Since August 2011, 89,000 children in Pennsylvania have lost their Medicaid coverage, including many with life-threatening illnesses who were mistakenly deemed ineligible. The state currently hasn’t a clue whether many of these children have any healthcare coverage at all.
How did this happen?
In late summer, the Pennsylvania Department of Welfare (DPW) began notifying hundreds of thousands of families by mail that they had ten days to provide necessary documentation in order to keep their children enrolled in Medicaid. If the family missed the deadline—or even if they met it but DPW failed to process the paperwork within the ten days—they were dropped from Medicaid.
Federal law indeed requires that families prove their Medicaid eligibility annually. Pennsylvania requires verification every six months. During the previous administration, under Democratic Governor Ed Rendell, caseloads grew as a result of the recession, while county assistance offices were shorthanded due to budget cuts. Caseworkers simply couldn’t keep pace with the workload and there was a backlog of renewal applications.
Enter Republican Governor Tom Corbett and his anti-spending, anti-government secretary of public welfare, Gary Alexander. They decided to plow ahead with their new approach to eligibility verification: ten days to receive and process the overdue renewals, and an assumption of ineligibility if the applications weren’t reviewed during that time period.
Predictably, the offices couldn’t keep up with the new deluge of mail. It doesn’t seem a stretch to suggest that a Republican administration—hostile to Medicaid—had identified a weakness in the system, exploited it, so that it could reduce spending while bolstering its claim that the system is broken.
Who are some of the victims wronged by the Corbett-Alexander approach to children’s health? A 5-year-old with leukemia; a 2-year-old with a congenital heart disorder; a severely disabled 12-year-old who requires home healthcare; 9-year-old twins, one with autism, the other with a hearing impairment; a 1-year-old with cerebral palsy.
Imagine, a parent of a toddler battling cancer, and suddenly a need to—as one advocate put it—“engage in a Kafkaesque process of getting your kid back on Medicaid.”
What is also deeply disturbing is this: normally when a child is no longer Medicaid-eligible in Pennsylvania parents are referred to the Children’s Health Insurance Program (CHIP), a federally subsidized healthcare program for low-income kids. The state takes great pride in near universal coverage of children—it offered one of the first CHIP programs in the country in 1992. But as advocates watched Medicaid enrollment fall off a cliff—89,000 dropped between August 2011 and January 2012—CHIP enrollment remained flat.
Where the hell are the kids? advocates began to ask.
DPW’s initial explanation was that the 89,000 kids dropped included families that moved out of state or were no longer income-eligible. But, when pressed for an accounting, DPW’s own analysis revealed that the number of families falling within these categories is paltry.
Secretary Alexander also played games with the numbers. As recently as May 1, during an interview on Pennsylvania public radio, he said: “It wasn’t children that were removed, it was families. We call them cases—so that there are parents and children.”
But Pennsylvania Partnerships for Children, a nonpartisan organization dedicated to improving the health, education and wellbeing of children and youth throughout the state, says that simply isn’t true. It points to DPW’s own records, which show that the 89,000 figure represents children dropped from Medicaid.
Secretary Alexander also offered this explanation for the state’s actions: “The problem we have, of course, is that we have federal rules and regulations that we have to follow and we have to do those redeterminations every six months.”
Actually, the problem the secretary has is either ignorance or lying: federal law requires eligibility renewals only once a year, and in some states even a verbal statement regarding income is sufficient.
Alternatives to DPW’s current neglectful approach have been offered: What about following up with phone calls and multiple mailings to ensure that children weren’t improperly denied coverage? Or a moratorium on dropping kids from the program until DPW is certain it is adequately processing the renewals? Or at least halting six-month eligibility reviews of children with the most serious illnesses? All of these options are permitted under federal law.
Every proposal or idea has been rejected, and tens of thousands of kids remain virtually disappeared by the Corbett-Alexander approach to healthcare.
Pennsylvania Set to Eliminate Safety Net of Last Resort
“On Sunday, nearly 70,000 Pennsylvanians with disabilities will lose their sole source of income overnight,” legal aid lawyer Michael Froehlich of Community Legal Services in Philadelphia told me yesterday.
The sudden elimination of the “safety net of last resort”—the General Assistance (GA) program—is especially troubling when one considers who is currently eligible for it: disabled or sick adults without children; domestic violence survivors, many of whom have just fled abusers (lifetime benefit capped at nine months); adults participating in alcohol and other drug treatment programs (also capped at nine months); adults caring for someone sick or disabled, or an unrelated child; and children living with an unrelated adult.
