ZAIRA EDNA C.

JOSE
BSSW 3 - BLOCK 1

International Social Welfare Programs

OVERVIEW:
These focused on income for the aged, disabled, unemployed, and parents or guardians with
dependent children. In this chapter, we study an array of programs whose purpose is to sustain
the quality of life, either by providing unkind benefits to meet a person’s basic needs for food,
housing, and medical care or by improving the physical and psychological well-being of the
individual. We also discuss three social welfare programs designed for targeted groups-military
services, families. Children, mental health, and corrections.

MANAGED CARE: A Radical Changed

- Was propelled by rapidly in bush care costs well beyond the rate of inflation resulting
from a number of factors a growing aged population, technology and costly new
treatments, the frequent ability to keep people alive at a cost, an emphasis on acute
care rather than preventive services, varying standards of treatment according to
geographic locations among others.
Managed care evolved through at least three generation (1) Placing some limits fists on
benefits through deductibles, cost sharing, second opinion and other means; (2)
different types of benefits in and out of the system, and (3) advanced provider selection,
patient care monitoring, and the utilization of quality measures.

Major Organizational Type

Managed care is implemented through a variety of mechanisms. The major types are described
in the following sections:

Health Maintenance Organizations – Health maintenance organizations provide a wide range of

health services to covered members for a fee or premium paid by unemployed, a government,
or a person or family.

Point-of-Service Plans. With the point-of-service (POS) plan, members make a decision about
the care they need at the point of service when the service is required.

Preferred Provider Organizations. A preferred provider organization (PPO) is a net work of

independent health care professionals that contract to provide care at discounted rates.
Providers must agree to utilization management and fixed reimbursement rates.

Physician Sponsored Networks. With the physician sponsored network (PSN), large groups of
health professionals join together and accept the financial risks of covering their patients health
care needs.

Impact on Services and Practitioners

Managed care is an industrialization of the delivery of health care. There are those who believe
the emphasis is more on controlling costs and increasing profits than on access the quality of
care. In fact, there can be adversarial prentices. Altruistic professionals are trained us he
helpers, but they must operate within a context of cost-consciousness and profit seeking. These
conflicting purposes have a heavy impact on social workers and others involved with health and
mental health care.

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Proponents
The proponents of managed care claim that the short-term consequences will be uncomfortable
but the escalating costs of health care must be controlled. According to these proponents, more
people will be provided with cost-effective health care. Treatment decisions will be based on
what is considered “best practice.”
Strategies to Achieve Profits
Schamess identified the strategies by which HMOs generate their profits from standard business
practices applied to problems that are not amenable to business solutions denying coverage to
people with preexisting conditions or those who seem likely to use services extensively limiting
and/or delving treatment to people whose difficulties do not respond to standardized treatment
protocols.

 Denying coverage to people with preexisting conditions or those who seem likely to use
services extensively.
 Limiting and/or denying treatment to people whose difficulties do not respond to
standardized treatment protocols
 Replacing professional judgment with multiple levels of organizational decision making
increasing requirements for record keeping and report writing
 Removing case managers responsible for utilization review from direct contact with both
patients/clients and practitioners and providing them access only through over loaded
telephone lines
 Requiring clinicians in comply with insurer policies and protocols or risk their
employment
 Using economic power to drive down payment rates to treatment institutions and
instituting difficult appeal procedures practitioners
 Promoting managed care as the most efficient, if not the only, approach to cost
containment

Public Criticism, Courts, and Legislation

Health maintenance organizations and managed care have received much criticism. These
criticisms led members of Congress to propose legislation for a “patients’ bill of rights” to
protect people from abuse by managed care and HMOs. Complaints about restricted access to
care and lack of satisfaction for grievances led over forty states to develop their own legislation
protecting patients

Health Care Programs

In the mid-1960s, two health programs were introduced under the Social Security Act Medicare
and Medicaid. Medicare is insurance-based, whereas Medicaid is a means-tested program

Goals. The Medicare program is a national health insurance program (HI) to

Health care for the aged and certain disabled persons. Hospital insurance (HI) is provided
through Part A and supplementary medical insurance (SMI) through Part B.

