always been a primary concern of
the Medicaid program. Yet the data for 1996 indicate that Medicaid payments for services for these
children (who constitute over 46 percent of all Medicaid recipients) averaged only a little over $1,000
per child. There are, however, certain other specific groups for whom Medicaid is at least as essential:
those comprising far fewer persons, but ones who have much larger per-person expenditures. Regardless
of their initial financial situation, their medical needs are so great and/or continuous that most of these
patients must eventually depend upon Medicaid. When expenditures for these high and lower cost
recipients are combined, the 1996 payments to health care vendors for over 36 million Medicaid
recipients average $3,400 per person.
Long term care is an important and increasingly utilized provision of Medicaid--especially as our
nation's population ages. Almost 45% of the total cost of care for persons using nursing facility or home
health services in the U.S. in recent years is paid for by the Medicaid program. A much larger percentage
is paid for by Medicaid, however, for those persons who use more than four months of such long-term
care. As Medicaid has continued to provide extensive nursing facility care over the years, the focus has
become the struggle to rely more on community-based long term care alternatives. The data for 1996
show that Medicaid payments for nursing facility (excluding ICF/MRs) and home health care totaled
$40.5 billion for more than 3.6 million recipients of these services -- an average 1996 expenditure of
more than $12,300 per long-term care recipient. With the percentage of our population who are elderly
and/or disabled increasing faster than the younger groups, the need for long term care is expected to
increase.
Another significant development in Medicaid is the growth in managed care as an alternative service
delivery concept different from the traditional fee-for-service system. Under managed care systems,
health maintenance organizations (HMOs), prepaid health plans (PHPs) or comparable entities agreeto
provide a specific set of services to Medicaid enrollees, usually in return for a predetermined periodic
payments per enrollee. Managed care programs seek to enhance access to quality care in a cost-effective
manner. Waivers may provide the States with greater flexibility in the design and implementation of
their Medicaid programs. Two major waivers (known as "1915(b)" and "1115") are an important part of
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the Medicaid program. Section 1915(b) of the law allows States to develop innovative health care
delivery or reimbursement systems. By January 1997, forty two States had a total of 100 approved
1915(b) waivers. Section 1115 of the law allows Statewide health care reform demonstrations for testing
various methods of covering uninsured populations, and testing new delivery systems, without
increasing costs. Fifteen States now have 1115 projects approved, and ten more States have 1115
projects under review. Finally, the Balanced Budget Act of 1997 provided States a new option to use
managed care. Medicaid managed care programs are growing rapidly. The number of Medicaid
beneficiaries who are now enrolled in some managed care program continues to increase, and may soon
approach 50 percent of all Medicaid enrollees. Several States have converted their entire Medicaid
programs into managed care.
Medicaid data as reported by the States indicate that more than 36 million persons received health care
service through the Medicaid program in 1996. These data show that, in addition to administrative costs,
the total outlays for the Medicaid program in 1996 included: direct payment to providers of $122 billion;
payments for various premiums (for HMOs, Medicare, etc.) of more than $16 billion; and payments to
the disproportionate share hospitals of $15 billion.
The total expenditure for the nation's Medicaid program was $160 billion ($ 91 billion in Federal and
$69 billion in State funds) in 1996. With anticipated impacts from the Balanced Budget Act of 1997,
projections now are that total Medicaid outlays may be $250 billion in fiscal year 2003, with an
additional $5.8 billion expected to be spent for the new Children's Health Insurance Program.
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MEDICARE: A BRIEF SUMMARY
MEDICAID: A BRIEF SUMMARY
THE MEDICAID -- MEDICARE RELATIONSHIP
CONCLUSION
THE MEDICAID -- MEDICARE RELATIONSHIP
The views expressed herein are those of the author, and do not necessarily reflect the
policy or legal position of any aspect of government. This is not a legal document. It is
not intended to offer legal, accounting or other professional advice, nor to fully explain
all of the provisions or exclusions of the relevant laws, regulations and rulings of the
Medicare and Medicaid programs, or of their relationship. The following very brief
summary should be used only as a brief overview and brief general guide to the
relationship between Medicare and Medicaid.
Medicare beneficiaries who have low incomes and limited resources may also receive help from the
Medicaid program. For persons who are eligible for full Medicaid coverage, the Medicare health care
coverage is supplemented by services that are available under their State's Medicaid program, according
to eligibility category. These additional services may include--for example--nursing facility care beyond
the 100 day limit covered by Medicare, prescription drugs, eyeglasses, and hearing aids. For persons
enrolled in both programs, any services that are covered by Medicare are paid for by the Medicare
program before any payments are made by the Medicaid program, since Medicaid is always "payor of
last resort."
Certain other Medicare beneficiaries may receive help through their State Medicaid program. Qualified
Medicare Beneficiaries (QMBs) and Specified Low-Income Medicare Beneficiaries (SLMBs) are the
best known and the largest in numbers. QMBs are those Medicare beneficiaries who have resources at or
belowtwice the standard allowed under the SSI program, and incomes at or below 100% of the FPL.
This also includes persons who are eligible for full Medicaid coverage. For QMBs, the State pays the HI
and SMI premiums and the Medicare coinsurance and deductibles, subject to limits that States may
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impose on payment rates. SLMBs are Medicare beneficiaries with resources like the QMBs, yet with
incomes that are higher--but still less than 120% of the FPL. For SLMBs, the Medicaid program only
pays the SMI premiums. The Medicare law states that disabled and working individuals who previously
qualified for Medicare because of disability, but who lost entitlement because of their return to work
(despite the disability), are allowed to purchase Medicare HI and SMI coverage. If these persons have
incomes below 200% of the FPL, but do not meet any other Medicaid assistance category, they may
qualify to have Medicaid pay their HI premiums as Qualified Disabled and Working Individuals
(QDWIs).
According to HCFA estimates, Medicaid provided some level of supplemental health coverage for 5.9
million persons who were Medicare beneficiaries in the above three categories for FY 1995. Although
they represent only 17% of the total Medicare enrollees, they accounted for 35% of the total Medicaid
expenditures ($53 billion in FY 1995)--including $10 billion for Medicare cost-sharing, $5 billion for
other acute care services and prescription drugs, and $38 billion and for long-term care.
