In Case You Missed It…

August 22, 2014 at 1:08 pm

This week on Off the Charts, we focused on health care and the safety net.

  • On health care, Jesse Cross-Call highlighted lessons that states wanting to expand Medicaid through waivers can learn from three states that already have.
  • On the safety net, LaDonna Pavetti marked Temporary Assistance for Needy Families’ (TANF) 18-year anniversary, noting that the program’s role as a safety net has declined sharply over time.

We released papers on SNAP’s medical expense deduction and lessons learned from states that have expanded Medicaid through waivers.  We also updated our TANF chart book and our paper on understanding the Social Security trust funds.

CBPP’s Chart of the Week:

A variety of news outlets featured CBPP’s work and experts recently. Here are some highlights:

Paul Ryan Recycles Weak Talking Point On Welfare Reform
Huffington Post
August 20, 2014

The Five Biggest Lies About Obamacare
The Daily Beast
August 17, 2014

Don’t miss any of our posts, papers, or charts — follow us on Twitter and Instagram.

States Seeking to Expand Medicaid Through Waivers Can Learn From Arkansas, Iowa, and Michigan

August 22, 2014 at 11:05 am

The federal government is considering proposals from Pennsylvania and Indiana to adopt health reform’s Medicaid expansion through a demonstration project, or waiver, and New Hampshire will soon submit its own.  The experience of the three states — Arkansas, Iowa, and Michigan — that have expanded through a waiver suggests that while the federal government will work with states to craft reasonable expansion plans, there are limits to the programmatic flexibility it will grant, as we explain in a new paper.

Waivers provide states with additional flexibility in how they operate their Medicaid programs, but they cannot be used to impose onerous requirements that make it difficult for eligible individuals to gain and maintain Medicaid coverage.  This principle has informed how the Department of Health and Human Services (HHS) has responded to waiver proposals so far.

Among the takeaways:

  • States may not disenroll people with incomes below the poverty line for non-payment of premiums.  While Iowa has received approval to charge beneficiaries with incomes between 50 and 100 percent of the poverty line modest premiums starting in 2015, the state will waive premiums for individuals who complete health risk and wellness assessments or attest to financial hardships.  Importantly, the state cannot disenroll individuals from coverage if they do not pay their premiums.
  • States may not require individuals to pay cost-sharing charges above what is allowed under Medicaid rules.  Medicaid cost-sharing rules provide states with significant flexibility while providing significant protections for beneficiaries that are intended to minimize barriers to necessary health care services.  The rules include special protections barring cost-sharing for children and pregnant women and for certain services such as family planning, emergency services, and maternity care.  People with incomes above the poverty line may be charged higher amounts, and providers cannot deny services to people with incomes below the poverty line who cannot afford to pay.  States must apply these protections to the newly eligible adults regardless of whether states expand Medicaid through a waiver.
  • States may not overly restrict certain benefits.  States have significant flexibility regarding benefits for newly eligible adults and can largely align their benefits with the benefits that private market plans provide.  Still, HHS has provided very limited waivers of Medicaid benefits.  And in Arkansas and Iowa, which are enrolling some or most of their expansion populations in private plans offered in the health insurance marketplaces, HHS has required that states augment marketplace benefits to ensure beneficiaries have access to the same benefits than if they were enrolled in regular Medicaid.
  • States can’t condition Medicaid eligibility on employment or participation in work search activities.  In December 2013, Pennsylvania Governor Tom Corbett proposed a Medicaid expansion waiver that would require anyone working fewer than 20 hours a week to register with the state’s unemployment compensation program and engage in 12 work search activities per month to remain eligible for Medicaid coverage.  Those judged not to be in compliance would have their health coverage revoked.  Gov. Corbett subsequently submitted a revised proposal to HHS that would charge beneficiaries differential premiums based on whether they are working or engaged in work search activities.  In response to Pennsylvania’s proposal, HHS has indicated that it is unlikely to approve waivers that condition either Medicaid eligibility or premium amounts on compliance with work search or other work-related activities.

Click here to read the full paper.

TANF at 18: A Weakened Role and Not a Model for Safety Net Reform

August 22, 2014 at 10:08 am

Eighteen years ago today, President Clinton signed into law the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 — commonly known as “welfare reform.”  A key component was its creation of the Temporary Assistance for Needy Families (TANF) block grant to replace Aid to Families with Dependent Children (AFDC).

Since then, TANF has played a shrinking role as a safety net for poor families (see chart), serving a small share of poor families and lifting many fewer families out of “deep poverty” (with incomes below half the poverty line) than AFDC did, as we explain and illustrate in our revised chart book.

A close look at TANF’s track record makes it clear that the program needs retooling to ensure that a strong safety net and sufficient employment assistance is available when people need them most.