Who is Eligible for the Program - Most Americans 65 years of age or older are automatically
entitled to protection under Part A (the hospital insurance program) by either themselves or
their spouses having paid the Hospital Insurance (HI) tax on earnings covered by Social Security
or the Railroad Retirement Systems. Part B is voluntary. All persons 65 years of age or older and
all persons enrolled in Part A may enroll in Part B by paying a monthly premium ($58.70 in
2003).

What Is the Form of the Benefit? Part A provides coverage for inpatient hospital services, up to
100 days of post hospital skilled nursing facility care, some home health services, and hospice
care. The first sixty days of inpatient hospital services in a benefit period are subject to a
deductible ($840 in 2003). A benefit period commences upon entry and ends when the person
has not been in a hospital or skilled nursing facility for sixty days. Part B generally pays 80
percent of the approved amount (fee schedule, reasonable charge, or reasonable cost) for
covered services in excess of an annual deductible ($100)

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New Drug Benefit. In 2003, Congress enacted and President Bush signed the Medicare
Prescription Drug, Improvement, and Modernization Act that provides prescription drug
benefits through Medicare. During 2004 and 2005, Medicare recipients could purchase a
discount card that was estimated to reduce drug costs 15 percent or more.
The drug benefit will be administered by private companies when it would have been more
efficient and cheaper to deliver the service as other Medicare benefits are.

Medicare Plan Choices. There are several ways to get health care coverage in the Medicare
program. Each program has different costs, benefits, physician choices, convenience, and
quality. The original Medicare plan is the nationwide health care program that pays for many
health care services and supplies but it doesn’t pay all of the health care costs. Additional costs
are coinsurance, co-payments, and deductibles, referred to as gaps in Medicare coverage.
Beneficiaries may choose to purchase a Medigap policy to cover these gaps in Medicare
coverage.

How Is the Program Financed? Medicare Part A is hospital insurance (H) financed by an
earmarked tax paid by the employer, employee, and those who are self- employed.
Medicare Part B supplementary Medical Insurance (SMI) is financed by monthly premiums paid
by the aged, disabled, and chronic renal disease enrollees (25 percent of costs) adjusted yearly
and by federal general revenues (75 percent

What Is the Level of Administration? The Centers for Medicare and Medicaid Services (CMS) of
the Department of Health and Human Services has the overall responsibility for the
administration of Medicare. The daily work of reviewing claims and making payments is done by
intermediaries for Part A and carriers for Part B. These are usually commercial insurers or Blue
Cross/Blue Shield plans.

Medicaid

Goals. Medicaid, authorized under the Social Security Act in 1965, is a federal-state matching
entitlement program to provide means-tested medical and health-related services
To low-income individuals and families.

Who Is Eligible for the Program? In 2002, approximately 50 million persons were covered by
Medicaid, some of whom-for example, elderly persons-may have had other coverage such as
persons who have Medicare.

What Is the Form of Benefit? The benefits are in-kind medical care services. There are no cash
benefits for beneficiaries; payments are made directly to the providers of services.

How Is the Program Financed? There is no preset limit (cap) on the total federal expenditures
for Medicaid. The federal government assists states with the cost of Medic- aid services through
a variable matching formula, which is adjusted annually

What Is the Level of Administration? Medicaid is a state-administered program. At the federal

level, the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and
Human Services is responsible for overseeing state operations.

Discussion. Medicaid serves as the long-term care safety net. Many Americans quickly deplete
their savings and qualify for Medicaid. Cuts and restrictions in Medicaid spending for nursing
home care mean greater burdens can be expected to fall on informal caregivers, and given such
restrictions by states, there would be little recourse for those in need.