The Balanced Budget Act of 1997 establishes a capped allocation to States, for each of five years
beginning January 1998, for payment of all or some of the Medicare SMI premiums for additional
Medicare beneficiaries: those with incomes that are above 120% and less than 175% of the FPL. This
exceeds the income levels established for QMBs and SLMBs. These beneficiaries are known as
Qualifying Individuals (QIs). Unlike QMBs and SLMBs, who may be eligible for Medicaid benefits in
addition to their QMB/SLMB benefits, the QIs cannot be otherwise eligible for medical assistance under
a State plan. The payment of this QI benefit is 100% Federally funded, up to the State's allocation. This
QI program provides financial assistance to additional persons needing help in acquiring adequate health
care coverage.
Top
MEDICARE: A BRIEF SUMMARY
MEDICAID: A BRIEF SUMMARY
THE MEDICAID -- MEDICARE RELATIONSHIP
CONCLUSION
CONCLUSION
The Department of Health and Human Services, the individual States, and the United States Congress
continually seek to make improvements in the Medicare and Medicaid programs' quality, effectiveness,
and extent of health care services. However, these programs must function within the various Federal
and State constraints of serious economic, social and political factors. As a result, Federal and State
regulations and laws continue to be reviewed for these very expensive, yet vitally important, Medicare
and Medicaid programs.
This report was prepared by
Mary Onnis Waid, Office of the Actuary, N3-01-21,
Health Care Financing Administration,
7500 Security Blvd, Baltimore, MD. 21244.
Top
MEDICARE: A BRIEF SUMMARY
MEDICAID: A BRIEF SUMMARY
THE MEDICAID -- MEDICARE RELATIONSHIP
CONCLUSION
18 of 19
11/2/98 4:50 PM
THE NATIONAL FOSTER CARE AWARENESS PROJECT
Recently there has been a great deal of well-deserved attention to the challenges young
people face as they make the transition from foster care to adulthood. News articles and
young people themselves point to the need for stronger systems of support for these
most vulnerable citizens. We must now move toward improvement of programs and
coordination of policies that will enhance the child welfare system's ability to help every
foster youth become a self-sufficient, contributing member of his or her community. This
discussion can be clearly articulated within the framework of existing child welfare reform
efforts that focus on safety, permanence, and well-being.
Safety
In the majority of states, emancipation of a foster youth is not determined by readiness,
but happens by statute at 18 or upon attainment of a high school diploma or GED.
Research demonstrates that young people who emancipate from the foster care system
experience great risk in terms of emotional, economic, and physical safety. They are
more likely to become homeless, to leave school without a diploma or GED, to experience
early parenthood, and to be victims of violence than their mainstream peers. Like all
youth in their age bracket, they are more likely to be unemployed or underemployed, with
the additional burden of less educational achievement and opportunity. Young people
report that the transition to independence and expected self-sufficiency is often very
rapid, sometimes unplanned for and unexpected, and results in their feeling "dumped".
Strengthen the system of support that contributes to the safety of young people
emancipating from the foster care system.
Increase early and consistent access to independent living preparation, especially
opportunities for realistic practice of employment and life skills.
Ensure the active involvement of young people in the individual planning and
decision making processes that will lead to successful emancipation.
Increase access to emergency shelter, transitional housing, and longer-term
affordable housing options; ensure that no youth is discharged to homelessness.
Provide support and concrete assistance, including healthcare, basic necessities,
and formal aftercare services through age 21.
Permanence
Young people need appropriate information about the strengths and limitations of all
permanency options, including adoption, legal guardianship, and other permanent living
arrangements, as well as emancipation. Though many foster teens are adopted each
year, emancipation to independence is the reality for many others. Long lasting,
supportive, and strong connections to family members, friends, and other adults are
critical to young people's healthy development while they are in foster care and to their
success in adult life. Young people report that relationships with people who care about
them and are there for them consistently make all the difference in the world when they
are on their own.
1001 G Street N.W., Suite 900E
Washington, D.C. 20001
(202) 393-1010
fax (202) 393-5510
*
www.kidscampaigns.org
Strengthen the system of support that contributes to permanence for young people
emancipating from the foster care system.
Provide more information about permanency options and support in making
decisions related to permanency to young people, families, foster/kinship
caregivers, prospective adoptive parents, and service providers.
Encourage discussions of permanence both inside and outside of the legal context
so that child welfare staff can help emancipating youth build the networks of
support they need to make successful transitions.
Ensure early and continuing access to supportive adults, including biological family
members, identified family/kin, mentors, former service providers, and other
community members who can be part of a long-term network of support.
Well-Being
Personal and social functioning, health, education and employment are all critical areas of
well-being for young people as they move toward adulthood. The experiences that result
in children and youth being placed in foster care, as well as the experience of foster care
itself, can create barriers to achieving well-being in any or all of these areas. Coordinated
efforts on the part of policymakers, public officials, caregivers, service providers,
educators, community members, and youth themselves are critical to the positive
development of young people making the transition to productive interdependence.
Young people who have left the foster care system say that disruptions in education due
to changing placements, inadequate preparation for the workplace, lack of access to
physical and mental health care, and the immediate struggle for day-to-day survival after
leaving care make planning for a good future very, very difficult.
Ensure the current and future well-being of transitioning foster youth.
Provide a continuum of support and preparation for adulthood that begins when a
child or youth enters foster care and continues through the post-emancipation
period.
Stabilize foster care placements to ensure educational continuity and achievement.
Increase youth involvement in the planning and delivery of services to transitioning
youth at the local, state, and national levels.
Create national and local networks of foster youths and former foster youths that
will enhance overall levels of support and participation.
Provide opportunities for organizations serving older youth to network with each
other, communicate strategies, and coordinate service delivery.
Facilitate greater coordination among and between national and local education,
housing, health, employment, and assistance programs to better serve this
population.
2
The Casey Family Program.
October 28, 1998
Dr. Carol Williams
Associate Commissioner
Children's Bureau
U.S. Department of Health & Human Services
330 C Street SW, Room 2070
Headquarters
Washington, DC 20201
1300 Dexter Avenue. N.
Seattle, WA 98109-3547
(206) 282-7300
Dear Carce Carol:
Fax (206) 282-3555
www.casey.org
We are delighted to see increasing attention to the issues of older youth
aging out of the foster care system including Mrs. Clinton's recent column
on the issue, the attention of varied media outlets as a result of this
summer's Washington Post article and new expressions of interest from
several foundations. It seems that the drumbeat created through the Foster
Care Project that came together in connection with the PBS documentary
Take This Heart is beginning to have an impact.