Yet some policymakers claim that welfare reform was such an extraordinary success that we should use it as a model for reforming other safety net programs.  But the facts don’t make that case.  For example, in TANF’s 18-year history, never-married mothers with a high school education or less made substantial gains in employment in only the first four years — largely due to the roaring economy of the late 1990s — and those gains have almost entirely eroded in the subsequent 14.  It is wishful thinking to assume that we could see the same employment gains we saw in TANF’s early years in today’s sluggish labor market.

The safety net (other than TANF) plays an extremely important role in reducing poverty and deep poverty in this country — a role that should be maintained.  The evidence from TANF suggests that applying TANF-like reforms to other safety net programs would likely cause more families to join the ranks of the deeply poor and cause some who are already deeply poor to become even poorer.

TANF reform is long overdue.  We should fix its problems before embarking on reforms that will repeat its failures.

Click here for the full chart book.

In Case You Missed It…

August 15, 2014 at 12:05 pm

This week on Off the Charts, we focused on food assistance, health reform, Social Security, the federal budget and taxes, and state budgets and taxes.

  • On food assistance, Becca Segal introduced our new database of schools nationwide that qualify for community eligibility and shared what school officials are saying about the benefits of the program, which allows schools in high-poverty areas to serve meals to all students at no charge.
  • On health reform, Jesse Cross-Call rebutted claims by opponents of health reform’s Medicaid expansion that the federal government frequently changes the share of states’ Medicaid costs that it covers.
  • On Social Security, Kathy Ruffing celebrated the program’s 79th birthday by explaining how it helps more than 58 million Americans.
  • On the federal budget and taxes, Chye-Ching Huang highlighted a new paper debunking the claim that high U.S. tax rates force companies to move their headquarters overseas.
  • On state budgets and taxes, Michael Leachman connected the dots between Kansas’ costly tax cuts and the recent downgrading of the state’s credit rating.

We released a paper on what the 2014 trustees’ report shows about Social Security and a database that identifies schools that qualify for community eligibility. We also updated our chart book on the legacy of the Great Recession.

CBPP’s Chart of the Week:

A variety of news outlets featured CBPP’s work and experts recently. Here are some highlights:

Economic recovery marked by lower-paying jobs, analysis finds
Los Angeles Times
August 11, 2014

All Somerset students qualify for free breakfast, lunch
DelmarvaNow
August 10, 2014

Don’t miss any of our posts, papers, or charts — follow us on Twitter and Instagram.

What Schools Are Saying About Community Eligibility

August 15, 2014 at 11:14 am

School officials around the country have explained (see here and here) why they’re adopting community eligibility, a powerful new tool to fight hunger in high-poverty neighborhoods by allowing schools to offer nutritious meals to all students at no charge.  As schools and families prepare for the new school year — and as the August 31st signup deadline for eligible schools approaches — here’s more of what school officials are saying about the benefits of community eligibility:

  • Bill Redwine, chair of Rowan County, Kentucky, board of education:

    “This program will have a direct benefit on students in the classroom because teachers know that students who are hungry or have not had breakfast have difficulty concentrating on their schoolwork. . . .  It will also benefit those parents who, in the past, have struggled to provide the money for their child’s meals.  This definitely is a win for our students, for their parents and for our district as a whole.”

  • Jesse Register, director of Metropolitan Nashville, Tennessee, schools:

    “We’re firm believers in educating the whole child and providing them what they need for productive school days.  If a child is hungry, he’s going to have trouble learning.  No child should go hungry and no child should be embarrassed about accepting a meal.  By making it universal, we don’t have to single out any child and we can make family budgets a little less tight.”

  • Margaret Allen, superintendent of Montgomery, Alabama schools:

    “Studies have shown that children who receive proper nutrition perform better in school. . . .   Many of our families live below the poverty line.  Even those that don’t, may skip meals to save money.  This will ensure learning won’t suffer because a student is hungry at school.”

  • Kim Hall, director of child nutrition services, Muskogee, Oklahoma, public schools:

    “Being able to eat a nutritious meal during the day helps the students learn — students that eat during the day are more likely to pay attention because they are not worried about being hungry.”

  • Joey Vaughn, nutrition director, Huntsville, Alabama, city schools:

    “Hopefully, this is going to do away with the stigma [of receiving free school meals] because everybody is going to be able to eat for free.  Nobody’s got to fill out any paperwork; nobody’s got to prove their financial status.”

  • Lisa Stevenson, principal of Neil Armstrong Elementary School, Eldridge, Iowa:

    “Families that don’t have as much money don’t spend the extra money to buy fresh fruits and vegetables at the grocery store because that’s expensive. . . .  This is an opportunity for us to get kids . . . on the right path to trying new and healthy food when they’re at school.”

  • Donna Hargens, superintendent of Jefferson County, Kentucky, public schools:

    “You can’t learn if you’re hungry so we know that providing breakfast and lunch for more of our kids is a really important ingredient and that’s just integral to kids learning.”