Nutrition Programs
Nutrition programs help low-income persons meet their nutritional needs. The Food Stamp
Program is a means-tested entitlement program, and the Supplemental Food Program for
Women, Infants, and Children has a budget cap, and is not only means-tested but targets a very
specific category of recipient.

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The Food Stamp Program

Goals. The Food Stamp Program is designed primarily to increase the food purchasing power of
eligible low-income households so they can buy a nutritionally adequate low-cost diet.

Who Is Eligible for the Program? Eligibility is based on financial, employment/training, and
categorical tests. A means test requires that those eligible have monthly income and assets
below limits set by law.

What Is the Form of the Benefit? All states use electronic benefit transfer (EBT) system, which
replace coupons with an ATM-like card with which purchases are deducted at the point of sale
from the recipient’s account.

How Is the Program Financed? The entire cost of benefit payments is covered by the federal
government from general revenues, except where states pay for issuing food benefits to
ineligible non-citizens or those made ineligible by the new work rule for able- bodied adults
without dependents

What Is the Level of Administration? At the federal level, the Food Stamp Program is
administered by the US Department of Agriculture’s Food and Nutrition Service, which gives
direction to welfare agencies through federal regulations that define eligibility requirements,
benefit levels, and administrative rules. It is responsible for overseeing participation by retail
food stores and other outlets that accept Food Stamps.

Discussion. The Food Stamp Program is a means-tested, selective program whose federal and
state expenditures totaled $24 billion in 2002, funding which decreased 22 per- cent from 1994
to 1999. Vertically the program is adequate in that it helps low-income households to obtain a
more nutritious diet. The program’s horizontal adequacy is questionable. While the program is
coherent with other public assistance programs, nevertheless, only 55 percent of the poor
population participate in the program.

Special Supplemental Nutrition Program for Women, Infants, and Children

Goals. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
provides food assistance, nutrition risk screening, and related services such as nutrition
education and breast-feeding support to low-income pregnant and postpartum women and
their infants, as well as to low-income children up to age 5 years.

Who Is Eligible for the Program? Participants in the program must have family income at or
below 185 percent of poverty and must be judged to be nutritionally at risk, defined as
detectable abnormal nutritional conditions, documented nutrition-related medical conditions,
health-impairing dietary deficiencies, or conditions that predispose people to inadequate
nutrition or nutrition-related medical problems

What Is the Form of the Benefit? Recipients receive supplemental foods monthly in the form of
actual food items or, more generally, vouchers for purchases of specific items in retail stores.
The law requires that the WIC program provide foods containing protein, iron, calcium, vitamin
A, and vitamin C. Among the items that may be included in a food package are milk, cheese,
eggs, infant formula, cereals, and fruit or vegetable juices.

How Is the Program Financed? The WIC program is federally funded from general revenues. It is
not an entitlement program, and participation is limited by the amount of federal funding
appropriate whatever are supplementary funding is made available, of the extent of
manufacturers infant formula rebates

What Is the Level of Administration? Federally funded, the WIC program is administered by
state and local health agencies. This program was authorized by the Child Nutrition Act of 1966.

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Discussion. WIC is a selective, means and diagnostic-tested program. In 2002, over two – third
of WIC enrollees were to have a family income before the federal property guidelines. The
program is coherent with TANF, food stamps, and Medicaid since receipt of those benefits also
satisfies the WIC program’s income test. Because the program de pends on limited federal
appropriations, not all persons who need the services can be accommodated.

School Lunch and Breakfast Programs

Goals. The National School Lunch and School Breakfast Programs provide federal cash and
commodity support for meals served by public and private nonprofit elementary and secondary
schools and residential child-care institutions that enroll and guarantee to offer free or reduced-
price meals to eligible low-income children.

