FLORIDA CATHOLIC CONFERENCE
Archdiocese of Miami + Diocese of
Diocese of St. Petersburg + Diocese of Orlando + Diocese of Pensacola-Tallahassee
VOLUME 4, NUMBER 1 / September 1983
"The harsh reality of Americas present economic system is that, without substantial and effective government intervention, people will go hungry; families will be homeless; mothers and children will be without basic health care. In theory one might hope that the government would not have to be the direct provider of these services; in reality, however, given the best efforts of the private sector, government must bear a large share of the burden. In short, the powers of government must be used in a constructive way, directly as well as indirectly, to guarantee a minimum level of decency for all Americans." Bishop Joseph M. Sullivan, testifying to Congressional Committee on behalf of the United States Catholic Conference, February 22, 1982.
One way to measure the moral strength (f a society is by the help it provides its citizens in need. Catholics, influenced by the social teaching of the Church, have a natural bias for the poor andthe vulnerable in our society. In the expenditure of tax revenues, we are especially concerned that the poor--children, elderly, disabled and sick--are treated decently and fairly.
How does Florida treat its poor?
Who are those poor?
What improvements can citizens realistically strive for?
EXPENDITURES OF THE FLORIDA TAX DOLLAR FROM THE GENERAL REVENUE (Report of Comptroller 1981-82)
$0.57 - to education
0.14 - to general government
0.09 - to health programs
0.03 - to PUBLIC WELFARE
0.09 - to corrections and law enforcement
0.03 - to natural resources
0.05 - other
COMPARISON OF FLORIDAS PER CAPITA EXPENDITURES WITH THE 50 OTHER STATES (Federal Aid to States, U.S. Treasury, 1983)
Social and Child Welfare Services 38th
AFDC Payments 45th
Since the first edition of FACTS ON FLORIDA WELFARE six years ago, Florida has moved from 49th to 45th in AFDC payments; dropped from 36th to 38th in Child Welfare Services; and has remained 49th in Medicaid.
|WHO ARE FLORIDA'S POOR?
Over 1/3 of our poor are children.
1/5 of our poor are over age 60.
The remainder are disabled, unemployed or marginally employed adults.
|ARE MOST OF FLORIDAS
POOR ON WELFARE?
There are over 1 1/2 million Floridians living at or below the poverty level.1
70% of the poor receive no cash assistance from the state.
POVERTY IN FLORIDA
WHY DON'T MOST PEOPLE ON WELFARE WORK?
|Children under working age||195,054||42%|
|Mothers and grandmothers with child care responsibilities||
|Retired or elderly persons||80,889||18%|
|Disabled, blind or mentally incapacitated||
|Total persons receiving state cash assistance||457,805||100%|
The average length of time on AFDC in Florida is 29 months. 3
Although there is an unemployed parent program authorized by law, it is not funded in Florida. Thus, where both parents are out of work, the children cannot receive AFDC benefits unless the father abandons the family.
SINGLE PARENT (FEMALE) AND 1.75 CHILDREN
HOW COMFORTABLY DO FLORIDIANS ON WELFARE LIVE?
Because of the very low payment level many poor Floridians, who might
otherwise qualify, are refused services under the AFDC program.
The maximum current payment of $273.00 per month for a parent and three children with no outside income is the only cash available for maintaining the household.
The same family may receive $253.00 in food stamps.4 Many poor families who are eligible do not use food stamps for varying reasons, among which are difficulties encountered in certification and demeaning public attitudes toward "people on food stamps." 63% of the eligible persons on AFDC or SSI are not receiving food stamps.4
FAMILY OF 4 WITH NO OUTSIDE INCOME
|Food Stamps (4)||$253||$3,036|
(This is well below the $9,862 poverty level as determined by Dept. of Commerce.)
PRINCIPAL FROGRAMS AVAILABLE IN FLORIDA
|MEDICAID . . . Certain medical care for low income persons.|
|FOOD STAMPS . . . A nutritional program to assist in the purchasing of necessary food. The degree of assistance depends upon individual income and expenses.|
|SOCIAL SERVICES . . . Other specialized services to help the poor and disabled (such as adoption, foster care, prevention of child abuse, etc.)|
|AFDC . . . Aid to Families with Dependent Children (Cash payments for needy children who are deprived of the support of one or both parents.)|
|S.S.I., and O.S.S . . . Supplemental Security Income (cash payments to the blind, aged, permanently and totally disabled). Minimal additional payments for special care for dependent children and adults are provided through O.S.S.|
l. a. Money, Income and Poverty Status of Families and Persons in the U.S.,1982, U.S. Department of Commerce Bureau of the Census.
b. F.S.U, File 3 DATA, 1980 Census of Population and Housing, sample count.
2. Report of Direct Assistance Programs, Department Of HRS, August 1983.
3. Dept. of HRS - SPSS computer run against active case file - 1982.
4. Dept. of HRS --- FNS --- 256 Summary, May, 1983.
5. Dept. of HRS Rule 10C - 1.103, Sept., 1983.
MEDICAID IN FLORIDA
Florida's Medicaid program is inadequate. Only 17% of our poor have Medicaid coverage.1 Eligibility for the program is limited to those who are receiving AFDC or SSI benefits, children in foster care, children with subsidized adoptions, and some residents of institutions.