Our recent conversations about convening key practitioners, policymakers,
and alumni of the system to help develop policy boundaries now seem
even more relevant, and the time more urgent. To capitalize on this
current attention, we propose to work with you to convene a meeting early
in 1999 to take a deliberate and analytical look at current policy and
practice regarding self-sufficiency and the transition from foster care to
independent living. The outcome for this convening would be to capture
best thinking about policy and practice improvements leading to better
outcomes for young people aging out of the foster care system.
We suggest convening a group of 25-30 individuals in Washington, D.C.
in February or March for a facilitated meeting that will result in concrete
recommendations about policy and practice enhancements. Optimum
timing for this gathering relates to the presentation of the Administration's
year 2000 budget and programs. The Casey Family Program is committed
to underwriting the cost of this meeting. Attendees would include policy
experts, practitioners, and alumni of the foster care system from across the
country, with diverse perspectives but committed to reaching consensus on
recommendations for the Administration.
As you and I discussed. we would like the Children's Bureau to be a
partner so that this is a joint public/private effort. In light of the First
Lady's interest in this issue, the optimum auspices for this convening
would be the White House. Staff from The Casey Family Program and
Annie E. Casey Foundation, partners in the Foster Care Project, have a
meeting with Nicole Rabner of Mrs. Clinton's staff on November 3rd to
discuss independent living and in part to explore possible involvement of
the First Lady with this convening.
This gathering is one of a multi-phased effort to work on this issue. We
will continue to be responsive to the White House as a resource and want
to work with and support the staff of the Children's Bureau in developing
ideas and policies that can improve the lives of older youth in care. We
will work with our partners as well to continue bringing attention to this
population of children and to gathering and sharing 'best practices' across
the country.
I would welcome the chance to talk to you this week about this convening.
We are prepared to move forward as soon as possible. Thank you.
Julio Ruth W. Massinga
Chief Executive Officer
Withdrawal/Redaction Marker
Clinton Library
JMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
D TYPE
002. list
Clearance information re Foster Care Emancipation [event] (partial)
11/16/1998
P6/b(6)
(2 pages)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15410
FOLDER TITLE:
Emancipation-Interagency Issue [1]
2012-1035-S
kc998
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
PI National Security Classified Information |(a)(1) of the PRA|
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRAJ
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
[002]
Clearance Information for Monday, November 16th, 1998 4:00PM - 5:30 PM
Staff member: Nicole Rabner
RE: Foster Care Emancipation
Carol Williams
Department of Health and Human Services
DOB:
P6/(b)(6)
SS#:
Sheldon C. Bilchik
Shay Bilchik
Department of Justice
DOB:
SS#:
P6/(b)(6)
Sarah Ingersoll
Department of Justice
DOB
P6/(b)(6)
SS#:
Gina Wood
Department of Justice
DOB:
SS#:
P6/(b)(6)
Maureen McLaughlin
Department of Education
DOB:
P6/(b)(6)
SS#:
Lynn Jennings
Department of Labor
DOB:
SS#:
P6/(b)(6)
Teresa Scannell
Corporation for National Service/AmeriCorps
DOB:
P6/(b)(6)
SS#:
Deborah Jospin
Corporation for National Service/AmeriCorps
DOB:
P6/(b)(6)
SS#:
[002]
Fred Karnas
Department of Housing and Urban Development
DOB:
SS#:
P6/(b)(6)
John Gomperts
Corporation for National Service/AmeriCorps
DOB:
SS#:
November 13, 1998
Mrs. Bernadette Chirac
Palais de l'Eysee
55 rue du Faubourg Saint-Honore
75800 Paris
Dear Bernadette:
Thank you for your thoughtful letter about your recent
travel to Correze. I have warm memories of our visit and am
delighted to know that les Correziens feel as I do. I am also
pleased to know that you had an enjoyable trip to New York and
I look forward to seeing you again soon.
With warm regards to you and President Chirac, I remain
Sincerely yours,
Hillary Rodham Clinton
PHOTOCOPY
PRESERVATION
CLINTON LIBRARY PHOTOCOPY
Azing Out
Justice
THE WHITE HOUSE
WASHINGTON
shay Sarah Inguall
0 Lyan deunings, DOL (Rich Magaher)
219-6197x126
Manreen McLanghlin, DOE DepAS
TOO
205-2987
Zov Broggro, HUD
John Gaming
708-4306
Mark School 708-4230
4492
Mark forthwing
708-1226
Canol Williams HHS off 4-
487
205-8618
CNS Johng omperts x121
? - Ters Scanell 606-5000 X 300
Susan Weres 206-282-7300
American Neec
Donna Start 410-547-6600
DOL,
Naty Coalitn
CDF- - May lee Aven
November xx, 1998
- Draft.
MEMORANDUM FOR DISTRIBUTION
FROM:
NICOLE RABNER
DOMESTIC POLICY COUNCIL
SUBJECT:
Meeting on Foster Care Emancipation Issues
Please join a discussion on Thursday, November 12th, about young people "aging out" of
foster care. As many of you know, when young people in foster care turn 18, federal foster care
assistance ends and they begin an often difficult transition to independence. While there are
some federal assistance programs run by the Department of Health and Human Services that
target this age group, they are small in scale.
The purpose of this interagency meeting is to explore how we can better target existing
resources to serve this vulnerable population. As I have mentioned to many of you on the phone,
we hope to develop an interagency initiative in this area.
To the extent possible, please come to the meeting prepared to discuss the programs
administered by your agency that affect these young people and your agency's possible
contributions to an initiative that better targets new and ongoing resources to serve them.
Attached please find a background piece on this issue prepared by the Department of Health and
Human Services and a recent column by the First Lady on this topic.
The meeting will take place on Thursday, November 12th, at 4:00pm in Room 211 of
the Old Executive Office Building. Please call Debra XX to confirm your attendance and
provide clearance information (date of birth and SSN). I look forward to seeing you next
Thursday. Thanks very much.
DISTRIBUTION:
Friday
Carol Williams, Department of Health and Human Services
XXX, HHS
3pm?
Shay Bilchik, Department of Justice 616-3650
Sarah Ingersoll, Department of Justice
307-5911
Maureen McLaughlin, Department of Education
Lynn Jennings, Department of Labor
Fred Karnis, Department of Housing and Urban Development
John Gomperts, Corporation for National Service
Tess Scannel, Corporation for National Service
Jennifer Klein, White House Domestic Policy Council
Trooper Sanders, Mrs. Gore's Office
10/23/98.. FRI 14:13 FAX
001
FACSIMILE TRANSMITTAL SHEET
AMERICORPS#NATIONAL CIVILIAN COMMUNITY CORPS
1201 New York Avenue, NW
9th Floor
Washington, D.C. 20525
(202) 606-5000
(202) 565-2791 (FAX)
TO: Nicole Rabner
DATE: 10/23/98
ORGANIZATION: Office of the First Lady
PHONE #:
FROM: Mrma Hodge for
H. Gen. Andrew Chambers
FAX #:
456-2878
PHONE EXTENSION #:
PAGES, INCLUDING COVER: 2
COMMENTS:
002
What is AmeriCorps*
kinds of service
AmeriCorps*NCCC, the National Civilian Community
AmeriCorps NCCC members provide?