Who Is Eligible for the Program? Both the Breakfast and Lunch Programs have a three-tiered
system that allows children from families with incomes below 130 percent of the poverty line to
receive free meals, children from families from 130 to 185 percent of the poverty level to
receive meals at a reduced price; and provides a small subsidy for children whose family income
does not qualify them for free or reduced price meals or whose families do not apply

How Is the Program Financed? Both programs are funded from federal general revenues
through the budget of the Department of Agriculture Food and Nutrition Service.

What Is the Level of Administration? These programs are administered on the federal level by
the Food and Nutrition Service and administered locally by school districts, individual schools,
and certain nonprofit residences.

Discussion. The School Breakfast Program serves far fewer students (1.4 billion lunches) than
does the School Lunch Program (4.7 billion breakfasts). This means tested and selective program
meets federal nutrition standards and thus provides healthful food to many children whose
families are unable to do so. It makes more sense to increase the availability of breakfasts
without diminishing the availability of lunches as that can enhance student health and learning
throughout the day.

Low-Income Home Energy Assistance

Goals. The Low-Income Home Energy Assistance Program (LIHEAP) is designed to help eligible
households pay their home heating or cooling bills, provide assistance for low- cost
weatherization, and provide assistance during energy-related emergencies.

Who Is Eligible for the Program? States have considerable discretion to determine eligibility
criteria and the types of assistance to be provided. Recipients of SSI, TANF, food stamps, or
means-tested veterans’ benefits may receive benefits. States can also opt to make payments to
households with incomes up to 150 percent of federal poverty guidelines or 60 percent of the
state’s median income, whichever is greater.

What Is the Form of the Benefit? States may provide three types of services: (1) help eligible
households pay their home heating or cooling bills; (2) use up to 15 percent of their LIHEAP
allotment for low-cost weatherization, and (3) provide assistance to households daring energy-
related emergencies

How Is the Program Financed? The LIHEAP is a block-grant program funded entirely by the
federal government. In 2003, the program was funded at $1.9 billion.

What Is the Level of Administration? At the federal level, the program is administer by the
Administration for Children and Families of the Department of Health and Human Services
States.

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Discussion. This program illustrates the problems that occur when a needed service is not an
entitlement. Because funding for this program is capped, once the available dollars are spent,
those who come for heating and cooling assistance are turned away. The program is horizontally
inadequate; it is vertically inadequate as well because, especially in severe weather, the
available dollars are not sufficient to meet many persons’ needs.

Housing

Goals. The primary purpose of housing assistance is to reduce housing costs and improve
housing quality for low-income households by providing decent and safe rental housing for
eligible low-income families, the elderly, and persons with disabilities.

Who Is Eligible for the Program? Public housing is limited to low-income families and
individuals based on annual gross income whether as an elderly person, someone with a
disability, or as a family.

What Is the Form of Benefit? Most federal housing aid is now targeted to very low income
through the direct rental assistance programs. There are two basic approaches: (1) project-
based aid that supports projects specifically to produce low-income housing through new
construction or substantial rehabilitation; and (2) household-based subsidies that permit renters
to choose standard housing units in the existing private housing stock. Some funding is also
provided to modernize units built with federal aid.

What Is the Level of Administration? The major housing programs are administered by the US
Department of Housing and Urban Development (HUD) through area offices and local public
housing authorities and the U.S. Department of Agriculture’s Farm Service Agency (FSA), which
administers housing programs for rural families and domestic farm laborers through state and
county governments and with county committees appointed by the secretary of agriculture.

Discussion. The number of assisted households has leveled off at approximately 5 mil- lion.
Several cost containment measures have been enacted, including slowed growth in average
subsidies. Rents are increasing at a slower rate or even declining, and the maximum allowable
rent is being gradually decreased.

Veterans’ Benefits

Goals. Veterans’ benefit programs are provided as recognition of service to the nation.