In all, over 90 percent of recipients are temporarily or permanently disabled. The 68,000 people in the program—or just about one in every 200 residents—receive approximately $205 per month. Those funds enable many people to rent a room, pay for transportation to needed appointments, cover co-pays, or escape abuse. DPW estimates that eliminating the GA program will save the state $150 million annually.
According to Froehlich, when the GA rolls were trimmed in 1982, 1994 and 1996, people were provided sixty days notice. But this time “many people won’t find out until they go to withdrawal their money next week to pay their July rent.”
There are reports that the welfare office in Philadelphia is bringing in additional guards to protect staff on Monday.
Froehlich and Community Legal Services are part of PA Cares for All, a coalition of more than 100 organizations that initially fought to save the program and then offered an alternative proposal: eliminate GA assistance for approximately 40,000 people, but maintain it for 30,000 of the most sick and disabled; plus children, domestic violence survivors and people actively participating in drug and alcohol treatment programs. That plan would cost $42.l million annually, and allow an annual savings of $107.9 million.
“We’ve just tried every way we can to mitigate the harm,” said Froehlich.
The coalition has pressed its case on both moral and economic grounds. In a May 22 “Open Letter to Pennsylvania House and Senate Members,” the coalition writes: “No child should be homeless. In fact, no one should be homeless. People with disabilities and older adults should be able to live safely and with dignity. Women and children should be able to live free from violence, especially in their own homes.”
The coalition also argues that cutting the program makes absolutely no fiscal sense.
“The loss of General Assistance will be more expensive for taxpayers,” the letter reads, noting that if just 7 percent of current recipients enter the criminal justice system, $150 million in savings from eliminating the program will suddenly be a $9 million overall cost to taxpayers. If just 1 percent of current recipients end up in psychiatric hospitals the overall cost of eliminating the program will be $20 million; and if just 20 percent end up in homeless shelters that will mean a $23 million hit to taxpayers instead of any savings. (And the coalition projects that the number of current GA recipients turning to the shelter system will be much higher than 20 percent; people will quickly overwhelm the shelters, houses of worship and human services providers.)
According to Froehlich, the most frustrating part about this decision is that the resources are available if Governor Corbett or the legislature had any interest at all in preserving the program. In fact, the state just announced a $1.65 billion tax credit to Shell Oil over twenty-five years in order to bring an ethylene cracker plant to Western Pennsylvania. According to the Pennsylvania Budget and Policy Center, “the 400 permanent jobs at the plant will come at a hefty price to taxpayers, $165,000 per year per job, or $4.125 million per job over the 25-year life of the program.”
“And the administration’s saying we can’t come up with $42 million for our alternative proposal to help the very most vulnerable, most needy Pennsylvanians?” said Froehlich.
Froehlich has begun getting calls from clients who are asking, “What’s next? What are we going to do?”
“I don’t have an answer for most of them,” he said. “I got nothing.”
Poverty and Pride
Tomorrow is the last day of LGBT Pride Month: a time for individuals to be visible and out, and for a movement of LGBT and non-LGBT people to demonstrate that we’re here and not going anywhere. It’s also a time to reflect on the progress we’ve made and to recommit to the work that remains in order to achieve full equality.
Some of that work involves paying much more attention to LGBT folks living in poverty.
A report issued by the Movement Advancement Project, Family Equality Council, and Center for American Progress (CAP)—“All Children Matter: How Legal and Social Inequalities Hurt LGBT Families”—notes that there are now an estimated 2 million children being raised in LGBT families, and they are twice as likely to be poor than children of heterosexual married couples. The average household income for LGBT families with children is 20 percent less than heterosexual couples with children. LGBT families live in 96 percent of US counties, and same-sex couples in the South are more likely to be raising children than those in other regions of the country.
“It’s true, we actually don’t just live in California, New York and DC,” says report co-author Jeff Krehely, vice president of LGBT research and communications at CAP. “We live all across the country—some of us have kids, some of us don’t. We’re all races and ethnicities, and our earnings run the gamut. We basically reflect the diversity of this country.”
Krehely says that even national advocates sometimes fail to recognize LGBT diversity, and the demographics in the South are a great example of that. He suggests that a lower cost of living combined with less social mobility for low-income families might explain why so many LGBT families remain in a region “not exactly known for being welcoming to gay people or minorities.”