Corps, is a 10-month residential national service program
The number one priority for AmeriCorps*NCCC members
for young women and men of all social, economic, and
is improving the environment Members construct, map,
educational backgrounds. The program takes its inspira-
and improve urban and rural parks; restore streams and
tion from the Depression-era Civilian Conservation Corps
rivers; and conduct environmental education programs in
(CCC), which put thousands of young people to work
schools and community centers.
restoring our natural environment AmeriCorps*NCCC
Projects are as diverse as the communities they serve.
retains the CCC's focus on the environment, but recog-
Members work to address communities' most pressing
nizes that as the challenges our nation faces become
needs in the areas of education, public safety, human
more diverse, so must the solutions.
needs, and the environment Recently, eight teams paint-
AmeriCorps*NCCC encourages citizens to act on their
ed nearly 300 units and renovated common areas in a pub-
responsibility to themselves, their communities, and
lic housing apartment complex for senior citizens. In part-
their country by mobilizing local community members to
nership with local health departments, AmeriCorps*NCCC
work alongside AmeriCorps*NCCC members.
teams developed and implemented a comprehensive
AmeriCorps*NCCC combines the best of military ser-
immunization outreach campaign that identified over 1,800
vice, including leadership and team building, with the
children with delinquent records.
best practices of civilian service.
What benefits do AmeriCorps*
in times of special need, AmeriCorps*NCCC members
members earn?
Where do AmeriCorps
come together to provide intensive disaster relief. Several
AmeriCorps*NCCC teams are trained by the U.S. Forest
Along with an experience of a lifetime, AmeriCorps* *NCCC me
members live?
Service for forest fire suppression. All members receive
bers receive a modest living allowance and room and board wt
Four of AmenCorps*NCCC's regional campuses are
disaster relief training. Members have assisted on a vari-
participating in the program. At the end of their term of servi
located on downsizing or closed military bases - in
ety of relief efforts, including aiding flood victims in West
they receive an education award of $4,725 to help pay for colle-
Washington, DC; Charleston, S.C.; Aurora, Colo.; and San
Virginia, Pennsylvania, Texas, California, and Louisiana.
graduate school, or training programs- or to repay student loa
Diega, Calif. The fifth campus is located on the grounds
Although AmeriCorps*NCCC can help pay child care for memb-
of the VA Medical Center in Perry Point, Md. Members
with dependent children by matching a portion of members' p
share rooms in residence halls equipped with lounges
ments, children are not allowed to live on the campuses.
and other shared areas.
10/23/98. FRI 14:13 FAX
After rigorous training, members work on a variety of pro-
Who is eligible to join AmeriCorps NCCC?
jects lasting one day to six weeks. Members may be tem-
AmeriCorps*NCCC is looking for women and men between the a
porarily relocated from their campuses to projects in com-
of 18 and 24 who are ready to commit up to a year of their lives to IT
munities throughout their region of the country. During
ing America stronger, safer, smarter, and healthier. Applicants shr
their service, members serve in teams with people of all
also be willing to relocate to any of the five AmeriCorps*NCCC c
different backgrounds who have one important thing in
puses. Members must be citizens, nationals, or lawful permar
common- - a commitment to serving their communities.
resident aliens of the United States.
revynus - C. 6 approps MRS
Y
I
Maureen McGlanghtin
servely disadvan
Independent student - quite eligibility
Are they prepared?
New p.. P
HEA - Gear up- - middle schools - prepare
for - Them h/s.
at is Reve - helping to know-
TRIO programs - precollege, in college- -
Preparation
Carol, etc. IL
HRC- hope, enthusiasm - set tone
six issue areas
1. kinnup cale - improved
oversing ht not same when put of relatives
need same preparation / training
foster came training
ler strongent-why Y conflict res. not needed line -
key I crue: training. iscensing, subsid
subsidy less Than before
2. forer came youth aging out
range of services meding
c-training of for job trans ed:,
housing (homeleaners) inel- -medicave, TANF
job training (end TANF els.)
3- improving adverceat adoptine
cut them sterestypes- PSAs (teenage
deserve an apoptive opportunity too.
4. Ed illnes
wards of The Slate homeless yun M
not harm op- nonscholastic training.
finish h-s, schotoroly way po.
5. Ec Epp.
reo: IL skills I training- need a base
to start from hef. they can be
dont start early enough, not intensive
enough
Bridge to adulthood They need particularly u/
challenge. they have
Transitimal Living - safe, stable to he
6. Youger Surrents
training for teen parents /ablings /olden
can
HHS thinking:
1. kinship care- Dept. enconrage states to encourage
IL in kindleep care- - informally ml relatives.
we can't pay for it (only for children in formal
foster care system)
add icme to Their deliberati in - working group
2. Emaricipate
Labor jobs / training / apprenticeship.
tagets Union connections- - support
HUD
of of housing
alert local housey anth / directionary res.
-AConty-mad Hup $ to fould - use some
space - mendors
(avail only for kids some resources)
HHS - ACFA
Education - fed scholarship program- -
info gets to teids - targetted - indegent
kids
Tuition reminion prog. - state univ-
dicseminate model - FL
Addrescent Op. -funding- Demo - adoptn of
older youth - -continue to dothat -
ho st placement support - succesoful
EK SEPTEMBER 9. 1998
ON ASSIGNMENT
One
-on-
One
mitted to continuing her once-a-week sessions with
Daniel as he enters middle school this fall.
"I can't change their lives or take away their pain,"
Buonato says about the children she helps. "But I can
give them the skills to make a better life."
Most children in foster care don't have someone like
Buonato-someone whose main purpose is to keep
children in school and on grade level in spite of the
trouble and instability around them.
BY LINDA JACOBSON
With roughly half a million children in foster care-
a 74 percent increase since 1986-it's obvious that a
greater number of the nation's students are in the
child-welfare system. The increase is strongly linked to
parents' addiction to crack-cocaine.