Who Is Eligible for the Program? Eligibility for most veterans’ benefits is based on discharge
from active military service under other than dishonorable conditions for a mini- mum period
specified by law; family members or survivors of deceased veterans are also eligible. “Active
service” generally means full-time service as a member of the Army, Navy. Air Force, Marines, or
Coast Guard or as a commissioned officer of the Public Health Service, the Environmental
Services Administration, or the National Oceanic and Atmospheric Administration. Completion
of at least six years of honorable service in the Selected Reserves also provides for home-loan
benefits for those not otherwise eligible.

What Is the Form of Benefit? The Department of Veterans Affairs (VA) programs include
veterans’ compensation and pensions, readjustment benefits, medical care, and housing and
loan guaranty programs. Also provided are life insurance, burial benefits, and special counseling
and outreach programs.

How Are the Programs Financed? The VA is funded from federal general revenue, Except where
military personnel contribute or co-payments are required. In 2002, a total o$52.8 billion was
expended

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What Is the Level of Administration? The VA is a federal program administered nationally by
the Department of Veterans Affairs in coordination with other agencies where appropriate to
the service to be provided, including among others the Department of Labor, the Farm Service
Agency of the Department of Agriculture, Department of Housing and Urban Development for
mortgage insurance, and the Small Business Administration.

Discussion. It is interesting that, in contrast to the rest of the U.S. health care system, the
veterans’ medical program is a true form of nationalized medicine.

Employment Programs
The Workforce Investment Act (WIA, 1998) created a system designed for a “work first”
approach that uses the labor market to evaluate the pool of workers seeking employment and
training assistance. The legislation also strengthened links between the workforce in- vestment
system and the reauthorized adult education, literacy, and vocational rehabilitation programs.
Linkages are established through state workforce boards with authority to guide the
development of the system, local area workforce boards, one-stop systems, unified state plans,
and accountability.

Personal Social Services

Historically, five major social welfare systems have been identified: education, income
maintenance, health, housing, and employment. Comparative international studies led to the
identification of a sixth system with a long tradition-the personal social services. These services
are intended to meet the normal anticipated social needs that arise in modem industrial nations

The functions of personal social services are the following:

 Contributing to socialization and development.

 Offering daily living and growth supports for average people (not just problem groups).
 Disseminating information about and facilitating access to services and entitlements
anywhere in the social sector, inclusive of all six social welfare fields.
 Securing for the frail and aged, the handicapped, the with mental retardation, the
incapacitated of social care and ad necessary to support functioning in the community
or in substitute living arrangements.
 Arranging substitute home or residential care or creating new permanent family
relationship for children whose parents are not able to fulfill their roles.
 Providing help, counseling, and guidance to assist individuals and families facing
problems, crises, or sickness to establish functional capacities and overcome the
difficulties.
 Supporting mutual aid, self-help, and activities aimed at prevention.
 Overcoming problems county living.
 Advocating changes in policies, programs, and service planning.
 Integrating the variety of appropriate programs or services as they influence individuals
and families, to ensure coordination for maximum effect.
 Controlling or supersizing deviant individuals who may harm themselves while offering
care or opportunity for assistance, guidance, growth, it change.

What Is the Form of the Benefit? A cursory look at the functions listed above can suggest the
variety of benefits associated with this great diversity of aims and functions

Who Is Eligible for the Program? Eligibility for these services is based on a determination of
need, including diagnosis, and the individual financial meats of the potential client.

How Is the Program Financed? In the private sector, services are funded by member- ship and
user fees, grams, bequests, purchases of service, third-party payments, and donations which
are tax deductible

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What Is the Level of Administration? There is no central coordinating organization that gives
direction to the personal social services. Services may be administered locally and relatively
autonomously, or by state associations, or in combinations of national stale, regional and local
organization as well as through umbrella organizations.