“But knowing these kinds of demographics isn’t just about thinking more accurately about LGBT realities,” says Krehely. “It’s about being more effective as an advocate and realizing, for example, if we say, ‘We’re not going to get marriage equality in Mississippi or Alabama anytime soon, so we’re not going to play in those states,’ well, then we’re leaving behind a lot of people—including some of very the people who are most in need, and most in need of our advocacy.”
At the heart of the economic struggles for LGBT families rich, poor, and in between, is what the report calls the “legal stranger” issue. In contrast to a child of a heterosexual couple, a child born to (or raised by) two LGBT parents “may have one parent deemed a legal stranger by law, threatening to undercut family permanency.” These children lack protection when their parents’ relationship dissolves or a parent dies; the relationship to his or her parents will be recognized in fewer than half of all US states; fear of a parent’s deportation hangs over the heads of too many children of bi-national, same-sex couples.
“Say one parent is here on a student visa or a work visa,” says Krehely. “The visa expires—that parent could be deported, taken away from his or her kids. It’s more than just heart wrenching. If that parent is the breadwinner—the family’s economic security is at stake. This all impacts the well being of kids when there is this kind of instability in terms of emotional support, love, being taken care of and being provided for financially and materially.”
The legal stranger definition also leads to difficulties accessing the safety net since benefits depend on “legal” household size and income. Cash assistance, health insurance, child care assistance, educational loans and other forms of assistance may not be available to LGBT families due to the narrow legal definition of family. LGBT families often can’t take advantage of the Child Tax Credit or Earned Income Tax Credit—both of which have a significant anti-poverty effect and ease the financial costs of raising children. Social Security and Survivors Benefits are denied if a non-recognized parent dies, even if the children were financially dependent on the parent, and even if the parents are legally married in their state; surviving same-sex spouses are also denied benefits.
“The legal stranger issue is something that most people who don’t know much about LGBT people can relate to,” says Krehely. “Everybody gets into positions where you rely on those relationships to help a family member in need. What would happen if that just didn’t exist for you? ”
Some of the recommendations the report makes include: recognizing LGBT families across safety net programs and providing equitable treatment in the tax code; passing parental recognition laws at the state level to fully protect children in LGBT families; legalizing and federally recognizing marriage for gay and lesbian couples; creating stronger support services for LGBT families, particularly families of color, low-income and transgender parents.
Pride Month is great, but there are eleven other months in the year that require the same kind of commitment if we are going to get the work done. You can get involved with the groups that authored this report, Immigration Equality, Half in Ten, and many others. Anti-poverty advocates also can ensure that the concerns of LGBT people are addressed in their ongoing work.
“This isn’t about ‘special rights,’” says Krehely. “It’s about leveling the proverbial playing field.”
The Supreme Court and Medicaid
When I heard the news about Chief Justice John Roberts’s big surprise for America I was just as excited as the next guy. But then I read that the Court struck down the formidable stick that the legislation provided the federal government to compel states to expand Medicaid. Suddenly, a good day for most Americans seemed—as usual—like a mixed bag or worse for the poor as decisions on Medicaid expansion would be left to the states (see Pennsylvania above for implications).
I tweeted—because I try to do that just like the young folks now: “not to be a buzz kill, but I think the #Medicaid decision potentially sucks for poor people. Fed gov loses stick to compel states to expand.”
Then I did what I should have done before I tweeted (which is why I used to avoid tweeting altogether) and surveyed people who know a hell of a lot more about this stuff than I do. Here are some observations from the Center on Budget and Policy Priorities for your consideration if you are still trying to figure out the implications:
“The typical state [Medicaid program] only covers working parents who make less than 63 percent of the poverty line ($12,790 a year for a family of three) and non-working parents with incomes below 37 percent of the poverty line ($7,063 a year). Only a handful of states provide coverage to any low-income adults without dependent children.… The Medicaid expansion would cover these poor and low-income adults by expanding Medicaid to 133 percent of the poverty line ($25,390 for a family of three). CBO assumed an additional 17 million adults would receive Medicaid coverage by 2022, as a result.… The federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years.… Because the expansion is such a good deal for states, they should move forward and cover low-income adults in their states. But what happens in states that do not go ahead and provide coverage? The poorest adults—primarily parents and other adults working for low wages—will be left out in the cold.”