Seattle
Teachers, while sympathetic to the needs of abused
hen Marie Buonato met Daniel three
and neglected children, often don't know who they
W
years ago, he was on his ninth foster
are. And even if they did, they've probably never been
home, he had been expelled from a
trained to recognize and handle the behaviors and at-
private school, and he hadn't been
titudes that many children in foster care exhibit, such
enrolled in a new school for several
as anger and an inability to concentrate. In addition,
weeks because his social worker didn't know where he
many such youngsters have learning disabilities, and
would end up being placed.
some refuse to speak. One study found that foster
Buonato began meeting with him in his new foster
children are more likely than others to be emotionally
home once a week-a condominium here on Lake
disturbed.
Washington, where he lives with the woman he now
What's more, with caseloads of 30 or more children,
calls his grandmother.
social workers are S0 focused on removing children
"He was very, very angry," says Buonato, a Roman
from abusive situations and meeting their basic needs
Catholic nun with a background in education and
that attending to such concerns as reading scores and
counseling. "In spite of all the bravado he puts on, he's
homework completion is practically impossible.
very insecure."
But a growing number of efforts around the country
Now 11, Daniel, an engaging and attractive boy who
are working to bring educators and social workers to-
has been in foster care most of his life because his birth
gether and to emphasize that these children need an
mother abandoned him, talks about what he's good at
education along with food, clothing, and safe homes.
in school.
"I like reading, and I like Marie. She's helping me
work on my division." he says. "The best thing is she's
here."
Improving the lot of foster children is
Buonato is a tutor for Seattle's Treehouse agency,
a tough task. Making it tougher has been what many
which serves schoolchildren in King County's child-
see as an underlying mistrust between educators and
welfare system. While Treehouse's tutoring program
social workers. "The two systems don't understand
primarily serves elementary students, Buonato is com-
each other, they don't respect each other, and they see
Providing a safe haven has long been the mission
of the foster-care system. Now, though, a small
but growing number of jurisdictions are counting
education among foster children's basic needs.
Abandoned by his mother, Daniel floundered in school until he was matched up long term with a tutor.
PHOTOS BY JIM BATES
EK SEPTEMBER 9. 1998
ON ASSIGNMENT
no reason to work together," says Sandra Altshuler. an as-
Being in the schools allows the tutors to meet with the
sistant professor of social work at the University of Illinois
students on a daily basis and to become what many of these
at Urbana-Champaign. She's been running a research pro-
children have never had in their lives-a dependable adult.
ject and mentoring program for foster children at two mid-
die schools in Champaign for the past two years.
Teachers complain that social workers hide behind poli-
cies that are intended to protect the privacy of children,
Lindy Orlin, one of the Treehouse tutors,
while caseworkers contend that schools tend to hold up the
sits at a standard-sized library table with 9-year-old Ash-
transfer of student records when a child is sent to a new
ley (not her real name) at Emerson School, located south of
school. As a result, students are often caught in the middle.
the city in the Rainier Valley. The two flip through a tablet
But it's in the middle where people like Altshuler and Jap-
of Ashley's drawings, a collection of flowers, faces, and col-
Ji Keating, the director of Treehouse's tutoring program, feel
orful patterns.
The school day is ending, but it's been a big
one for Ashley. Her teacher has enlarged several
pieces of her best artwork and plans to exhibit
them at parent night later in the week.
But on this afternoon, Ashley is preoccupied
with something else that's going on in her life—
a move that's about to take place into a family
interested in adopting her. She's worried, Orlin
later explains, that she'll be gone before parent
night because her current foster family is al-
ready packing up her clothes, including the
dress she plans to wear to the event.
"The teachers don't know what's going on,"
Orlin says, "but they are very sympathetic" that
the girl is going through emotional turmoil over
some private matter.
The tutors do much more than their title im-
plies. One role they play is to help the schools
become more familiar with child-protective ser-
vices. Teachers, who are alerted to the foster
status of children, also gain more awareness of
their needs because they meet with the tutors
to set academic and behavioral goals for the
boys and girls.
It took a while, however, for the tutors to get
access to the information they felt they needed.
"One of the biggest things was finding out if
the kids were passing," Keating says. "How
could we find out if we were doing our jobs well
if we didn't even know if the kid was passing or
failing?"
Treehouse tutors have since forged strong re-
lationships with many of the educators they
work with. "They are more than trained tutors.
They are providing one-on-one support," says
Claudia Allan, the principal of Concord School in
Principal Claudia Allan, left, confers with Jap-Ji Keating,
the southwest section of Seattle. "The
about the foster children her agency works with at
students can pick up the academics that they've
Concord Elementary School in Seattle.
been shut out of because of a chaotic home life."
Of the 65 children served by Treehouse tutors
last school year, 70 percent were found to be liv-
ing in "turbulent to highly turbulent" family sit-
uations, Keating says, referring to a recently completed eval-
comfortable. They are, in effect, creating a position that
uation of the project.
hasn't existed before.
Despite their circumstances, many of the children made
"To know both systems, and to be able to use both sys-
remarkable progress. Only two pupils did not advance to the
tems-that takes skill," says Keating, who came to the Pa-
next grade level. More than half improved their math skills
cific Northwest four years ago to work on her doctorate in
by one or more grade levels. The results were similar in
education at Seattle University.
reading and spelling.
The tutoring program is one of four programs at Treehouse,
More than two-thirds of the group met all or most of their
which was organized four years ago and is subsidized with pri-
individual behavioral goals, and most of the children
vate donations. But it's not the one that the local newspapers
achieved all or most of their reading and math goals.
write about. Little Wishes, the project that gives foster children
"These are highly capable children," Keating says. "When
a chance to redeem their wishes, usually gets the attention.
you put that network of loving care around them, they can
"But education is the gift that keeps on giving," Keating
do it."
says, laughing at her use of the cliche.
Until last school year, her five tutors drove all over the city
to meet with the children they were serving.
"We were spending a lot of money on gas, and the tutors
The tutors find that their biggest challenge
were becoming exhausted," she says.
is helping the children concentrate. And they say it's com-
But now, they are each based at an elementary school
mon for these students to wander away from class or school
with high numbers of children in out-of-home placements.
activities when they don't want to do something.
A sixth one is expected to be added this fall at an elemen-
That's why behavior goals, in addition to academic ones,
tary school in Bellevue, a town east of Seattle, on the other
are set. Sometimes, they are as simple as keeping an orga-
side of Lake Washington.
nized book bag or turning in homework assignments.
SEPTEMBER 9. 1998 EDUCATION WEEK 45
Most of the tutors have also
found sneaky ways to help the
children focus on their work.