Title XX

Goals. The purpose of Title XX (of the Social Security Act Social Services Block Grant Program is
to assist states in furnishing services aimed at one or more of these goals. (1) achieve or
maintain economic self-support to prevent, reduce, or eliminate dependency (2) achieve or
maintain self-sufficiency, including reduction or prevention of dependency: (3) prevent or
remedy neglect, abuse, or exploitation of children and adults unable to protect their own
interests, or preserve, rehabilitate, or reunite families; (4) prevent or reduce inappropriate
institutional care by providing for community-based or home-based care, or other forms of less
intensive care; and (5) secure referral or admission for institutional care when other forms of
care are inappropriate, or provide services to individuals in institutions.

Who Is Eligible for the Programs? Suites are given wide discretion to determine the services to
be provided and the groups that may be eligible for services.

What Is the From of the Benefit? During 2001, states mainly used Title XX funds for the
following services, among many others: day care for children (forty-five states); protective
services for children (forty-three); home-based services (homemakers, chore persons.

How Is the Program Financed? This program is a capped entitlement program, Block grants are
given to states to help them achieve goals such as preventing child abuse, increasing the
availability of child care, and providing community-based care for the elderly and disabled.

What Is the Level of Administration? Title XX is administered on the state and local levels

Discussion. The consolidation block-grant tactic and reduced allocations forced states to choose
among programs and their funding levels. For example, should they give less to the aged or
more to the disabled? Provide services for children or assist needy adults? Block grants for the
social services distributed in this way meant that bargaining for funds had to be accomplished at
the state level, a divisive situation in which very difficult decisions had to be made. Questions
also have been raised about the competence of the states to deliver necessary services with less
money, with fewer available resources, and with conflict in the relationship between states and
localities, as well as special interest groups within the states.

Defense Department Social and Mental Health Services

All military branches provide social and mental health services for service personnel, spouses,
and other family members. Important during peacetime, these services become even more
urgent during wartime when family members are placed in harm’s way and far from family.

Services to Families
In the best of times, all families need services that enrich their lives and the general nature of
community living. As we have grown interdependent as a society, not everyone can be an
expert at everything, and it is normal for families to call on a variety of experts and services.
Some families will be unable to cope with harsh economic situations, loss of jobs and financial,
interpersonal, and interfamilial difficulties. Divorce and separation, family and domestic
violence, parent-child conflict, strained relationships between husband and wife or domestic
partners, as well as the difficulties of combining families all are among the types of family
problems for which people seek help. It is important to keep in mind that not everyone who
seeks help is experiencing problems out of the ordinary and that seeking help cannot be
equated with mental disturbance.

Services to Children

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Child welfare services have two broad emphases: (1) the enhancement of the functioning of all
families and all children, and (2) services provided for families and children with special needs.
All families and children face developmental stresses and problems.

Dimensions. During 2003, almost 3 million reports of child maltreatment were made to Child
Protective Services in the United States. Of this large number, approximately two- thirds were
investigated or assessed. The other one-third percent were screened and nor pursued.

The Victims. Nationally, there were an estimated 906,000 victims of maltreatment, rate of
almost 12.5 per 1,000 children. Some 60 percent suffered neglect, just over 19 per cent were
physically abused; and just over 10 percent were sexually abused. Others were victims of
different types of maltreatment.
Perpetrators. Who maltreats children? Approximately 80 percent of the perpetrators parents;
other relatives and unmarried partners of parents account for another 10 percent Camp
counselors, school employees, and unknown relationships account for the remainder

Fatalities. Child fatality estimates are based on records of Child Protective Services and other
agencies. In 2003, an estimated 1,500 children died due to neglect or abuse. Almost 80 percent
of the children who were killed were younger than 4 years old. Infant boys (younger than 1
year) had the highest rate of fatalities (18 per 100,000); infant girls were killed at a rate of 14
deaths per 100,000. Overall, the death rate per 100,000 children was 2.