—Judy Solomon, vice president for health policy, Center on Budget and Policy Priorities
“The single biggest challenge may lie in the decisions that states make regarding health coverage for uninsured people living below the poverty line—primarily working-poor parents and other adults who work for low wages.… A state would have little basis for refusing to implement the Medicaid expansion, other than for narrow ideological reasons. But in any state that does refuse to implement the expansion, a shocking inequity will arise. People with incomes between 100 percent and 400 percent of the poverty line will be eligible for subsidies to help them afford coverage in the new health insurance exchanges. But people below the poverty line will not be eligible, because the Affordable Care Act assumes they’ll be in Medicaid instead.”
—Robert Greenstein, president, Center on Budget and Policy Priorities
I think it’s safe to say that a lot of work lies ahead to make sure that the poor aren’t once again cut out of a good deal.
Houston Janitors (continued)
The story of Adriana Vasquez and 3,400 fellow janitors down in Houston continues to gain traction. Nation editor Katrina vanden Heuvel wrote about it in her weekly column for the Washington Post, and her tweet brought the story to the attention of NPR’s Here & Now. The Matthew Filipowicz Show also gave the story quite a bit of airtime.
This Sunday, civil rights activist and actor Danny Glover will visit the city to meet privately with a delegation of janitors. They will later be joined by faith and civil rights leaders at a news conference at 2 pm (Third Ward Multi-Services Center, 3611 Ennis Street).
“It’s magnificent. It’s great that an actor like Danny Glover cares about janitors—you just don’t see that very often,” Vasquez told me. “I hope this will bring further attention to the plight of janitors and working people in Houston and across the United States.”
Act Now to Support WIC
Welcome Home the Nuns on the Bus: Monday, July 2, 12–1 pm, United Methodist Building, 100 Maryland Avenue NE, Washington, DC. The Soul Sisters wrap up their nine-state, twenty-eight-city bus tour to call attention to the House Republican-passed Ryan budget and the damaging effects it would have on poor, vulnerable and struggling people throughout America. Help give them the welcome and thanks they deserve.
50 Years Since The Other America: Understanding & Addressing Poverty in the 21st Century: Tuesday, July 10, 9am – 5pm, The Newseum Knight Conference Center, Washington, DC. Leading researchers, practitioners, and journalists will assess how economic and policy trends are affecting poverty today, and will discuss promising new policies and strategies for lifting and keeping Americans out of poverty.
2012 Kansas Conference on Poverty: July 25–27, Hyatt Regency, Wichita, Kansas. I’ll be there and I’m honored to be speaking. But I’m also staying for the whole shindig, because I’m going to learn a lot from the people running this show, and so can you. The Kansas Association of Community Action Programs and the Kansas Community Action Network have their fingers on the pulse of poverty and what’s happening in the anti-poverty community. Plus Deborah Weinstein, executive director of the Coalition on Human Needs, is keynoting. My opinion: through her thirty years of advocacy experience she’s pretty much like some sort of Jedi Master on all things poverty-related. It’s kinda scary.
Articles and Other Resources
“EITC Encourages Work and Success in School and Reduces Poverty,” Jimmy Charite, Indivar Dutta-Gupta, and Chuck Marr
“Children’s Share of Federal Budget Decreasing,” First Focus
“Evidence Free Policy Decisions: Driving an Epidemic,” Dr. Deborah Frank
“Women Who Don’t Have Anything Close to ‘It All’,” Katrina vanden Heuvel
“Faith Reflection on the May Jobless Numbers and Older Workers,” Interreligious Working Group on Domestic Human Needs
“Cutting Food Stamps While Giving the Sugar Lobby Billions,” Zaid Jilani
US poverty (less than $22,314 for a family of four): 46 million people, 15.1 percent of population.
Number of poor children receiving cash aid: one in five.
Poverty rate for people in female-headed families: 42 percent.
Single mothers with incomes under $25,000: 50 percent.
Single mothers working: 67 percent.
Deep poverty (less than $11,157 for a family of four): 20.5 million people, 6.7 percent of population. Up from 12.6 million in 2000.
Increase in deep poverty, 1976–2010: doubled—3.3 percent of population to 6.7 percent.
Americans with no income other than food stamps: 6 million, 2 percent of population.
Twice the poverty level (less than $44,628 for a family of four): 103 million people, roughly 1 in 3 Americans.
Families receiving cash assistance, 1996: 68 for every 100 families living in poverty.
Families receiving cash assistance, 2010: 27 for every 100 families living in poverty.
Impact of public policy, 2010: without government assistance, poverty would have been twice as high—nearly 30 percent of population.
Quote of the Week
“Nothing like this in recent history.” —Pennsylvania resident and longtime advocate for children and families, on the state’s Medicaid debacle