Some use candy or small gifts
as an incentive-an indulgence
that Keating admits she al-
lows. She once gave a little girl
50 cents every time she would
ride the school bus and not
argue with the driver. The
youngster earned $25, and
Keating took her shopping.
Marie Buonato, who works
out of Wing Luke Elementary
School, also in the Rainier Val-
ley, used to carry a stuffed bear
for the children to talk to or to
hug. One girl, who struggled so
much with her writing assign-
ments. gave the bear a hug
every time she put a word on
paper.
Orlin has incorporated art
and poetry into her tutoring
sessions, and often tells the
students to "draw themselves
Daniel works on a lesson with Marie Buonato, who has tutored the 11-year-old for three
without their bodies" ac-
years, including summers. The tutoring will continue when he goes to middle school.
tivity that Ashley used to pro-
duce several pieces of artwork.
But since her recent school
transfer, Keating reports. Ash-
ley hasn't been drawing. And her new school is too far
backgrounds were more likely to participate in job-training
away for her to continue meeting with Orlin.
programs than those who had lived with their parents, but
less likely than the comparison group to attend a formal
postsecondary education program.
But the educational deficits of children in the child-wel-
The odds against children in foster care
fare system can start long before formal schooling begins.
achieving success in school are great. Studies dating back
A study, released last year by researchers from Allegheny
more than 30 years conclude that when children enter fos-
University of the Health Sciences in Philadelphia. showed
ter care, they are already behind academically, and they
higher rates of speech and language delays among infants
don't catch up.
and toddlers in foster care.
And with a growing emphasis nationwide on higher aca-
In fact. children younger than 4 represent the fastest-
demic standards and student and teacher accountability,
growing segment of the foster-care population. They end
educators and child-welfare experts fear that many stu-
up in the system largely because their parents lose cus-
dents in these circumstances are bound to get left behind
tody as a result of crack-cocaine use, which is once again
without extra help.
on the rise, surveys show.
"The kids in child welfare are not going to pass those
Judith Silver, an assistant professor of pediatrics and one
tests." contends Janis Avery, the managing director of Tree-
of the Allegheny University researchers, says little infor-
house. referring to new statewide tests in Washington state.
mation is available on whether young children in foster care
A national study from 1991, conducted by Ronna Cook at
are receiving early-intervention services.
Westat. a research company in Rockville. Md.. found that out
The success of the foster-care system has always been cal-
of 810 18-year-olds who had left the foster-care system within
culated in terms that have little to do with how a child is far-
a single year. two-thirds had not completed high school.
ing in school. Words such as "permanency" and "reunifica-
Children in foster care are also less likely than children
tion" are commonly used to describe a child's home and
living with their parents to be in a college-bound track in
family situation, but little, if anything, is said about academic
high school. even though the grades and test scores of both
performance or what children are likely to do after they "age
groups are about the same, according to a 1997 analysis of
out" of the system at 18.
the U.S. Department of Education's "High School and Be-
But Treehouse and similar projects are trying to change
yond" survey. Wendy Whiting Blome, a consultant to the
that by collecting and monitoring school performance data
Washington. D.C.-based Child Welfare League of America.
on children in foster care and urging child-welfare agencies
also found in her analysis that children in foster care were
to do the same.
more likely to report that they had been disciplined in
"One of the things that has been an ongoing frustration for
school and that they had been in "serious trouble with the
me is that these case outcomes are not kid outcomes. We
law" during their high school years.
measure success by when the kid gets out of the system. not
Once out of high school, young adults from foster-care
by what happens to the kid," says Mei Lan Loi. Until July, Loi
Academic success often eludes foster children. Some new
tutoring projects link them with reliable adults who help
with their studies and allay their feelings of isolation.
SEPTEMBER 9. 1998
ON ASSIGN
was a planner at the Vera Institute of Justice in New York
ment to share data in a way that would reveal just where
City. where she worked on a project in which a caseworker
the city's 40,000 foster children go to school and how they
from the city's children's services administration was assigned
are progressing.
as a liaison to a middle school in Brooklyn. The caseworker
In addition to making data on such information as repeat
provides individual and group-counseling sessions to a hand-
school absences available to children's services. the "memo-
ful of foster children and serves as a contact for teachers.
randum of understanding" included the appointment of school
A private, nonprofit agency, the Vera Institute works as a
system and child-welfare liaisons who would work together on
consultant to local, national, and international government
cases. The new relationship between agencies also includes
joint staff-development courses.
"When you have two systems that
are providing services for the same
family, the same child, it's incumbent
upon the systems to collaborate," says
Pedro Cordero. the director of intera-
gency affairs for children's services.
Another collaborative project is
taking place across Massachusetts.
It began on a pilot basis in the mid-
dle of the 1996-97 school year and
has now grown to reach roughly 500
children in 15 districts.
"The goal was really to try to get
the different groups to communicate
better-teachers, foster parents, and
social services." says Susan Stelk,
the education coordinator for the
state department of social services.
In addition to assigning a liaison to
work with the schools and the case-
workers and offering training to the
various parties involved. the project
has provided direct services to chil-
dren in foster care, such as tutoring,
after-school activities, and psycholog-
ical counseling
iel talks to William Cook, his former principal at Dunlap Elementary School. For his
While information was collected
into middle school this fall, his foster mother enrolled him in a Catholic school.
on all 551 of the children involved in
the project, 41 of them were followed
more closely by an outside evaluator,
who found small improvements in
school attendance and behavior over
agencies on criminal and juvenile-justice issues. A middle
the course of last school year.
school was chosen for the project in an effort to reduce delin-
More telling were the numerous anecdotal accounts of
quency among young adolescents.
better relationships between foster parents, school person-
Loi's goal was to see "a body of caseworkers" throughout
nel, and caseworkers, Stelk says.
the city trained to focus on foster children when they are hit-
The plan for the coming year is to reduce funding
ting their adolescent years and to increase education and
slightly in some districts while expanding the services to
other services to children in their early teens.
districts that serve more children in foster and adoptive
To give these programs a chance at success, Loi believes
homes.
that paid professionals, rather than volunteers, need to work
The Massachusetts project has been paid for with state
with the children.
money so far, and this year it received $470,000. But Stelk
"You need people with certain skills. This is not just about
hopes the local communities will be able to pay for the activ-
getting nice people who want to do some nice things for
ities in the future.
kids," she says. "These kids need some extreme structure.