The Estimated Economic Cost of Maltreatment. Child abuse and neglect have social costs for
the individuals, families, and society. The trauma affects the lives of individuals both in the short
and long term. The suffering and trauma experienced by these persons and their families are
not measurable but many studies have documented the connections between abuse and
neglect and medical, emotional, psychological, and behavioral disorders. Abused and neglected
children are more likely than others to suffer from depression.

Child Welfare Services. The goal of child welfare services is to promote the safety and well-
being of children and their families and to improve or provide substitutes for functions that
parents have difficulty performing.

The Federal and State Governments Child welfare programs are supported by national, state,
and local laws. The federal government sets policy, regulation, financial assistance to the states,
and monitors program operations.

Poverty and Other Stresses. Unemployment and poverty contribute to child abuse and neglect.
Suffice it to say that children growing up in many poor families are impacted in a multitude of
ways, including abuse and neglect, and these are exacerbated by the fact that their families are
poor.

Family Preservation Services. Family preservation services are intended for children and
families, including extended and adoptive families who are at risk or in crisis. Services provided
include help to reunite children with their biological families-if appropriate-or to place them for
adoption or another permanent arrangement

Family Foster Care. Family foster care provides planned, time-limited care by families who
substitute for the families who cannot adequately care for their children. Social services are also
provided for these families to help resolve the problems that led to the placement of the child

Adoption. Adoption creates a legal family for a child when the biological family is unable or
unwilling to serve as parents. Adoption creates new families, expands existing families, and
involves new adoptive parents, including relatives’ guardianships. The Adoption Assistance
Program provides help for states to develop agreements with parents who adopt eligible
children with special needs

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Foster Care Independence Program. The Independent Living Program (the Foster Care
Independence Program) was established to assist youths who eventually will be emancipated
from the foster care system.

Issues. There are recent creative programs designed to provide homes for children who might
otherwise not be adoptable such as older children, those from minority backgrounds, and those
with disabilities, including those with AIDS and babies born addicted to crack cocaine. Social
workers in schools, mental health agencies, hospitals, and other settings increasingly recognize
the special problems experienced by gay and lesbian young people

Mental Health Services

Who Is Eligible for the Programs? The intensified need for mental health services during World
War II, especially in the military, led to the passage of the National Mental Health Act (1946),
which focused attention on the mental health needs of the populace and emphasized treatment
and prevention services. This initial step was followed by the establishment of the National
Institute of Mental Health in 1959. In 1963, the Mental Retardation Facilities and Community
Mental Health Centers and Construction Act provided funds for the construction of community
mental health centers, and subsequent amendments funded personnel. Medicaid and Medicare
also provide psychiatric services for eligible persons.

What Is the Form of Benefit? The benefits received in mental health programs are diagnosis,
treatment in the hospital or community, long-term or emergency consultation, professional
care, case management, and educational services in the community.

How Is the Program Financed? Using monies from federal block grants, state mental health
departments or state health departments operate statewide networks of mental health
services. Mental health services are sometimes financed by state departments of education
through special education programs.

What Is the Level of Administration? The Substance Abuse and Mental Health Services
Administration of the U.S. Department of Health and Human Services administers the federal
block grant.

Discussion. Deinstitutionalization has not lived up to expectations. Community living is

preferable to residence in mental hospitals but persons following discharge require therapeutic
and supportive settings and help for using them. Community care has not received the support
it needs.

What Is the Form of Benefit? The number of Americans in local jails and state and federal
correctional facilities and on probation or parole reached 6.7 million (1.4 million imprisoned) in
2002. L

How Is the Program Financed? The Violent Crime Control and Law Enforcement Act (1994)
emphasized the construction of new prisons, boot camps, and other facilities, funding for
additional police officers, and prevention programs. The Bureau of Prisons and Board of Parole,
funded by general federal revenues, is part of the US.

What Is the Level of Administration? The offices mentioned previously administer research and
program demonstration grants at the federal level and assist state and local authorities in the
correctional field.

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