THE MEDICALLY UNDERSERVED POOR
Most of the 1 million poor not covered by Medicaid have no
medical insurance coverage. They receive little or no preventive health care and rely on
emergency treatment at clinics, hospital emergency rooms or private physicians. Some
services are provided at the county health units but funding is limited and services are
Some counties have no prenatal services for poor, pregnant women. The chronically ill poor as well as the elderly poor have inadequate medical coverage and depend upon often inappropriate, expensive treatment in hospitals.
WHO IS PAYING FOR INDIGENT HEALTH CARE?
In the Medicaid program, every dollar spent by our state is
matched by $1.12 from the federal government. Because of Florida's low participation in
the program our citizens are subsidizing health care costs in other states who are drawing
down more Medicaid funds from our federal tax dollars. In Florida, health care costs for
those indigents not covered by Medicaid are passed to consumers through Increased hospital
rates. 1982 costs of $129 million in indigent care by Florida hospitals were absorbed by
paying patients through hospital rate increases of over $9 per day. In addition, Florida
hospitals charged off bad debts totaling on in-1982, a large portion which is attributed
to the cost of indigent care. 2
Ad valorem taxpayers absorb much of the cost at county health units and clinics in hospitals. Over $30 million was provided by local units of governments to hospitals for cost incurred by lndigents requiring hospital care in 1982.2 Additionally, over $117 million of state general revenue is budgeted to the Department of HRS for the provision of needed medical services for those who don't qualify for Medicaid.3
The heavy burden of 100% funding of health care costs for many indigents now borne by consumers and ad valorem taxpayers can be alleviated by expansion of the Medicaid program.
MEDICALLY NEEDY & HOW IT WORKS
Many states provide additional coverage for their poor
through a "medically needy" program.
Under this Medicaid program, the state sets a medically needy income level (MNIL) which must be at least as high as the AFDC payment standard or the payments made to SSI recipients and may be as high as 133 1/2% of the allowable AFDC payment.4 Then families whose incomes fall above the AFDC eligibility level and below the MNIL automatically become eligible for Medicaid.
Persons can also become eligible if after their medical expenses are deducted from their income they fall below the MNIL'5 This is known as the "spend down" provision.
HOW TO EXPAND MEDICAID
In the Medicaid program there are several optional coverage
groups and services available in many other states which Florida does not fund.1 After
weighing the needs to be met and the costs, we recommend that Florida initiate expansion
of its Medicaid program by adopting the following options:
1.A targeted "medically needy" program serving children from single parent families who would be eligible for AFDC except for income, pregnant women eligible for AFDC except for income and infants in neonatal intensive care. Much of this cost would be offset by general revenue now expended.
2. Poor, married pregnant women who because they are married cannot qualify for AFDC. This option became available to states in 1982.6
3. All poor children whose families are otherwise eligible for AFDC but can't qualify because both parents are in the home.
4. A "medically needy" program serving those in all categories. This would include parents, children, aged and disabled.
5. AFDC, two-parent, unemployed families. This is the most expensive since it requires financial assistance payments.
1. Dept. of HRS, Medicaid Program Office Report to House Commerce Sub-Committee, Sept. 13, 1983
2. Impact of Indigents on Florida Hospitals, HCCB, Sept. 12, 1983.
3. Conferarice Comittee Report an SB1-B, June 24, 1983.
4. 42 U.S.C. 1396b(f)(1)B
5. 42 C.F.R. 436.301(a)(1)(ii)
6. 42 U.S.C. 1396d
WHAT'S HAPPENING TO THE UNSERVED FOOR?
Where do the over 1 million poor who are not eligible for
state financial assistance turn for help?
According to a 1981-82 survey only 22 of the 67 counties in Florida provide short-term financial assistance to those in need. The average payment is $64 per month and most assistance is for 1 month only. A few heavily populated counties provide financial assistance for up to 5-6 months. The Dade County budget for 1982-83 emergency assistance was $6 million funded primarily from ad valorem taxes.2 A few counties offer emergency shelter, food andclothing. The only service to the poor which is provided by all counties is burial assistance.
The county financial assistance is provided for those who can't qualify for the state AFDC or SSI assistance due to the rigid eligibility requirements. Over $12 million is expended annually :by the counties. Although there are federal funds available on a 50% match for the state to provide .emergency assistance to families, Florida does not fund the program. Thus, county ad valorem taxpayers fund the very limited county programs.
The voluntary sector through churches and other service agencies are being called upon as never before to provide emergency assistance to the "new poor" in Florida. Thousands are fed daily in soup kitchens in communities around the state. Food pantries and clothes closets are depleted as rapidly as they are filled. Shelters are filled to capacity and many are turned away. The demands are far too great to be met by the private sector alone. There is a clear need for state emergency assistance to all families in need, utilizing the federal funds available for this purpose.
1. Florida Association of County Welfare, Executives Survey Questionnaire 1981-82.
2. Director of Office of Emergency Assistance, Dade County, Sept. 1, 1983.
1984 STATE LEGISLATIVE PROPOSALS
With your support for the passage of legislative funding
proposals below, Florida can and will improve its provision of basic subsistence and
health care for the poor.
1. Expansion of the Medicaid program to include:
a. a targeted "medically needy" program for children in AFDC families, AFDC eligible pregnant women and infants in neonatal intensive care;
b. poor, married pregnant women;
c. all poor children whose families are otherwise eligible for AFDC but can't qualify because both parents are in the home.
2. Increasing the AFDC payment level to more adequately meet the basic needs.
3. Expansion of the AFDC program to fund some general assistance or emergency assistance for poor families.