Both private and public foster-care programs are also try-
You can say, 'I will take you home and buy you pizza,' and
ing harder to find homes for children in familiar neighbor-
they still won't come."
hood surroundings-and near their schools-even though
Like Loi, the University of Illinois' Altshuler also found
they might be losing a parent.
the middle school years to be a critical time for young people
A 1980 federal law called for such arrangements, but the
in foster care. After working with students for two years-in
reality has been that children are often placed outside their
focus groups and through a mentoring program-she partic-
communities because of a shortage of foster families.
ularly noticed their achievement starting to slack off during
Children in foster care often miss big chunks of the school
the last quarter of the school year.
year because they are so mobile. And with the transfer of
To her. the slippage suggests "that they are very anxious
student records sometimes delayed in the process. adminis-
about the summer. and they see school as a safe place."
trators and teachers often don't know how to serve incoming
foster children.
After reviewing Treehouse's data from last year. it became
clear to Keating, the director of the agency's tutoring program,
Most efforts to draw attention to and improve
just how damaging a disruption during the school year can be.
educational results for children in foster care are small,
"What we're finding is that every time a child moves, they
pilot-level programs unconnected to any national network or
go through a period of not being able to re-engage." she says.
organization. But one large-scale project under way in New
"They are obsessed with 'Where am I going to go?
York City could permanently change the way the school sys-
Sometimes, she adds, they just shut down and quit talking.
tem and the child-welfare agency operate there, as well as
A few schools have found creative ways to provide the
influence other districts and agencies around the country.
transportation necessary to keep children from changing
About 1½ years ago, Nicholas Scopetta, the commissioner
schools-yet again.
of children's services in New York City, and Rudolph F. Crew,
Gatzert Elementary School in Seattle. for example. re-
the chancellor of the city's school system, reached an agree-
ceives extra money from the district to cover transportation
SEPTEMBER 9. 1998 EDUCATION WEEK 47
One of the biggest challenges facing child-welfare workers
and educators is their underlying mistrust of one another.
They don't understand or respect each other, one expert says.
costs for homeless children. and it is extending those ser-
foster children is another key to helping schools address
vices to children in foster care.
these students' needs, Noble says.
"If they move across town, it doesn't mean they have to
Foster parents, however, are often handicapped by the
lose their school," says Randy Riley, an intervention spe-
fact that biological parents generally retain many decision-
cialist at Gatzert.
making rights in the education of their children, particu-
Keating is pursuing a legislative package in Washington
larly when it comes to special education.
state that would include some funding for transportation so
A not-uncommon scenario, according to caseworkers and
students in foster care wouldn't have to change schools SO
foster parents, is that school officials might believe a child
often. She also wants the state to create a program specifi-
needs to be tested for special education, but the birth par-
cally for foster children in middle school that would give
ents won't give permission. They might be angry with the
them added support in preparing for high school. And she
school in the first place for reporting suspected child abuse
wants full college scholarships for those students when they
or neglect.
graduate.
Such situations further complicate the relationship be-
Both Texas and Florida already offer tuition waivers to
tween schools and social workers and keep students from
foster children who want to attend college.
getting the instruction they need.
Other foster parents note what they describe as a preju-
dice against children in foster care and an automatic re-
sponse from the schools to label such youngsters with a be-
While most of the projects that seek to bring
havior disorder or learning disability.
educators and social workers closer together are just getting
"The first place the school wants to stick them is in spe-
off the ground. one program in California dates back to 1972.
cial education," says Pearl Graham, a foster parent from
The Foster Youth Services Program provides tutoring and
Austin, Texas, and a former teacher.
counseling to children in foster care in six school districts.
A 1992 study on the use of special education services by
But Robert Ayasse. a social-services liaison for the Mount
foster children in Illinois found that more than six times as
Diablo district, east of San Francisco, wrote in a 1995 arti-
many foster children were receiving special education as
cle that one of the most valuable things the program does is
had been identified by the state's children and family-ser-
track down school transcripts and other important docu-
vices department. Researchers concluded that social work-
ments, such as birth certificates and immunization records.
ers didn't know enough about the needs of the children they
Often. there are big gaps in these students' education histo-
were responsible for.
ries because of their transience. When they need to start ac-
Shirley Hedges, the president of the National Foster Par-
cumulating credits for graduation, turning up the records
ent Association, based in Crystal Lake, III., and a foster par-
becomes even more critical.
ent for 23 years, says she eventually home-schooled some of
Foster Youth Services, which served about 3,100 children
her charges because they were constantly being sent home
last school year and received $1.4 million from the state, is
from school for disruptive behavior. She also served on the
one of a few programs to receive state aid-and to receive it
local school board in Hopkins County, Ky., for eight years,
for so long.
and saw to it that foster parents were invited to serve on
But Ayasse believes attention to this issue will continue
local school councils.
to grow, thanks in part to changes in states' welfare systems
under the 1996 federal welfare-reform law. "The percentage
of foster kids who end up on public aid is astronomical." he
says.
Fortunately for Daniel, the Seattle 11-year-
Research shows that anywhere from 30 percent to 50 per-
old. his foster "grandmother," 70-year-old Cornelia Bosley, is
cent of former foster children wind up on welfare as adults.
one of those advocates. She enrolled him in a Catholic
Moreover, adolescent girls in foster care are twice as likely
school this fall because she was worried about how he
as other girls in their age group to get pregnant, according
would fare in a public middle school. She's also in the
to Kathy Barbell, the director of foster care for the Child
process of adopting him.
Welfare League of America.
"Daniel's got some tough little ways, but he's come a
Experts recommend that schools of education train new
mighty long way since he's been with me," Bosley says, as
teachers on how the child-welfare system works and inform
Daniel steps out on the patio to play with a Nerf toy that
them about some of the common effects that foster care has
Keating brought him.
on children. Teachers should also be more careful about ask-
Bosley also gives Treehouse much of the credit for
ing students to do such assignments as making a family
Daniel's improvement.
tree or bringing baby pictures from home, says Lynne
Daniel. whom Keating describes as a "little Denzel Wash-
Steyer Noble, a senior consultant for the Center for Child
ington," had the chance to share his own thoughts recently
and Family Studies at the University of South Carolina in
at a citywide fund-raiser. He and hundreds of other foster
Columbia.
children were given scholarships to attend summer camp,
"It's not so much that school people want to be mean. It's
and the proceeds from the evening were going to the Tree-
that they don't know in a lot of cases what goes on with
house camp program.
these kids." says Noble, a foster parent for 20 years. She also
Going to camp, Keating says, has been Daniel's first suc-
conducts training workshops for new foster and adoptive
cessful social experience-one of the first places he hasn't
parents, as well as caseworkers.
been kicked out of.
But Allan. the principal in Seattle. believes that teachers
"Campfire in the evening was a time for talking about the
should be shielded from some information about their stu-
day. for saving positive things about each other and singing
dents so they can concentrate on teaching.
songs." Daniel read to the audience from a speech that
Showing foster parents how to better navigate their way
Buonato helped him write. "Every night, I went to bed feel-
through the school system and become advocates for their
ing very tired and very, very happy."
IL
HELPING MORE STUDENTS PREPARE FOR COLLEGE THROUGH "GEAR UP"
"I also ask this Congress to support our efforts to enlist colleges and universities to reach out to disadvantaged
children starting in the sixth grade so that they can get the guidance and hope they need so they can know that they,
too, will be able to go on to college."
--President Clinton, State of the Union address, January 27, 1998
The Higher Education Amendments of 1998 launch GEAR UP, a new national effort to encourage
more young people to have high expectations, stay in school and study hard, and go to college.
High-achieving students from low-income families are five times less likely to attend college than
high-achieving students from high-income families [NELS 1998].
In a recent survey, almost 70% of parents indicated that they have little information or want more
information about which courses their child should take to prepare for college, and 89% of parents
want more information about how to pay for college, including the use of tax credits [Gallup, Sept.
1998].
The President's High Hopes Proposal. Earlier this year, President Clinton proposed the High Hopes for
College initiative to create a national ethic that every college should partner with at least one middle
school in a low-income community to help raise expectations and ensure that students are well-prepared
for college. In the new HEA law, the High Hopes proposal and the National Early Intervention
Scholarship and Partnership (NEISP) program are joined, as two different types of grants, under the new
GEAR UP program.
GEAR UP (Gaining Early Awareness and Readiness for Undergraduate Programs). This new
competitive grant program, authorized at $200 million in FY99, supports early intervention and college
awareness activities at both the local and the state level. The Senate's FY99 Appropriations bill allocates
to GEAR UP $75 million of the $140 million the President requested for High Hopes. The House
Appropriations bill did not include funding for GEAR UP. The final appropriations legislation is now
pending in Congress. GEAR UP funding will be split between partnership grants and state grants, with at
least one-third allocated to each.
GEAR UP Partnership grants. As outlined in the President's High Hopes for College proposal, this
initiative will award multi-year grants to locally-designed partnerships between colleges and high-poverty
middle schools, plus at least two other partners -- such as community organizations, businesses, religious
groups, state education agencies, parent groups, or non-profits -- to increase college-going rates among
low-income youth. To be most effective, partnerships will be based on the following proven strategies:
Informing students and parents about college options and financial aid, and providing students
with a 21st Century Scholar Certificate -- an early notification of their eligibility for financial aid;
Promoting rigorous academic coursework based on college entrance requirements;
Working with a whole grade-level of students in order to raise expectations for all students; and
Starting with 6th or 7th grade students and continuing through high school graduation with
comprehensive services including mentoring, tutoring, counseling, and other activities such as after
school programs, summer academic and enrichment programs, and college visits.
GEAR UP State grants. These grants are based on the current National Early Intervention Scholarship
and Partnership (NEISP) program and will be awarded to states to provide scholarships, college
information and early intervention activities. State programs will target services to low-income students
and will provide college scholarships for participating students. College and community partnerships are
not required but are encouraged, and many NEISP programs involve local organizations. Nine states
received NEISP grants in FY98 totaling $3.6 million. These NEISP programs provide a variety of early
intervention services and college awareness activities to students from 1st to 12th grade.
We anticipate that GEAR UP grant applications will be available in the beginning of next year. Questions
or requests for more information can be directed to [email protected].
EXAMPLES OF MENTORING AND EARLY INTERVENTION PROGRAMS
Many states education agencies, colleges, and secondary schools have had success working together to
increase college enrollment rates among low-income students. To this end, the new GEAR UP program
will support early intervention initiatives with elements of the successful practices described below.
Early Identification Program (Fairfax, Virginia): George Mason University (GMU) and the
Fairfax County Public Schools developed the Early Identification Program (EIP) in 1987 to
increase the number of minority students who enter college. Since then, additional school districts
and new partners have joined the effort, including Booz Allen and Hamilton, Mobil Corporation,
NationsBank and Crestar Bank. The program works with minority students that demonstrate
academic potential and provides year-round tutoring, mentoring and other support throughout high
school, including weekend and summer academic programs, special projects in math, science,
English and computer science, campus visits, and workshops for parents. The program reports
having graduated 6 classes from high school with a 71% retention rate. Of those who completed 4
years in EIP, 95% have gone on to college.
Pace Hispanic Outreach Program (White Plains, NY): The program is a unique tutorial
initiative for Hispanic immigrant students at the White Plains High School that is run through a
collaborative effort involving the White Plains School District, Pace University and Centro
Hispano. One-to-one tutorial sessions are held during study hall periods and are designed to
complement and reinforce classroom instruction in English, mathematics and social studies. In
addition, the program enlists high school counselors to provide weekly clinics to help high school
seniors prepare college applications, financial aid forms and essays. Active community support
and parental involvement has helped build confidence among participants by reducing the sense of
powerlessness that language barriers cause in some Hispanic families.
Passport to College (Riverside, California): At the core of this effort is a partnership between
Riverside Community College in California, the local school district, and a number of schools and
local businesses. Its purpose is to encourage disadvantaged students to continue on to college.
The program works with an entire grade of students, beginning in 5th grade, and follows them
through high school graduation. Currently, 11,500 students are participating. Volunteers work
with the students, teachers and parents in activities, including: campus tours, classroom
presentations, teacher training workshops, parent meetings, and financial aid workshops. All
participating students who graduate from high school are guaranteed admission to Riverside
Community College.
Project GRAD (Houston, Texas): Project GRAD (Graduation Really Achieves Dreams) is a
school-community collaboration to improve the instructional quality and school environment for
children in Houston's inner city schools. This effort combines research-based curricular reform in
math, reading and language arts with comprehensive services, including tutoring, mentoring and
counseling, for children in kindergarten through high school. The project works with whole
networks of schools -- elementary through high school -- to develop a consistent emphasis on high
standards for all students. Project GRAD also promises all 9th grade students a $1,000 per year
college scholarship if they reach basic academic standards. Currently, 24 schools in Houston and
over 17,000 students are involved with Project GRAD. This massive effort is supported by a
partnership of school, corporate, and community-based organizations and foundations.